1
|
April MD, Long B. Trauma in pregnancy: A narrative review of the current literature. Am J Emerg Med 2024; 81:53-61. [PMID: 38663304 DOI: 10.1016/j.ajem.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION Trauma accounts for nearly half of all deaths of pregnant women. Pregnant women have distinct physiologic and anatomic characteristics which complicate their management following major trauma. OBJECTIVE This paper comprises a narrative review of the most recent literature informing the management of pregnant trauma patients. DISCUSSION The incidence of trauma during pregnancy is 6-8%. The focus of clinical assessment must be on the mother, starting with the primary survey. During airway management, clinicians should consider early intubation if necessary and utilize gastric tubes to minimize the risk of aspiration. Pregnant women experience progesterone-mediated hyperventilation, and normal PaCO2 levels may portend imminent respiratory failure. Clinicians should utilize left lateral tilt in hypotensive pregnant women to displace the uterus off the inferior vena cava. Ultrasonography is an attractive imaging modality for pregnant women which is specific for ruling in intraabdominal hemorrhage but not sufficiently sensitive to exclude this diagnosis. Clinicians should not hesitate to order computed tomography imaging in unstable patients if there is diagnostic ambiguity. Cardiotocographic monitoring simultaneously assesses uterine contractions and fetal heart rate and should last at least 4 h for pregnant women following even minor abdominal trauma if their fetus has achieved viable gestational age (approximately 24 weeks). In the event of cardiac arrest, peri-mortem cesarean section may improve outcomes for the mother and fetus alike. Unique specific complications include uterine rupture and placental abruption, which require emergent resuscitation and obstetrics consultation for definitive management. Emergency clinicians should maintain a low threshold for transfer to a tertiary care center given correlations between even isolated and relatively minor traumatic injuries with adverse fetal and maternal outcomes. CONCLUSIONS Trauma is a common cause of morbidity and mortality in pregnant women. Emergency clinicians must understand the evaluation and management of pregnant trauma patients.
Collapse
Affiliation(s)
- Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 14th Field Hospital, Fort Stewart, GA, USA.
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| |
Collapse
|
2
|
Farghaly MAA, Aziz HF, Puthuraya S, Abdalla A, Aly H, Mohamed MA. Placental abruption and risk for intraventricular hemorrhage in very low birth weight infants: the United States national inpatient database. J Perinatol 2024:10.1038/s41372-024-02017-y. [PMID: 38811756 DOI: 10.1038/s41372-024-02017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To examine the association of placental abruption with intraventricular hemorrhage (IVH) in very low birth weight (VLBW) infants. METHODS We examined the National Inpatient Sample (NIS) datasets. Preterm infants <1500 g birth weight (BW) were included. The odds ratios (OR) of developing IVH and severe IVH in association with placental abruption were calculated. Adjusted OR (aOR) were calculated using logistic regression models. RESULTS The study included 113,445 VLBW infants. IVH occurred in 18.7% in the infants who were born to mothers with history of placental abruption versus 14.7% in infants without placental abruption, aOR 1.25 (95%CI: 1.13-1.38), p < 0.001. Severe IVH occurred in 6.4% in infants born to mothers with history of placental abruption versus 4.0% in those without placental abruption, aOR 1.53 (95%CI: 1.30-1.78), p < 0.001. CONCLUSION Placental abruption is associated with increased prevalence of IVH and severe IVH in VLBW infants.
Collapse
Affiliation(s)
- Mohsen A A Farghaly
- Neonatology Division, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
- Faculty of Medicine, Aswan University, Aswan, Egypt.
| | - Hany F Aziz
- Neonatology Division, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Subhash Puthuraya
- Neonatology Division, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Alshimaa Abdalla
- Neonatology Division, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Hany Aly
- Neonatology Division, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Mohamed A Mohamed
- Neonatology Division, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| |
Collapse
|
3
|
Santos JW, Grigorian A, Lucas AN, Fierro N, Dhillon NK, Ley EJ, Smith J, Burruss S, Dahan A, Johnson A, Ganske W, Biffl WL, Bayat D, Castelo M, Wintz D, Schaffer KB, Zheng DJ, Tillou A, Coimbra R, Tuli R, Santorelli JE, Emigh B, Schellenberg M, Inaba K, Duncan TK, Diaz G, Tay-Lasso E, Zezoff DC, Nahmias J. Predictors of fetal delivery in pregnant trauma patients: A multicenter study. J Trauma Acute Care Surg 2024; 96:109-115. [PMID: 37580875 DOI: 10.1097/ta.0000000000003964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
BACKGROUND Pregnant trauma patients (PTPs) undergo observation and fetal monitoring following trauma due to possible fetal delivery (FD) or adverse outcome. There is a paucity of data on PTP outcomes, especially related to risk factors for FD. We aimed to identify predictors of posttraumatic FD in potentially viable pregnancies. METHODS All PTPs (≥18 years) with ≥24-weeks gestational age were included in this multicenter retrospective study at 12 Level-I and II trauma centers between 2016 and 2021. Pregnant trauma patients who underwent FD ((+) FD) were compared to those who did not deliver ((-) FD) during the index hospitalization. Univariate analyses and multivariable logistic regression were performed to identify predictors of FD. RESULTS Of 591 PTPs, 63 (10.7%) underwent FD, with 4 (6.3%) maternal deaths. The (+) FD group was similar in maternal age (27 vs. 28 years, p = 0.310) but had older gestational age (37 vs. 30 weeks, p < 0.001) and higher mean injury severity score (7.0 vs. 1.5, p < 0.001) compared with the (-) FD group. The (+) FD group had higher rates of vaginal bleeding (6.3% vs. 1.1%, p = 0.002), uterine contractions (46% vs. 23.5%, p < 0.001), and abnormal fetal heart tracing (54.7% vs. 14.6%, p < 0.001). On multivariate analysis, independent predictors for (+) FD included abdominal injury (odds ratio [OR], 4.07; confidence interval [CI], 1.11-15.02; p = 0.035), gestational age (OR, 1.68 per week ≥24 weeks; CI, 1.44-1.95; p < 0.001), abnormal FHT (OR, 12.72; CI, 5.19-31.17; p < 0.001), and premature rupture of membranes (OR, 35.97; CI, 7.28-177.74; p < 0.001). CONCLUSION The FD rate was approximately 10% for PTPs with viable fetal gestational age. Independent risk factors for (+) FD included maternal and fetal factors, many of which are available on initial trauma bay evaluation. These risk factors may help predict FD in the trauma setting and shape future guidelines regarding the recommended observation of PTPs. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
Collapse
Affiliation(s)
- Jeffrey W Santos
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, (J.W.S., A.G., A.N.L., E.T.-L., D.C.Z., J.N.), University of California, Irvine, Orange; Department of Surgery (N.F., N.K.D., E.J.L.), Cedars-Sinai Medical Center, Los Angeles; Division of Trauma and Critical Care (J.S.), Harbor-UCLA Hospital, Torrance; Department of Trauma, Acute Care Surgery, Surgical Critical Care (S.B.), Loma Linda Medical Center, Loma Linda; Riverside School of Medicine (A.D.), University of California, Riverside; Cottage Health Research Institute (A.J., W.G.), Santa Barbara Cottage Hospital, Santa Barbara; Trauma and Acute Care Surgery, Scripps Memorial Hospital (W.L.B., D.B., M.C.), La Jolla; Department of Surgery (D.W., K.B.S.), Sharp Memorial Hospital, San Diego; Department of Surgery (D.J.Z., A.T.), UCLA David Geffen School of Medicine, Los Angeles; Department of Surgery, Comparative Effectiveness and Clinical Outcomes Research Center-CECORC (R.C., R.T.), Riverside University Health System Medical Center, Moreno Valley; Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery (J.E.S.), University of California San Diego School of Medicine, San Diego; Division of Acute Care Surgery (B.E., M.S., K.I.), LAC+USC Medical Center, University of Southern California, Los Angeles; and Department of Trauma (T.K.D., G.D.), Ventura County Medical Center, Ventura, California
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Liggett MR, Amro A, Son M, Schwulst S. Management of the Pregnant Trauma Patient: A Systematic Literature Review. J Surg Res 2023; 285:187-196. [PMID: 36689816 DOI: 10.1016/j.jss.2022.11.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Trauma during pregnancy is the leading cause of non-obstetric maternal death and complicates up to 5%-7% of pregnancies. This systematic review without meta-analysis explores the current literature regarding the assessment and management of pregnant trauma patients to provide evidence-based recommendations to guide the general surgeon regarding the prognostic value of laboratory testing including Kleihauer-Betke testing, duration of maternal and fetal monitoring, the use of tranexamic acid, the safety of radiographic studies, and the utility of perimortem cesarean section to improve maternal and fetal mortality. MATERIALS AND METHODS A systematic search of MEDLINE (Ovid), the Cochrane Library (Wiley), and Embase (Elsevier) was performed. The reference lists of included studies were reviewed for relevant citations. RESULTS Of the 45 studies included in this review, there was reasonable evidence to suggest that the minimally injured pregnant trauma patient should be observed for a minimum of 4 h, CT scans to rule out traumatic injury are necessary and safe, perimortem cesarean sections should be performed as soon as maternal cardiac arrest occurs. CONCLUSIONS We recommend delivery by perimortem cesarean section as soon as possible after maternal cardiac arrest, to provide TXA to the hemorrhaging pregnant trauma patient, to obtain trauma CT scans as indicated, and to observe the injured pregnant patient for a minimum of at least 4 h. Additional high-quality studies focusing on the prognostic potential of KB tests and other laboratory studies are needed.
Collapse
Affiliation(s)
- Marjorie R Liggett
- Department of General Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Ali Amro
- Department of General Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Moeun Son
- Yale University School of Medicine, Obstetrics, Gynecology & Reproductive Sciences, New Haven, Connecticut
| | - Steven Schwulst
- Department of General Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
5
|
Brandt JS, Ananth CV. Placental abruption at near-term and term gestations: pathophysiology, epidemiology, diagnosis, and management. Am J Obstet Gynecol 2023; 228:S1313-S1329. [PMID: 37164498 PMCID: PMC10176440 DOI: 10.1016/j.ajog.2022.06.059] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 05/12/2023]
Abstract
Placental abruption is the premature separation of the placenta from its uterine attachment before the delivery of a fetus. The clinical manifestations of abruption typically include vaginal bleeding and abdominal pain with a wide variety of abnormal fetal heart rate patterns. Clinical challenges arise when pregnant people with this condition present with profound vaginal bleeding, necessitating urgent delivery, especially when there is a concern for maternal and fetal compromise and coagulopathy. Abruption occurs in 0.6% to 1.2% of all pregnancies, with nearly half of abruption occurring at term gestations. An exposition of abruption at near-term (defined as the late preterm period from 34 0/7 to 36 6/7 weeks of gestation) and term (defined as ≥37 weeks of gestation) provides unique insights into its direct effects, as risks associated with preterm birth do not impact outcomes. Here, we explore the pathophysiology, epidemiology, and diagnosis of abruption. We discuss the interaction of chronic processes (decidual and uteroplacental vasculopathy) and acute processes (shearing forces applied to the abdomen) that underlie the pathophysiology. Risk factors for abruption and strengths of association are summarized. Sonographic findings of abruption and fetal heart rate tracings are presented. In addition, we propose a management algorithm for acute abruption that incorporates blood loss, vital signs, and urine output, among other factors. Lastly, we discuss blood component therapy, viscoelastic point-of-care testing, disseminated intravascular coagulopathy, and management of abruption complicated by fetal death. The review seeks to provide comprehensive, clinically focused guidance during a gestational age range when neonatal outcomes can often be favorable if rapid and evidence-based care is optimized.
Collapse
Affiliation(s)
- Justin S Brandt
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
| | - Cande V Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; Cardiovascular Institute of New Jersey and Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| |
Collapse
|
6
|
Chang YH, Chien YW, Chang CH, Chen PL, Lu TH, Hsu IL, Li CY. Maternal outcomes in association with motor vehicle crashes during pregnancy: a nationwide population-based retrospective study. Inj Prev 2023; 29:166-172. [PMID: 36941051 DOI: 10.1136/ip-2022-044810] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/29/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Limited studies have assessed the association of motor vehicle crashes (MVCs) during pregnancy with adverse maternal outcomes using a population-based nationwide dataset that covers all MVCs. METHODS A total of 20 844 births from women who had been involved in MVCs during pregnancy were obtained from the National Birth Notification (BN) Database in Taiwan. We randomly selected 83 274 control births from women in the BN matched on age, gestational age and crash date. All study subjects were linked to medical claims and the Death Registry to identify the maternal outcomes after crashes. Conditional logistic regression models were used to estimate the adjusted odds ratio (aOR) and 95% CI of adverse outcomes associated with MVCs during pregnancy. RESULTS Pregnant women involved in MVCs had significantly higher risks of placental abruption (aOR=1.51, 95% CI 1.30 to 1.74), prolonged uterine contractions (aOR=1.31, 95% CI 1.11 to 1.53), antepartum haemorrhage (aOR=1.19, 95% CI 1.12 to 1.26) and caesarean delivery (aOR=1.05, 95% CI 1.02 to 1.09) than the controls. Such elevated risks tended to be higher in the MVCs with greater severity. Scooter riders had higher ORs of various adverse maternal outcomes than car drivers. CONCLUSIONS Women involved in MVCs during pregnancy were at increased risk of various adverse maternal outcomes, especially in those with severe MVCs and riding scooters at MVCs. These findings suggest that clinicians should be aware of these effects, and educational materials that include the above information should be provided as part of prenatal care.
Collapse
Affiliation(s)
- Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiung-Hsin Chang
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Lin Hsu
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| |
Collapse
|
7
|
Bagou G, Sentilhes L, Mercier FJ, Berveiller P, Blanc J, Cesareo E, Dewandre PY, Douai B, Gloaguen A, Gonzalez M, Le Conte P, Le Gouez A, Madar H, Maisonneuve E, Morau E, Rackelboom T, Rossignol M, Sibiude J, Vaux J, Vivanti A, Goddet S, Rozenberg P, Garnier M, Chauvin A. Guidelines for the management of urgent obstetric situations in emergency medicine, 2022. Anaesth Crit Care Pain Med 2022; 41:101127. [PMID: 35940033 DOI: 10.1016/j.accpm.2022.101127] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To provide recommendations on the management of urgent obstetrical emergencies outside the maternity ward. DESIGN A group of 24 experts from the French Society of Emergency Medicine (SFMU), the French Society of Anaesthesia and Intensive Care Medicine (SFAR) and the French College of Gynaecologists and Obstetricians (CNGOF) was convened. Potential conflicts of interest were formally declared at the outset of the guideline development process, which was conducted independently of industry funding. The authors followed the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method to assess the level of evidence in the literature. The potential drawbacks of strong recommendations in the presence of low-level evidence were highlighted. Some recommendations with an insufficient level of evidence were not graded. METHODS Eight areas were defined: imminent delivery, postpartum haemorrhage (prevention and management), threat of premature delivery, hypertensive disorders in pregnancy, trauma, imaging, cardiopulmonary arrest, and emergency obstetric training. For each field, the expert panel formulated questions according to the PICO model (population, intervention, comparison, outcomes) and an extensive literature search was conducted. Analysis of the literature and formulation of recommendations were conducted according to the GRADE method. RESULTS Fifteen recommendations on the management of obstetrical emergencies were issued by the SFMU/SFAR/CNGOF panel of experts, and 4 recommendations from formalised expert recommendations (RFE) established by the same societies were taken up to answer 4 PICO questions dealing with the pre-hospital context. After two rounds of voting and several amendments, strong agreement was reached for all the recommendations. For two questions (cardiopulmonary arrest and inter-hospital transfer), no recommendation could be made. CONCLUSIONS There was significant agreement among the experts on strong recommendations to improve practice in the management of urgent obstetric complications in emergency medicine.
Collapse
Affiliation(s)
- Gilles Bagou
- SAMU-SMUR of Lyon, University Hospital Edouard Herriot, Lyon, France.
| | - Loïc Sentilhes
- Gynaecology and Obstetrics Department, University Hospital Pellegrin, Bordeaux, France
| | - Frédéric J Mercier
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Antoine Béclère, Clamart, France
| | - Paul Berveiller
- Gynaecology and Obstetrics Department, CHI Poissy Saint-Germain, Poissy, France
| | - Julie Blanc
- Gynaecology and Obstetrics Department, University Hospital Hôpital Nord, Marseille, France
| | - Eric Cesareo
- SAMU-SMUR 69, University Hospital Hospices Civils de Lyon, Lyon, France
| | - Pierre-Yves Dewandre
- Department of Anaesthesiology and Critical Care Medicine, University hospital of Liège, Liège, Belgium
| | | | - Aurélie Gloaguen
- Emergency Department, Hospital William Morey, Chalon-sur-Saone, France
| | - Max Gonzalez
- Department of Anaesthesiology and Critical Care Medicine in Gynaecology and Obstetrics, University Hospital Jeanne de Flandre, Lille, France
| | | | - Agnès Le Gouez
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Antoine Béclère, Clamart, France
| | - Hugo Madar
- Gynaecology and Obstetrics Department, University Hospital Pellegrin, Bordeaux, France
| | | | - Estelle Morau
- Department of Anaesthesiology, Critical Care, Pain and Emergency, University hospital Carémeau, Nîmes, France
| | - Thibaut Rackelboom
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Pellegrin, Bordeaux, France
| | - Mathias Rossignol
- University Paris Cité - APHP Nord, Department of Anaesthesiology and Critical Care Medicine, University Hospital Lariboisière, Paris, France
| | - Jeanne Sibiude
- Gynaecology and Obstetrics Department, University Hospital Louis Mourier, Colombes, France
| | - Julien Vaux
- SMUR 94, University Hospital Henri Mondor, Créteil, France
| | - Alexandre Vivanti
- Gynaecology and Obstetrics Department, Antoine Béclère University Hospital, Clamart, France
| | - Sybille Goddet
- SAMU-SMUR 21 and Emergency Department, University Hospital of Dijon, Dijon, France
| | - Patrick Rozenberg
- Gynaecology and Obstetrics Department, CHI Poissy Saint-Germain, Poissy, France
| | - Marc Garnier
- Sorbonne University, GRC29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Anthony Chauvin
- SAMU-SMUR 75 and Emergency Department, Lariboisière University Hospital, Paris, France; Université de Paris, INSERM U942 MASCOT, Paris, France
| |
Collapse
|
8
|
Bagou G, Sentilhes L, Mercier FJ, Berveiller P, Blanc J, Cesareo E, Dewandre PY, Douay B, Gloaguen A, Gonzalez M, Le Conte P, Le Gouez A, Madar H, Maissonneuve E, Morau E, Rackelboom T, Rossignol M, Sibiude J, Vaux J, Vivanti A, Goddet S, Rozenberg P, Garnier M, Chauvin A. Recommandations de pratiques professionnelles 2022 Prise en charge des urgences obstétricales en médecine d’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
9
|
Slootweg YM, Zwiers C, Koelewijn JM, van der Schoot E, Oepkes D, van Kamp IL, de Haas M. Risk factors for RhD immunisation in a high coverage prevention programme of antenatal and postnatal RhIg: a nationwide cohort study. BJOG 2022; 129:1721-1730. [PMID: 35133072 PMCID: PMC9543810 DOI: 10.1111/1471-0528.17118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/30/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate which risk factors for RhD immunisation remain, despite adequate routine antenatal and postnatal RhIg prophylaxis (1000 IU RhIg) and additional administration of RhIg. The second objective was assessment of the current prevalence of RhD immunisations. DESIGN Prospective cohort study. SETTING The Netherlands. POPULATION Two-year nationwide cohort of alloimmunised RhD-negative women. METHODS RhD-negative women in their first RhD immunised pregnancy were included for risk factor analysis. We compared risk factors for RhD immunisation, occurring either in the previous non-immunised pregnancy or in the index pregnancy, with national population data derived from the Dutch perinatal registration (Perined). RESULTS In the 2-year cohort, data from 193 women were eligible for analysis. Significant risk factors in women previously experiencing a pregnancy of an RhD-positive child (n = 113) were: caesarean section (CS) (OR 1.7, 95% CI 1.1-2.6), perinatal death (OR 3.5, 95% CI 1.1-10.9), gestational age >42 weeks (OR 6.1, 95% CI 2.2-16.6), postnatal bleeding (>1000 ml) (OR 2.0, 95% CI 1.1-3.6), manual removal of the placenta (MRP) (OR 4.3, 95% CI 2.0-9.3); these factors often occurred in combination. The miscarriage rate was significantly higher than in the Dutch population (35% versus 12.-5%, P < 0.001). CONCLUSION Complicated deliveries, including cases of major bleeding and surgical interventions (CS, MRP), must be recognised as a risk factor, requiring estimation of fetomaternal haemorrhage volume and adjustment of RhIg dosing. The higher miscarriage rate suggests that existing RhIg protocols need adjustment or better compliance.
Collapse
Affiliation(s)
- Y M Slootweg
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Centre for Clinical Transfusion Research, Sanquin Research, Amsterdam, the Netherlands
| | - C Zwiers
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Centre for Clinical Transfusion Research, Sanquin Research, Amsterdam, the Netherlands
| | - J M Koelewijn
- Centre for Clinical Transfusion Research, Sanquin Research, Amsterdam, the Netherlands.,Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - E van der Schoot
- Centre for Clinical Transfusion Research, Sanquin Research, Amsterdam, the Netherlands.,Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - D Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - I L van Kamp
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - M de Haas
- Centre for Clinical Transfusion Research, Sanquin Research, Amsterdam, the Netherlands.,Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands.,Department of Haematology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
10
|
Kyozuka H, Murata T, Fukusda T, Yamaguchi A, Kanno A, Yasuda S, Sato A, Ogata Y, Endo Y, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Teenage pregnancy as a risk factor for placental abruption: Findings from the prospective Japan environment and children's study. PLoS One 2021; 16:e0251428. [PMID: 33984034 PMCID: PMC8118252 DOI: 10.1371/journal.pone.0251428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Placental abruption is a significant obstetric complication that affects both maternal and neonatal mortality and morbidity. The present study examined the effect of maternal age on the incidence of placental abruption. Methods We used data of singleton pregnancies from the Japan Environment and Children’s Study, which was a prospective birth cohort study conducted between January 2011 and March 2014 across 15 regional centers in Japan. A multiple regression model was used to identify whether maternal age (<20 years, 20–24 years, 25–29 years, 30–34 years, and ≥35 years) is a risk factor for placental abruption. The analyses were conducted while considering the history of placental abruption, assisted reproductive technology, number of previous deliveries, smoking during pregnancy, body mass index before pregnancy, and chronic hypertension. Results A total of 94,410 Japanese women (93,994 without placental abruption and 416 with placental abruption) were recruited. Herein, 764, 8421, 25915, 33517, and 25793 women were aged <20 years, 20–24 years, 25–29 years, 30–34 years, and ≥35 years, respectively. Besides advanced maternal age (≥35 years; adjusted odds ratio: 1.7, 95% confidence interval: 1.1–2.5), teenage pregnancy was also a risk factor for placental abruption (adjusted odds ratio: 2.8, 95% confidence interval: 1.2–6.5) when the maternal age of 20–24 years was set as a reference. Conclusions In the Japanese general population, besides advanced maternal age, teenage pregnancy was associated with placental abruption. Recently, the mean maternal age has been changing in Japan. Therefore, it is important for obstetric care providers to provide proper counseling to young women based on up-to-date evidence.
Collapse
Affiliation(s)
- Hyo Kyozuka
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
- * E-mail:
| | - Tsuyoshi Murata
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toma Fukusda
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akiko Yamaguchi
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Aya Kanno
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shun Yasuda
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
| | - Yuta Endo
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Fukushima Medical Center for Children and Women, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | | |
Collapse
|
11
|
Baldwin HJ, Nippita TA, Torvaldsen S, McGee TM, Rickard K, Patterson JA. Validation of anaemia, haemorrhage and blood disorder reporting in hospital data in New South Wales, Australia. BMC Res Notes 2021; 14:167. [PMID: 33947454 PMCID: PMC8094525 DOI: 10.1186/s13104-021-05584-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Hospital data are a useful resource for studying pregnancy complications, including bleeding-related conditions, however, the reliability of these data is unclear. This study aims to examine reliability of reporting of bleeding-related conditions, including anaemia, obstetric haemorrhage and blood disorders, and procedures, such as blood transfusion and hysterectomy, in coded hospital records compared with obstetric data from two large tertiary hospitals in New South Wales. RESULTS There were 36,051 births between 2011 and 2015 included in the analysis. Anaemia and blood disorders were poorly reported in the hospital data, with sensitivity ranging from 2.5% to 24.8% (positive predictive value (PPV) 12.0-82.6%). Reporting of postpartum haemorrhage, transfusion and hysterectomy showed high sensitivity (82.8-96.0%, PPV 78.0-89.6%) while moderate consistency with the obstetric data was observed for other types of obstetric haemorrhage (sensitivity: 41.9-65.1%, PPV: 50.0-56.8%) and placental complications (sensitivity: 68.2-81.3%, PPV: 20.3-72.3%). Our findings suggest that hospital data may be a reliable source of information on postpartum haemorrhage, transfusion and hysterectomy. However, they highlight the need for caution for studies of anaemia and blood disorders, given high rates of uncoded and 'false' cases, and suggest that other sources of data should be sought where possible.
Collapse
Affiliation(s)
- Heather J. Baldwin
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
| | - Tanya A. Nippita
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW Australia
| | - Siranda Torvaldsen
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
- School of Public Health and Community Medicine, UNSW, Sydney, NSW Australia
| | - Therese M. McGee
- OG Department, Clinical Support Unit, Level 3, G Block, Westmead Hospital, Westmead, NSW Australia
- The University of Sydney Westmead Clinical School, Westmead, NSW Australia
| | - Kristen Rickard
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW Australia
| | - Jillian A. Patterson
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
| |
Collapse
|
12
|
Pai CW, Wiratama BS, Lin HY, Chen PL. Association of Traumatic Injury With Adverse Pregnancy Outcomes in Taiwan, 2004 to 2014. JAMA Netw Open 2021; 4:e217072. [PMID: 33877308 PMCID: PMC8058639 DOI: 10.1001/jamanetworkopen.2021.7072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Literature has suggested that trauma among pregnant women is associated with an increased risk of adverse pregnancy outcomes. However, limited research has investigated the association of trauma with adverse pregnancy outcomes by using a national data set. OBJECTIVE To investigate the association between traumatic injury and adverse pregnancy outcomes. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study of pregnant women in Taiwan linked 3 data sets, the Taiwan Birth Registry, Household Registration Information, and National Health Insurance Research Database, from January 1, 2004, through December 31, 2014. Data, including the characteristics of pregnant women and infants, were extracted from the Taiwan Birth Registry data set; to obtain trauma data, this data set and the Household Registration Information data set were collectively linked to National Health Insurance Research Database data. The combined data set was analyzed from January to July 2019. Adverse pregnancy outcomes and premature delivery were defined using International Classification of Diseases, Ninth Revision, Clinical Modification codes. EXPOSURES The primary exposures of this study were 2 clinical variables related to injury during pregnancy: medical treatment in the emergency department (yes or no) and hospitalization (yes or no). MAIN OUTCOMES AND MEASURES The main outcome variable was adverse pregnancy outcomes, and the secondary outcome variable was premature delivery. Multivariate logistic regression models were used to investigate the association of injuries with adverse pregnancy outcomes after controlling for demographic characteristics and other pregnancy-related variables. RESULTS A total of 2 973 831 pregnant women (2 475 805 [83.3%] aged 20-34 years) were enrolled between 2004 and 2014, of whom 59 681 (2.0%) sought medical treatments due to injuries. Results of multivariate logistic regression models showed that women receiving emergency treatments more than once were 1.08 times as likely (adjusted odds ratio, 1.08; 95% CI, 1.05-1.10) to have adverse pregnancy outcomes than women who received no emergency treatment. Women with injury-related hospitalization were 1.53 times more likely (adjusted odds ratio, 1.53; 95% CI, 1.41-1.65) to have adverse pregnancy outcomes than women who did not sustain injuries. Furthermore, recurrent injuries were associated with a 572% increase in odds of premature delivery (adjusted odds ratio, 6.72; 95% CI, 2.86-15.80). CONCLUSIONS AND RELEVANCE In this study, trauma among pregnant women was associated with an increased risk of adverse pregnancy outcomes, as were hospitalization and emergency department visits due to injury.
Collapse
Affiliation(s)
- Chih-Wei Pai
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Bayu Satria Wiratama
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Epidemiology, Biostatistics and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta City, Indonesia
| | - Hsiao-Yu Lin
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
13
|
Baldwin HJ, Nippita TA, Rickard K, Torvaldsen S, McGee TM, Patterson JA. Reporting of gestational diabetes and other maternal medical conditions: validation of routinely collected hospital data from New South Wales, Australia. Int J Popul Data Sci 2021; 6:1381. [PMID: 34007895 PMCID: PMC8103993 DOI: 10.23889/ijpds.v6i1.1381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction Hospital datasets are a valuable resource for examining prevalence and outcomes of medical conditions during pregnancy. To enable effective research and health planning, it is important to determine whether variables are reliably captured. Objective To examine the reliability of reporting of gestational and pre-existing diabetes, hypertension, thyroid conditions, and morbid obesity in coded hospital records that inform the population-level New South Wales Admitted Patient Data Collection. Methods Coded hospital admission data from two large tertiary hospitals in New South Wales, from 2011 to 2015, were compared with obstetric data, collected by midwives at outpatient pregnancy booking and in hospital after birth, as the reference standard. Records were deterministically linked and sensitivity, specificity, positive predictive values and negative predictive values for the conditions of interest were obtained. Results There were 36,051 births included in the analysis. Sensitivity was high for gestational diabetes (83.6%, 95% CI 82.4–84.7%), pre-existing diabetes (88.2%, 95% CI 84.1–91.6%), and gestational hypertension (80.1%, 95% CI 78.2–81.9%), moderate for chronic hypertension (53.5%, 95% CI 47.8–59.1%), and low for thyroid conditions (12.9%, 95% CI 11.7–14.2%) and morbid obesity (9.8%, 95% CI 7.6–12.4%). Specificity was high for all conditions (≥97.8%, 95% CI 97.7–98.0) and positive predictive value ranged from 53.2% for chronic hypertension (95% CI 47.5–58.8%) to 92.7% for gestational diabetes (95% CI 91.8–93.5%). Conclusion Our findings suggest that coded hospital data are a reliable source of information for gestational and pre-existing diabetes and gestational hypertension. Chronic hypertension is less consistently reported, which may be remedied by grouping hypertension types. Data on thyroid conditions and morbid obesity should be used with caution, and if possible, other sources of data for those conditions should be sought.
Collapse
Affiliation(s)
- Heather J Baldwin
- The University of Sydney Northern Clinical School, Women and Babies Research, NSW, Australia; Northern Sydney Local Health District, Kolling Institute, Australia
| | - Tanya A Nippita
- The University of Sydney Northern Clinical School, Women and Babies Research, NSW, Australia; Northern Sydney Local Health District, Kolling Institute, Australia.,Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, Australia
| | - Kristen Rickard
- The University of Sydney Northern Clinical School, Women and Babies Research, NSW, Australia; Northern Sydney Local Health District, Kolling Institute, Australia.,Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, Australia
| | - Siranda Torvaldsen
- The University of Sydney Northern Clinical School, Women and Babies Research, NSW, Australia; Northern Sydney Local Health District, Kolling Institute, Australia.,Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, Australia.,School of Public Health and Community Medicine, UNSW, Australia
| | - Therese M McGee
- OG Department, Clinical Support Unit, Level 3, G Block, Westmead Hospital, Westmead, Australia; The University of Sydney Westmead Clinical School, NSW, Australia
| | - Jillian A Patterson
- The University of Sydney Northern Clinical School, Women and Babies Research, NSW, Australia; Northern Sydney Local Health District, Kolling Institute, Australia
| |
Collapse
|
14
|
Bryant MK, Roy S, Purcell LN, Porras KL, Spencer A, Udekwu P. Trauma in Pregnancy: The Relationship of Trauma Activation Level and Obstetric Outcomes. Am Surg 2020. [DOI: 10.1177/000313481908500742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Trauma in pregnancy is a leading cause of poor fetal and obstetric outcomes. Trauma team activation (TTA) criteria include injury with ≥ 20 weeks gestational age (GA). A retrospective analysis was performed on pregnant patients evaluated at a Level 1 trauma center. Patients were characterized by TTA: full, partial, or non-TTA, and TTA criteria independent of pregnancy. Index trauma and delayed delivery hospitalization outcomes were examined. Bivariate analysis, t test, and logistic regression were used when appropriate. From 2010 to 2015, 216 full, 50 partial, and 50 non-TTAs presented. Independent of pregnancy, 79 per cent of patients did not meet the TTA criteria. Fourteen (4%) had a pregnancy-related complication during index hospitalization (eight fetal and two maternal deaths). Nine of ten deaths occurred in patients meeting TTA independent of pregnancy. Delivery complications were greater in the index (52%, 13/25) versus subsequent (5%, 17/155) hospitalizations and were predicted by the respiratory rate ( P = 0.016) and injury severity score ( P < 0.001). Poor delayed delivery outcomes were associated with earlier GA ( P < 0.002) and longer index hospitalization ( P < 0.024). Odds of complication are higher in patients meeting the physiologic and anatomic criteria criteria for TTA versus GA criteria alone, signifying overtriage. Trauma activation protocols should be adapted based on the physiologic and anatomic criteria criteria in pregnant patients.
Collapse
Affiliation(s)
- Mary K. Bryant
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| | - Sara Roy
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| | - Laura N. Purcell
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| | - Kristina L. Porras
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| | - Alex Spencer
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| | - Pascal Udekwu
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| |
Collapse
|
15
|
Placental abruption and long-term cardiovascular morbidity of the offspring. Arch Gynecol Obstet 2018; 299:393-401. [PMID: 30474712 DOI: 10.1007/s00404-018-4974-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE While placental abruption is often associated with short-term adverse pregnancy outcomes, we sought to assess whether placental abruption increases the risk for long-term cardiovascular morbidity of the offspring. METHODS To study the long-term cardiovascular hospitalizations of offspring of patients with and without placental abruption, cardiovascular morbidity was assessed up to the age of 18 years according to a predefined set of ICD-9 codes associated with hospitalization of the offspring. Our data consist of deliveries which occurred between the years 1991 and 2014 in a tertiary medical center. Pregnancies following fertility treatments, multifetal pregnancies, and pregnancies with offspring with congenital anomalies, lack of prenatal care, and perinatal mortality were excluded from the study. We used Kaplan-Meier curve to compare cumulative morbidity incidence and Cox proportional hazards model to control for confounder. RESULTS During the study period, we examined 217,910 deliveries, out of which 0.46% (n = 1003) were effected by placental abruption. Compared to normal birth children, children born to mothers with placental abruption did not show a significantly higher cumulative incidence of long-term cardiovascular morbidity (1.0% vs. 0.6%; p = 0.127). Placental abruption was not noted as an independent risk factor for long-term cardiovascular morbidity of offspring in the Cox regression analysis, which adjusted for confounders. CONCLUSION Our study does not support the association between placental abruption and risk for long-term cardiovascular morbidity of the offspring.
Collapse
|
16
|
Yoo BJ. Pelvic Trauma and the Pregnant Patient: a Review of Physiology, Treatment Risks, and Options. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0136-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
17
|
Jha P, Behr S, Morgan T, Washburn E, Lucero J, Chen LM, Poder L. Imaging findings of concealed intra-amniotic hemorrhage in the setting of placenta previa and placenta accreta spectrum disorder. Emerg Radiol 2018; 25:553-556. [PMID: 29911274 DOI: 10.1007/s10140-018-1618-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Abstract
Placental abruption is an important cause of feto-maternal hemorrhage, with significant impact on both fetal and maternal mortality. In most cases, it presents with abdominal pain and vaginal bleeding. However, vaginal bleeding may be absent with concealed intra-amniotic hemorrhage, as in cases with placenta previa, hence confounding this diagnosis. In such cases, imaging studies may be obtained to evaluate for abdominal pain in pregnancy; hence, radiologists should be aware of the ultrasound and magnetic resonance (MR) imaging appearance of intra-amniotic hemorrhage. This includes presence of markedly echogenic amniotic fluid on US. Hemorrhage signal intensity on MR imaging varies with the duration of bleeding. In acute to subacute cases, it will present as T1 isointense and T2 hypointense amniotic fluid. This case is the first report of MR imaging findings of acute concealed intra-amniotic hemorrhage.
Collapse
Affiliation(s)
- Priyanka Jha
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - Spencer Behr
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Tara Morgan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Erin Washburn
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Lucero
- Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA
| | - Lee-May Chen
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA, USA
| | - Liina Poder
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
18
|
Abstract
OBJECTIVE To determine whether certain patterns of pelvic ring injury are associated with more frequent intrauterine fetal demise (IUFD). DESIGN Retrospective review. SETTING Level 1 trauma center. PATIENTS/PARTICIPANTS Of 44 pregnant patients with pelvic and/or acetabular fractures, 40 had complete records that allowed determination of fetal viability. χ2 tests were used for categorical variables (Fisher exact tests when expected cell counts were fewer than 5), and t tests were used for continuous variables. MAIN OUTCOME MEASUREMENTS Fetal or maternal death. RESULTS Sixteen patients had isolated acetabular fractures, 25 had isolated pelvic ring injuries, and 3 had acetabular fractures with concomitant pelvic ring injuries. Maternal and fetal mortality were 2% and 40%, respectively. No patients with isolated acetabular fractures experienced IUFD, compared with 68% (15/22) of those with isolated pelvic ring injuries (P < 0.0001). Eight (53%) of 15 IUFDs were associated with lateral compression (LC)-I pelvic ring injuries (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen 61-B2). Of the 13 LC-I pelvic ring injuries, 8 (62%) resulted in IUFD. Pelvic ring stability, Young-Burgess classification, and operative treatment were not associated with IUFD. Maternal Glasgow Coma Scale (average 13.2) and Injury Severity Score (average 18.2) at admission were predictive of IUFD. CONCLUSIONS The most frequent pelvic fractures in gravid trauma patients are LC-I. Although the rate of maternal mortality was low, the risk of IUFD was quite high (40%). LC-I pelvic ring injuries often had catastrophic outcomes, with IUFD in 62% of cases. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
19
|
Abstract
Traumatic uterine rupture is rare, occurring in 0.6% of blunt trauma cases, and usually results from very violent accidents in which patients usually also sustain other major injuries. Following severe blunt abdominal trauma, fetal loss can result from maternal hypotension or hypoxemia, placental abruption, maternal death, and uterine rupture. Although less common, fetal loss can also occur in minor injuries. We report a patient who sustained an isolated anterior uterine rupture with fetal demise without any associated abdominal or pelvic injuries. This case report highlights the importance of proper seat belt usage and placement because both can reduce maternal and fetal morbidity and mortality in motor vehicle accidents.
Collapse
Affiliation(s)
- Christina Lien
- Department of General Surgery, Arrowhead Regional Medical Center, USA
| | - Aamna Ali
- Department of General Surgery, Arrowhead Regional Medical Center, USA
| | - John Culhane
- Department of General Surgery, Arrowhead Regional Medical Center, USA
| |
Collapse
|
20
|
Auriault F, Thollon L, Pérès J, Behr M. Adverse fetal outcome in road accidents: Injury mechanism study and injury criteria development in a pregnant woman finite element model. ACCIDENT; ANALYSIS AND PREVENTION 2016; 97:96-102. [PMID: 27596046 DOI: 10.1016/j.aap.2016.08.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 08/06/2016] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
This study documents the development of adverse fetal outcome predictors dedicated to the analysis of road accidents involving pregnant women. To do so, a pre-existing whole body finite element model representative of a 50th percentile 26 weeks pregnant woman was used. A total of 8 accident scenarios were simulated with the model positioned on a sled. Each of these scenarios was associated to a risk of adverse fetal outcome based on results from real car crash investigations involving pregnant women from the literature. The use of airbags and accidents involving unbelted occupants were not considered in this study. Several adverse fetal outcome potential predictors were then evaluated with regard to their correlation to this risk of fetal injuries. Three predictors appeared strongly correlated to the risk of adverse fetal outcome: (1) the intra uterine pressure at the placenta fetal side area (r=0.92), (2) the fetal head acceleration (HIC) (r=0.99) and (3) area of utero-placental interface over a strain threshold (r=0.90). Finally, sensitivity analysis against slight variations of the simulation parameters was performed and assess robustness of these criteria.
Collapse
Affiliation(s)
- F Auriault
- Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, F-13016, France.
| | - L Thollon
- Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, F-13016, France
| | - J Pérès
- Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, F-13016, France
| | - M Behr
- Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, F-13016, France
| |
Collapse
|
21
|
Obstetric and neonatal outcome following minor trauma in pregnancy. Is hospitalization warranted? Eur J Obstet Gynecol Reprod Biol 2016; 203:78-81. [DOI: 10.1016/j.ejogrb.2016.05.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/12/2016] [Accepted: 05/21/2016] [Indexed: 11/19/2022]
|
22
|
Rossignol M. Trauma and pregnancy: What anesthesiologist should know. Anaesth Crit Care Pain Med 2016; 35 Suppl 1:S27-S34. [PMID: 27386762 DOI: 10.1016/j.accpm.2016.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Mathias Rossignol
- Department of anesthesiology, critical care and pre-hospital intensive care unit, hôpital Lariboisière, Assistance publique-Hopitaux de Paris, Paris, France.
| |
Collapse
|
23
|
Auriault F, Brandt C, Chopin A, Gadegbeku B, Ndiaye A, Balzing MP, Thollon L, Behr M. Pregnant women in vehicles: Driving habits, position and risk of injury. ACCIDENT; ANALYSIS AND PREVENTION 2016; 89:57-61. [PMID: 26809074 DOI: 10.1016/j.aap.2016.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 01/09/2016] [Accepted: 01/10/2016] [Indexed: 06/05/2023]
Abstract
This study proposed to broadly examine vehicle use by pregnant women in order to improve realism of accident simulations involving these particular occupants. Three research pathways were developed: the first consisted in a questionnaire survey examining the driving habits of 135 pregnant women, the second obtained measurements of 15 pregnant women driving position in their own vehicle from the 6th to the 9th month of pregnancy by measuring distances between body parts and vehicle parts, and the third examined car accidents involving pregnant occupants. Results obtained indicate that between 90% and 100% of pregnant women wore their seat belts whatever their stage of pregnancy, although nearly one third of subjects considered the seat belt was dangerous for their unborn child. The measurements obtained also showed that the position of the pregnant woman in her vehicle, in relation to the various elements of the passenger compartment, changed significantly during pregnancy. In the studied accidents, no correlation was found between the conditions of the accident and the resulting fetal injury. Results reveal that pregnant women do not modify significantly the seat setting as a function of pregnancy stage. Only the distance between maternal abdomen and steering wheel change significantly, from 16 cm to 12 cm at 6 and 9 month respectively. Pregnant women are mainly drivers before 8 months of pregnancy, passengers after that. Car use frequency falls down rapidly from 6 to 9 months of pregnancy. Real crashes investigations indicate a low rate of casualties, i.e. 342 car accidents involving pregnant women for a period of 9 years in an approximately 1.7 million inhabitants area. No specific injury was found as a function of stage of pregnancy.
Collapse
Affiliation(s)
- F Auriault
- Aix-Marseille Université, IFSTTAR, LBA UMR_T24, F-13916 Marseille, France.
| | - C Brandt
- Ecole Universitaire de Maïeutique Marseille Méditerranée, F-13916 Marseille, France
| | - A Chopin
- Ecole Universitaire de Maïeutique Marseille Méditerranée, F-13916 Marseille, France
| | - B Gadegbeku
- IFSTTAR, TS2, UMRESTTE UMR_T9405, F-69500 Bron, France; Université de Lyon, F-69622 Lyon, France; Université Lyon 1, F-69373 Lyon, France
| | - A Ndiaye
- IFSTTAR, TS2, UMRESTTE UMR_T9405, F-69500 Bron, France; Université de Lyon, F-69622 Lyon, France; Université Lyon 1, F-69373 Lyon, France
| | - M-P Balzing
- Ecole Universitaire de Maïeutique Marseille Méditerranée, F-13916 Marseille, France
| | - L Thollon
- Aix-Marseille Université, IFSTTAR, LBA UMR_T24, F-13916 Marseille, France
| | - M Behr
- Aix-Marseille Université, IFSTTAR, LBA UMR_T24, F-13916 Marseille, France
| |
Collapse
|
24
|
Miller N, Biron-Shental T, Peleg K, Fishman A, Olsha O, Givon A, Kessel B. Are pregnant women safer in motor vehicle accidents? J Perinat Med 2016; 44:329-32. [PMID: 26356252 DOI: 10.1515/jpm-2015-0163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/29/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Motor vehicle accidents (MVAs) are a major incidental cause of pregnancy-associated maternal deaths in the US. The goal of this research was to evaluate the incidence, risks, and fetal and maternal outcomes of pregnant women involved in MVAs. In addition, we examined the relationship between the injury severity score (ISS) and car seat location in pregnant and non-pregnant women. METHODS This involved a retrospective cohort study of female patients who were involved in MVAs and hospitalized between the years 2006 and 2013. Data were collected from the Israeli National Trauma Registry. Severity and outcomes of pregnant and non-pregnant women with blunt trauma were compared. RESULTS In this study, 3794 pregnant and 3441 non-pregnant patients aged 18-40 years were analyzed. The majority of pregnant patients were drivers (n=2515, 67%) as opposed to passengers (n=1279, 33%). Pregnant patients had lower ISS than non-pregnant patients (P<0.001). Out of these pregnant patients, 38 (1%) had adverse maternal-fetal pregnancy outcomes, including (1) placental abruption 0.1% and (2) miscarriage (0.2%). One pregnant patient died (0.03%) compared with 32 (0.93%) of the non-pregnant patients (P<0.0001). A significant negative correlation between gestational age and spontaneous abortion was found (P<0.009). CONCLUSIONS The severity of injury and the mortality rate of pregnant patients involved in MVAs are significantly lower compared with non-pregnant patients. Pregnant drivers had a significantly lower severity of trauma compared with pregnant passengers.
Collapse
|
25
|
|
26
|
Auriault F, Thollon L, Behr M. Development of a Gravid Uterus Model for the Study of Road Accidents Involving Pregnant Women. J Biomech Eng 2015; 138:2473565. [PMID: 26592419 DOI: 10.1115/1.4032055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Indexed: 11/08/2022]
Abstract
Car accident simulations involving pregnant women are well documented in the literature and suggest that intra-uterine pressure could be responsible for the phenomenon of placental abruption, underlining the need for a realistic amniotic fluid model, including fluid-structure interactions (FSI). This study reports the development and validation of an amniotic fluid model using an Arbitrary Lagrangian Eulerian formulation in the LS-DYNA environment. Dedicated to the study of the mechanisms responsible for fetal injuries resulting from road accidents, the fluid model was validated using dynamic loading tests. Drop tests were performed on a deformable water-filled container at acceleration levels that would be experienced in a gravid uterus during a frontal car collision at 25 kph. During the test device braking phase, container deformation induced by inertial effects and FSI was recorded by kinematic analysis. These tests were then simulated in the LS-DYNA environment to validate a fluid model under dynamic loading, based on the container deformations. Finally, the coupling between the amniotic fluid model and an existing finite-element full-body pregnant woman model was validated in terms of pressure. To do so, experimental test results performed on four postmortem human surrogates (PMHS) (in which a physical gravid uterus model was inserted) were used. The experimental intra-uterine pressure from these tests was compared to intra uterine pressure from a numerical simulation performed under the same loading conditions. Both free fall numerical and experimental responses appear strongly correlated. The relationship between the amniotic fluid model and pregnant woman model provide intra-uterine pressure values correlated with the experimental test responses. The use of an Arbitrary Lagrangian Eulerian formulation allows the analysis of FSI between the amniotic fluid and the gravid uterus during a road accident involving pregnant women.
Collapse
|
27
|
Rocha Filho EA, Costa ML, Cecatti JG, Parpinelli MA, Haddad SM, Sousa MH, Melo EF, Surita FG, Souza JP. Contribution of antepartum and intrapartum hemorrhage to the burden of maternal near miss and death in a national surveillance study. Acta Obstet Gynecol Scand 2014; 94:50-8. [PMID: 25327163 DOI: 10.1111/aogs.12529] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 10/13/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the occurrence of severe obstetric complications associated with antepartum and intrapartum hemorrhage among women from the Brazilian Network for Surveillance of Severe Maternal Morbidity. DESIGN Multicenter cross-sectional study. SETTING Twenty-seven obstetric referral units in Brazil between July 2009 and June 2010. POPULATION A total of 9555 women categorized as having obstetric complications. METHODS The occurrence of potentially life-threatening conditions, maternal near miss and maternal deaths associated with antepartum and intrapartum hemorrhage was evaluated. Sociodemographic and obstetric characteristics and the use of criteria for management of severe bleeding were also assessed in these women. MAIN OUTCOME MEASURES The prevalence ratios with their respective 95% confidence intervals adjusted for the cluster effect of the design, and multiple logistic regression analysis were performed to identify factors independently associated with the occurrence of severe maternal outcome. RESULTS Antepartum and intrapartum hemorrhage occurred in only 8% (767) of women experiencing any type of obstetric complication. However, it was responsible for 18.2% (140) of maternal near miss and 10% (14) of maternal death cases. On multivariate analysis, maternal age and previous cesarean section were shown to be independently associated with an increased risk of severe maternal outcome (near miss or death). CONCLUSION Severe maternal outcome due to antepartum and intrapartum hemorrhage was highly prevalent among Brazilian women. Certain risk factors, maternal age and previous cesarean delivery in particular, were associated with the occurrence of bleeding.
Collapse
Affiliation(s)
- Edilberto A Rocha Filho
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), School of Medicine, Campinas, SP, Brazil
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Cheng HT, Wang YC, Lo HC, Su LT, Soh KS, Tzeng CW, Wu SC, Sung FC, Hsieh CH. Laparoscopic appendectomy versus open appendectomy in pregnancy: a population-based analysis of maternal outcome. Surg Endosc 2014; 29:1394-9. [PMID: 25171885 DOI: 10.1007/s00464-014-3810-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Laparoscopic appendectomy (LA) is the standard treatment of acute appendicitis for the general population; however, there is still some doubt regarding its safety for pregnant patients. Therefore, the purpose of this study is to investigate and compare the maternal outcome of pregnant patients with acute appendicitis following either an open appendectomy (OA) or LA from a population-based database. METHODS This study is based on the National Health Insurance Research Database. Patients with both ICD-9-CM codes for appendicitis (540.9, 540.0, and 540.1) and pregnancy (V22) in the same admission were considered to have acute appendicitis during pregnancy. These patients were divided into three groups according to the type of treatment: LA, OA, and non-operative treatment. Outcome measures that were compared between the groups included maternal complications such as preterm labor, abortion, and the need of cesarean section. Besides, the differences of medical expenditure and length of hospital stay between the groups were also analyzed. RESULTS From 2005 to 2010, a total of 859 pregnant women who had acute appendicitis were identified. They had increased risks for preterm labor, abortion, and increased requirement of cesarean section compared to the control group (i.e., those without acute appendicitis). Among the three groups, the non-operated group has the highest risk of preterm labor. Patients who underwent LA did not have any increased risk of maternal complications compared to the OA group. Furthermore, LA patients had shorter hospital stay than OA. CONCLUSION Compared to non-operative treatment, appendectomy is the preferred treatment for pregnant patients who have acute appendicitis. LA can be performed safely in pregnant patients without bringing additional maternal complications compared to OA.
Collapse
Affiliation(s)
- Han-Tsung Cheng
- Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan, ROC,
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Elevated maternal serum α-fetoprotein after minor trauma during pregnancy may predict adverse fetal outcomes. J Trauma Acute Care Surg 2014; 77:510-3. [PMID: 25159258 DOI: 10.1097/ta.0000000000000313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We evaluated the relationship between minor trauma during pregnancy and elevated maternal serum α-fetoprotein level. METHODS This is a retrospective review of pregnant patients admitted to Fukui Prefectural Hospital with trauma during a 10-year period. Charts were reviewed for maternal age, gestational age, injury characteristics, Injury Severity Score, the presence of abdominal pain, systolic pressure and heart rate on arrival, fetal hemoglobin level, and maternal serum α-fetoprotein (MSAFP) concentration on arrival. RESULTS Fifty-one pregnant patients with any trauma were treated at Fukui Prefectural Hospital. All patients were hemodynamically stable and had minor trauma. An adverse pregnancy outcome occurred in three patients (5%). One patient's fetus had a left kidney injury. Intrauterine fetal death occurred in two patients. The time from injury to fatal death was 180 minutes in one patient and 18 hours in the other patient. The mean ± SD fetal hemoglobin was 0.57% ± 0.88%. The mean ± SD MSAFP was 511 ng/mL ± 1,263 ng/mL. Three patients with adverse pregnancy outcome had a high MSAFP of greater than 1,000 ng/mL. CONCLUSION High level of MSAFP may be a predictor of poor fetal outcome following trauma during pregnancy regardless of the severity of the trauma or the mother's hemodynamic status. LEVEL OF EVIDENCE Epidemiologic study, level V.
Collapse
|
30
|
Kim JD, Ahn BM, Joo BS, Kwon JY, Chung HJ, Yu SB. Effect of propofol on prostaglandin E2 production and prostaglandin synthase-2 and cyclooxygenase-2 expressions in amniotic membrane cells. J Anesth 2014; 28:911-8. [PMID: 24752596 DOI: 10.1007/s00540-014-1830-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 03/30/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Surgery during pregnancy can be a cause of preterm labor or birth, possibly resulting from anesthetic agents or direct effects of surgery. This study was aimed to investigate the effect of propofol on uterine contractility by examining prostaglandin E2 (PGE2) production and the expression of PGE synthase 2 (PGES2) and cyclooxygenase-2 (COX-2) in amniotic membrane cells. METHODS Amniotic membranes were collected from healthy full-term women who underwent cesarean section at 37-40 weeks of gestation. The amniotic cells were cultured in α-modified-Eagle's medium with 10% fetal bovine serum for 24 h at 5% CO2 in a 37 °C incubator. Then, various doses of propofol (0.01-10 μg/ml) were used for treatment for 3 h. PGE2 concentrations in conditioned media were evaluated using ELISA. PGES2 and COX-2 expression were examined using RT-PCR and Western blot. Cell viability and apoptosis were examined by MTT, ATP assays, and the TUNEL method. RESULTS PGE2 production significantly decreased at 0.1 and 1.0 μg/ml propofol concentrations compared to controls. COX-2 and PGES2 mRNA expression was decreased in a dose-dependent manner with a significant difference at 0.1 μg/ml propofol compared to controls. The protein expression of COX-2 showed a similar result to mRNA expression, but protein expression of PGES2 was not significantly decreased. No effect of propofol was found in cell viability. CONCLUSIONS This study showed that propofol reduced the production of PGE2 and the expression of COX-2 and PGES2 without affecting cell viability.
Collapse
Affiliation(s)
- Ju Deok Kim
- Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, 34 Amnam-dong, Seogu, Busan, 602-702, Korea
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
Traumatic injuries in pregnancy are both common and burdensome. Optimal management includes proper triage, maternal resuscitation, fetal monitoring, and diagnostic imaging.
Collapse
Affiliation(s)
- Steffen Brown
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| | | |
Collapse
|
32
|
A 21-year-old woman with a uterine rupture. Air Med J 2013; 32:230-2, 74. [PMID: 24001907 DOI: 10.1016/j.amj.2013.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
|
33
|
Amorosa LF, Amorosa JH, Wellman DS, Lorich DG, Helfet DL. Management of pelvic injuries in pregnancy. Orthop Clin North Am 2013; 44:301-15, viii. [PMID: 23827834 DOI: 10.1016/j.ocl.2013.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pelvic fractures in pregnant women are usually high-energy injuries associated with risk of mortality to both mother and fetus. The mother's life always takes priority in the acute setting as it offers the best chance of survival to both the mother and the fetus. Indications for operative intervention of acute pubic symphysis rupture depend on presence of an open disruption, amount of displacement, and degree of disability. Chronic symphyseal instability related to pregnancy is a challenging problem and the first line of treatment is nonoperative care. A previous pelvic fracture is not a contraindication by itself to vaginal delivery.
Collapse
Affiliation(s)
- Louis F Amorosa
- Department of Orthopaedic Surgery, New York Medical College, 19 Bradhurst Ave, Suite 1300, Hawthorne, NY 10532, USA.
| | | | | | | | | |
Collapse
|
34
|
|