Fetal Deaths Related to Maternal Injury

Injury during pregnancy is an acknowledged cause of negative fetal outcomes, but, unfortunately, even the most severe outcome, fetal/neonatal death, is systematically excluded from US injury surveillance programs. This study therefore sought to determine rates of traumatic fetal death reported in state fetal death registries and to clarify some of the epidemiological aspects of these events. Fetal death certificates were available for 1995 through 1997 from 16 states, accounting for approximately 15,000 registered fetal deaths each year and for 55% of live US births. The 240 traumatic fetal deaths found in the 3-year review period represented 3.7 per 100,000 live births per year. The figure ranged from 0 to 6.5 in various states. Trauma accounted for 5.4 of every 1000 fetal deaths. Gestational age averaged 29.4 weeks. Deaths from traumatic fetal injury were most frequent at maternal ages of 15 to 19 years and declined with advancing maternal age. Maternal race was not a significant factor. Eighty-two percent of deaths resulted from motor vehicle-related crashes. Placental injury was described in 42% of cases. When the delivery mode was known, cesarean delivery accounted for 46% of births. Maternal mortality was 11%. Nearly two thirds of maternal deaths whose cause was specified were caused by motor vehicle-related injuries. Motor vehicle crashes are the major cause of fetal deaths related to maternal injury. It is hoped that improved tracking of fatal traumatic fetal injuries will prompt efforts to reduce the risk of injury to both the mother and fetus. Research on nonfatal fetal outcomes might also prove helpful.