A prospective controlled study of outcome after trauma during pregnancy.

In a prospective cohort study, 85 women who suffered varying degrees of trauma during pregnancy (12 to 41 weeks) were compared with a control group of pregnant women matched for gestational age. Fetomaternal transfusion occurred significantly more frequently in the study group (30.6% vs 8.2%, p less than 0.05). Study subjects whose placentas were anteriorly placed were at increased risk for fetomaternal transfusion on comparison with other placental positions (47% vs 23.5%, p less than 0.05). Immediate adverse outcomes including abruptio placentae occurred frequently in the study group (9.4%) and were not predictable on the basis of injury severity. When immediate adverse outcomes were excluded, there was no difference in pregnancy outcome. Four hours of cardiotocographic monitoring used as a screening tool was found to be an extremely sensitive but nonspecific indicator of immediate adverse outcomes. On the basis of these findings, it is recommended that routine screening for fetomaternal transfusion occur in all pregnant women who suffer trauma during pregnancy beyond 11 weeks' gestation and that a minimum of 4 hours of cardiotocographic monitoring occur in women greater than 20 weeks' gestation.

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

[2]  J. Jørgensen Feto‐Maternal Bleeding , 1977, Acta obstetricia et gynecologica Scandinavica.

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

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

[5]  W. Crosby,et al.  Safety of lap-belt restraint for pregnant victims of automobile collisions. , 1971, The New England journal of medicine.

[6]  M. Pearlman,et al.  Trauma in pregnancy. , 1988, Annals of emergency medicine.

[7]  D. Winn,et al.  Fetal death in motor vehicle accidents. , 1987, Annals of emergency medicine.

[8]  M. Miodovnik,et al.  Delayed abruption after maternal trauma as a result of an automobile accident. , 1981, The Journal of reproductive medicine.

[9]  M. Pichichero,et al.  Neonatal passive immunization by maternal vaccination. , 1984, Obstetrics and gynecology.

[10]  D. Barclay,et al.  Accidental trauma complicating pregnancy and delivery. , 1962, American journal of obstetrics and gynecology.

[11]  R G Snyder,et al.  Impact injuries in pregnancy. I. Experimental studies. , 1968, American journal of obstetrics and gynecology.

[12]  J. Schröder,et al.  Transplacental passage of blood cells. , 1975, Journal of medical genetics.

[13]  Fort At,et al.  Pregnancy outcome after noncatastrophic maternal trauma during pregnancy. , 1970 .

[14]  A. Poulson,et al.  Fetal death secondary to nonpenetrating trauma to the gravid uterus. , 1973, American Journal of Obstetrics and Gynecology.