Trauma in pregnancy. Predicting pregnancy outcome.

A multicenter study involving three American College of Surgeons Level 1 trauma centers was undertaken to assess parameters that may predict fetal outcome. The records of 93 injured pregnant patients admitted from April 1, 1985, to March 31, 1990, were reviewed. There were three maternal deaths (3%) (mean Injury Severity Score, 43). Fourteen fetal/neonatal deaths (15%) occurred during the acute care admission period. Of these, eight were fetal deaths (two associated with maternal death), four were cases of elective abortions, and two were neonatal deaths. In general, the maternal physiologic and laboratory parameters assessed failed to accurately predict pregnancy outcome, while Injury Severity Score did differ significantly between patients whose pregnancies were viable (Injury Severity Score = 6.2) and those whose pregnancies were nonviable (Injury Severity Score = 21.6). Unique to this study were the findings that the Glasgow Coma Score also differed significantly in patients with viable (Glasgow Coma Score, 14.5) and nonviable (Glasgow Coma Score, 12.0) pregnancies, while fetal heart rate at admission to the emergency department did not. In this study, the incidence of fetal death was increased following direct uteroplacental fetal injury (100% of cases), maternal shock (67%), pelvic fracture (57%), severe head injury (56%), and hypoxia (33%). The adequacy of noninvasive maternal monitoring in assessing fetal well-being is challenged, and a discussion of diagnostic modalities for assessment for the injured gravida is set forth.

[1]  S. Romney,et al.  EXPERIMENTAL HEMORRHAGE IN LATE PREGNANCY. EFFECTS ON MATERNAL AND FETAL HEMODYNAMICS. , 1963, American journal of obstetrics and gynecology.

[2]  W. F. Mcguirt,et al.  Effect of parasympathetic nerve stimulation on the uterine vascular bed. , 1967, American journal of obstetrics and gynecology.

[3]  J. Lavin,et al.  Abdominal trauma during pregnancy. , 1983, Clinics in perinatology.

[4]  J. Szalai,et al.  Early identification of high-risk patients using the "estimated" injury severity score and age. , 1989, Accident; analysis and prevention.

[5]  A. Mason,et al.  Thermal injury in the pregnant patient. , 1985, Surgery, gynecology & obstetrics.

[6]  F. Zuspan,et al.  Fetomaternal hemorrhage following trauma. , 1985, American journal of obstetrics and gynecology.

[7]  D. C. Dyer,et al.  Responses of isolated human uterine arteries to vasoactive drugs. , 1971, American journal of obstetrics and gynecology.

[8]  R. Brent The effect of embryonic and fetal exposure to x-ray, microwaves, and ultrasound: counseling the pregnant and nonpregnant patient about these risks. , 1989, Seminars in oncology.

[9]  N. Mcswain,et al.  Trauma in pregnancy. A 10-year perspective. , 1989, The American surgeon.

[10]  C. Brinkman,et al.  Uterine and systemic hemodynamic interrelationships and their response to hypoxia. , 1969, American journal of obstetrics and gynecology.

[11]  R. Lorenz,et al.  Blunt trauma during pregnancy , 1990 .

[12]  R. Matthews Obstetric implications of burns in pregnancy , 1982, British journal of obstetrics and gynaecology.

[13]  W. Xuewei,et al.  Burns during pregnancy: an analysis of 24 cases. , 1982, Burns, including thermal injury.

[14]  R. Fischer,et al.  Blunt maternal trauma: a review of 103 cases. , 1978, The Journal of trauma.

[15]  R. W. King,et al.  A STUDY OF INTERCURRENT CONDITIONS OBSERVED DURING PREGNANCY. , 1963, American journal of obstetrics and gynecology.

[16]  M. Mofid,et al.  Circulatory shock in pregnant sheep , 1972 .

[17]  D. Diamond,et al.  Maternal predictors of fetal demise in trauma during pregnancy. , 1991, Surgery, gynecology & obstetrics.

[18]  Joseph K.T. Lee,et al.  Computed Body Tomography With Mri Correlation , 1989 .

[19]  K. Karlsson The influence of hypoxia on uterine and maternal placental blood flow, and the effect of α-adrenergic blockade , 1974, Journal of perinatal medicine.

[20]  R. Fischer,et al.  Diagnostic peritoneal lavage for blunt trauma in pregnant women. , 1977, American journal of obstetrics and gynecology.

[21]  H. Champion,et al.  The Injury Severity Score revisited. , 1988, The Journal of trauma.

[22]  R. Grossman,et al.  Oxygen Utilization and Cardiovascular Function in Head-injured Patients , 1984 .

[23]  A. A. Taylor,et al.  Cardiovascular response to severe head injury. , 1983, Journal of neurosurgery.

[24]  K. Tracey,et al.  Abruptio placentae associated with cocaine use. , 1983, American journal of obstetrics and gynecology.

[25]  C. Benedict,et al.  Clinical significance of plasma adrenaline and noradrenaline concentrations in patients with subarachnoid haemorrhage. , 1978, Journal of neurology, neurosurgery, and psychiatry.

[26]  I. Civil,et al.  Clinical prospective injury severity scoring: when is it accurate? , 1989, The Journal of trauma.

[27]  J. K. Williams,et al.  Major trauma in pregnant women: maternal/fetal outcome. , 1990, The Journal of trauma.

[28]  M D Pearlman,et al.  A prospective controlled study of outcome after trauma during pregnancy. , 1990, American journal of obstetrics and gynecology.

[29]  R. Pepperell,et al.  MOTOR‐CAR ACCIDENTS DURING PREGNANCY , 1977 .

[30]  D. Baker,et al.  Trauma in the pregnant patient. , 1982, The Surgical clinics of North America.

[31]  T. Goodwin,et al.  Pregnancy outcome and fetomaternal hemorrhage after noncatastrophic trauma. , 1990, American journal of obstetrics and gynecology.

[32]  F. C. Greiss Uterine vascular response to hemorrhage during pregnancy, with observations on therapy. , 1966, Obstetrics and gynecology.