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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.
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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.
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Izumiyama T, Tsuji A, Tanaka K, Tateoka Y, Asahi R, Hamano H, Hitosugi M, Sugimoto S. Prediction of Placental Abruption of Pregnant Women Drivers with Various Collision Velocities, Seatbelt Positions and Placental Positions-Analysis with Novel Pregnant Occupant Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:827. [PMID: 39063404 PMCID: PMC11276204 DOI: 10.3390/ijerph21070827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
The aims of this study were as follows: the (a) creation of a pregnant occupant finite element model based on pregnant uterine data from sonography, (b) development of the evaluation method for placental abruption using this model and (c) analysis of the effects of three factors (collision speed, seatbelt position and placental position) on the severity of placental abruption in simulations of vehicle collisions. The 30-week pregnant occupant model was developed with the uterine model including the placenta, uterine-placental interface, fetus, amniotic fluid and surrounding ligaments. A method for evaluating the severity of placental abruption on this pregnant model was established, and the effects of these factors on the severity of the injury were analyzed. As a result, a higher risk of placental abruption was observed in high collision speeds, seatbelt position over the abdomen and anterior-fundal placenta. Lower collision speeds and seatbelt position on the iliac wings prevented severe placental abruption regardless of placental positions. These results suggested that safe driving and keeping seatbelt position on the iliac wings were essential to decrease the severity of this injury. From the analysis of the mechanism for placental abruption, the following hypothesis was proposed: a shear at adhesive sites between the uterus and placenta due to direct seatbelt loading to the uterus.
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Affiliation(s)
- Tomohiro Izumiyama
- Crash Safety Development Department, Vehicle Development Division, Mazda Motor Corporation, Hiroshima 730-8670, Japan (R.A.)
| | - Atsuno Tsuji
- Crash Safety Development Department, Vehicle Development Division, Mazda Motor Corporation, Hiroshima 730-8670, Japan (R.A.)
| | - Katsunori Tanaka
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan (M.H.)
| | - Yumiko Tateoka
- Department of Clinical Nursing, Shiga University of Medical Science, Otsu 520-2192, Japan;
| | - Ryusuke Asahi
- Crash Safety Development Department, Vehicle Development Division, Mazda Motor Corporation, Hiroshima 730-8670, Japan (R.A.)
| | - Hiroshi Hamano
- Crash Safety Development Department, Vehicle Development Division, Mazda Motor Corporation, Hiroshima 730-8670, Japan (R.A.)
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan (M.H.)
| | - Shigeru Sugimoto
- Crash Safety Development Department, Vehicle Development Division, Mazda Motor Corporation, Hiroshima 730-8670, Japan (R.A.)
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Jamali P, Kinkade KM, Ericson A, Tyler B, Prashad S, Catena RD. Different neurocognitive controls modulate obstacle avoidance through pregnancy. Exp Brain Res 2024; 242:505-519. [PMID: 38197941 DOI: 10.1007/s00221-023-06772-w] [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: 08/21/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024]
Abstract
Understanding why falls during pregnancy occur at over 25% rate over gestation has clinical impacts on the health of pregnant individuals. Attention, proprioception, and perception of the environment are required to prevent trips and falls. This research aimed to understand how the changes to these neurocognitive processes control obstacle avoidance through gestation. Seventeen pregnant participants were tested five times in 6-week intervals. Participants walked an obstacle course (OC), and we analyzed the crossings over obstacles that were set to 10% of participants' body height. Participants also performed an attentional network test (ANT: performance of specific components of attention), an obstacle perception task (OP: ability to visually define an obstacle and translate that to a body posture), and a joint position sense task (JPS: ability to recognize and recreate a joint position from somatosensation). In the OC task, average leading and trailing foot crossing heights significantly reduced by 13% and 23% respectively, with no change in variation, between weeks 13 and 31 of pregnancy, indicating an increased risk of obstacle contact during this time. The variability in minimum leading foot distances from the obstacle was correlated with all three neurocognition tasks (ANT, OP, and JPS). Increased fall rates in the second and third trimesters of pregnancy may be driven by changes in attention, with additional contributions of joint position sense and environmental perception at various stages of gestation. The results imply that a holistic examination on an individual basis may be required to determine individual trip risk and appropriate safety modifications.
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Affiliation(s)
- Pegah Jamali
- Gait and Posture Biomechanics Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA, 99164-2920, USA
| | - Kameron M Kinkade
- Gait and Posture Biomechanics Laboratory, Department of Kinesiology and Educational Psychology, Washington State University, Pullman, WA, 99164-1410, USA
| | - Asher Ericson
- Gait and Posture Biomechanics Laboratory, Department of Kinesiology and Educational Psychology, Washington State University, Pullman, WA, 99164-1410, USA
| | - Ben Tyler
- Gait and Posture Biomechanics Laboratory, Department of Kinesiology and Educational Psychology, Washington State University, Pullman, WA, 99164-1410, USA
| | - Shikha Prashad
- Cognitive Motor Neuroscience Laboratory, Department of Kinesiology and Educational Psychology, Washington State University, Pullman, WA, 99164-1410, USA
| | - Robert D Catena
- Gait and Posture Biomechanics Laboratory, Department of Kinesiology and Educational Psychology, Washington State University, Pullman, WA, 99164-1410, USA.
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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.
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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
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Dalton SE, Sakowicz A, Charles AG, Stamilio DM. Major trauma in pregnancy: prediction of maternal and perinatal adverse outcomes. Am J Obstet Gynecol MFM 2023; 5:101069. [PMID: 37399890 DOI: 10.1016/j.ajogmf.2023.101069] [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: 05/11/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Trauma, largely the consequence of motor vehicle crashes, is the leading cause of pregnancy-associated maternal mortality. Prediction of adverse outcomes has been difficult in pregnancy given the infrequent occurrence of traumatic events and anatomic considerations unique to pregnancy. The injury severity score, an anatomic scoring system with weighting dependent on severity and anatomic region of injury, is used in the prediction of adverse outcomes in the nonpregnant population but has yet to be validated in pregnancy. OBJECTIVE This study aimed to estimate the associations between risk factors and adverse pregnancy outcomes after major trauma in pregnancy and to develop a clinical prediction model for adverse maternal and perinatal outcomes. STUDY DESIGN This was a retrospective analysis of a cohort of pregnant patients who sustained major trauma and who were admitted to 1 of 2 level 1 trauma centers. Three composite adverse pregnancy outcomes were evaluated, namely adverse maternal outcomes and short- and long-term adverse perinatal outcomes, defined as outcomes occurring within the first 72 hours of the traumatic event or encompassing the entire pregnancy. Bivariate analyses were performed to estimate the associations between clinical or trauma-related variables and adverse pregnancy outcomes. Multivariable logistic regression analyses were performed to predict each adverse pregnancy outcome. The predictive performance of each model was estimated using receiver operating characteristic curve analyses. RESULTS A total of 119 pregnant trauma patients were included, 26.1% of whom met the severe adverse maternal pregnancy outcome criteria, 29.4% of whom met the severe short-term adverse perinatal pregnancy outcome definition, and 51.3% of whom met the severe long-term adverse perinatal pregnancy outcome definition. Injury severity score and gestational age were associated with the composite short-term adverse perinatal pregnancy outcome with an adjusted odds ratio of 1.20 (95% confidence interval, 1.11-1.30). The injury severity score was solely predictive of the adverse maternal and long-term adverse perinatal pregnancy outcomes with odds ratios of 1.65 (95% confidence interval, 1.31-2.09) and 1.14 (95% confidence interval, 1.07-1.23), respectively. An injury severity score ≥8 was the best cutoff for predicting adverse maternal outcomes with 96.8% sensitivity and 92.0% specificity (area under the receiver operating characteristic curve, 0.990±0.006). An injury severity score ≥3 was the best cutoff for the short-term adverse perinatal outcomes, which correlates with a 68.6% sensitivity and 65.1% specificity (area under the receiver operating characteristic curve, 0.755±0.055). An injury severity score ≥2 was the best cutoff for the long-term adverse perinatal outcomes, yielding a 68.3% sensitivity and 72.4% specificity (area under the receiver operating characteristic curve, 0.763±0.042). CONCLUSION For pregnant trauma patients, an injury severity score of ≥8 was predictive of severe adverse maternal outcomes. Minor trauma in pregnancy, defined in this study as an injury severity score <2, was not associated with maternal or perinatal morbidity or mortality. These data can guide management decisions for pregnant patients who present after trauma.
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Affiliation(s)
- Susan E Dalton
- Department of OB/GYN, Division of Maternal-Fetal Medicine, University of Utah Health, Salt Lake City, UT (Dr Dalton).
| | - Allie Sakowicz
- Department of OB/GYN, Division of Maternal-Fetal Medicine, Wake Forest University, Winston-Salem, NC (Drs Sakowicz and Stamilio)
| | - Anthony G Charles
- Department of General Surgery; Division of Critical Care and Trauma Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC (Dr Charles)
| | - David M Stamilio
- Department of OB/GYN, Division of Maternal-Fetal Medicine, Wake Forest University, Winston-Salem, NC (Drs Sakowicz and Stamilio)
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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.
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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
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Lopez CE, Salloum J, Varon AJ, Toledo P, Dudaryk R. The Management of Pregnant Trauma Patients: A Narrative Review. Anesth Analg 2023; 136:830-840. [PMID: 37058718 DOI: 10.1213/ane.0000000000006363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Trauma is the leading nonobstetric cause of maternal death and affects 1 in 12 pregnancies in the United States. Adhering to the fundamentals of the advanced trauma life support (ATLS) framework is the most important component of care in this patient population. Understanding the significant physiologic changes of pregnancy, especially with regard to the respiratory, cardiovascular, and hematologic systems, will aid in airway, breathing, and circulation components of resuscitation. In addition to trauma resuscitation, pregnant patients should undergo left uterine displacement, insertion of 2 large bore intravenous lines placed above the level of the diaphragm, careful airway management factoring in physiologic changes of pregnancy, and resuscitation with a balanced ratio of blood products. Early notification of obstetric providers, initiation of secondary assessment for obstetric complications, and fetal assessment should be undertaken as soon as possible but without interference to maternal trauma assessment and management. In general, viable fetuses are monitored by continuous fetal heart rate for at least 4 hours or more if abnormalities are detected. Moreover, fetal distress may be an early sign of maternal deterioration. When indicated, imaging studies should not be limited out of fear for fetal radiation exposure. Resuscitative hysterotomy should be considered in patients approaching 22 to 24 weeks of gestation, who arrive in cardiac arrest or present with profound hemodynamic instability due to hypovolemic shock.
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Affiliation(s)
- Carmen E Lopez
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joe Salloum
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Albert J Varon
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, Florida
| | - Paloma Toledo
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, Florida
| | - Roman Dudaryk
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, Florida
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Kirk CH, Ciraulo GE, Ciraulo RS, Falank CR, Ciraulo DL. Obstetrical Trauma: Reducing the Burden of Trauma Transfer to Tertiary Care Centers. Am Surg 2023:31348231157847. [PMID: 36797010 DOI: 10.1177/00031348231157847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND In rural state trauma systems, management of the obstetrical trauma patient often defaults to transfer to level I trauma centers. We evaluate the necessity of transferring obstetrical trauma patients without severe maternal injury. MATERIALS AND METHODS A retrospective 5-year review of obstetrical trauma patients admitted to a rural state-level I trauma center was conducted. Injury severity measures such as abdominal AIS, ISS, and GCS were correlated with outcomes. Furthermore, the impact of maternal and gestational age on uterine compromise, uterine irritability, and the need for cesarean section intervention are presented. RESULTS Twenty-one percent of patients were transferred from outside facilities with a median age of 29 years, average ISS of 3.9 ± 5.6, GCS of 13.8 ± 3.6, and abdominal AIS of 1.6 ± .8. Outcomes included maternal fatality of 2%, fetal demise of 4%, 6% experienced premature rupture of membranes, 9% experienced fetal placental compromise, 15% had uterine contractions, 15% of cesarean deliveries, and fetal decelerations occurred in 4%. Predictors of fetal compromise are strongly associated with high maternal ISS and low GCS. DISCUSSION The frequency of traumatic injury in this unique population of patients is fortunately limited. The best predictor for fetal demise and uterine irritability is maternal injury severity, measured by ISS and GCS. Therefore, without severe maternal trauma, obstetrical trauma patients with minor injuries can safely be managed at non-tertiary care facilities with obstetrical capabilities.
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Affiliation(s)
- Charlotte H Kirk
- 115985University of New England College of Osteopathic Medicine, Biddeford, ME, USA
| | | | | | | | - David L Ciraulo
- Department of Surgery, 92602Maine Medical Center, Portland, ME, USA
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Tanaka K, Motozawa Y, Takahashi K, Maki T, Nakamura M, Hitosugi M. Severity of Placental Abruption in Restrained Pregnant Vehicle Drivers: Correct Seat Belt Use Confirmed by Finite Element Model Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13905. [PMID: 36360785 PMCID: PMC9656600 DOI: 10.3390/ijerph192113905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
Despite wearing a seat belt, pregnant drivers often suffer from negative fetal outcomes in the event of motor accidents. In order to maintain the safety of pregnant drivers and their fetuses, we assessed the severity of placental abruption caused by motor vehicle collisions using computer simulations. We employed a validated pregnant finite element model to determine the area of placental abruption. We investigated frontal vehicle collisions with a speed of 40 km/h or less involving restrained pregnant drivers with a gestational age of 30 weeks. For a crash speed of 40 km/h, the placental abruption area was 7.0% with a correctly positioned lap belt across the lower abdomen; it was 36.3% with the belt positioned at the umbilicus. The area of placental abruption depended on collision speed, but we found that with a correctly positioned belt it likely would not lead to negative fetal outcomes. We examined the effects on placental abruptions of reconfiguring seat belt width and force limiter setting. A wider lap belt and lower force limiter setting reduced the area of placental abruption to 3.5% and 1.1%, respectively; however, they allowed more forward movement upon collision. A 2.5 kN force limiter setting may be appropriate with respect to both forward movement and reduced placental abruption area. This study confirmed the importance of correctly using seat belts for pregnant drivers. It provides valuable evidence about improving safety equipment settings.
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Affiliation(s)
- Katsunori Tanaka
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yasuki Motozawa
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | | | - Tetsuo Maki
- Department of Mechanical Engineering, Tokyo City University, Tokyo 158-8557, Japan
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
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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.
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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
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11
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Abstract
BACKGROUND The Western Trauma Association has undertaken publication of best practice clinical practice guidelines on multiple trauma topics. These guidelines are based on scientific evidence, case reports and best practices per expert opinion. Some of the topics covered by this consensus group do not have the ability to have randomized controlled studies completed due to complexity, ethical issues, financial considerations or scarcity of experience. Care of the pregnant trauma patient is one of these clinically complex situations that is based on physiologic data, standard trauma care, trauma care experience and outcomes. METHODS Review of multiple evidence based guidelines, case reports and expert opinion were compiled and reviewed. RESULTS The algorithm is attached with detailed explanation of each step, supported by data if available. CONCLUSIONS Resuscitative and trauma care of the mother is the utmost prioritySTUDY TYPEAlgorithm, expert opinion, consensus. LEVEL OF EVIDENCE III.
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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]
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13
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Diagnostic accuracy of Kleihauer-Betke (Kb) testing to predict fetal outcomes associated with fetomaternal hemorrhage: a retrospective cohort study. J Perinatol 2022; 42:91-96. [PMID: 34408259 DOI: 10.1038/s41372-021-01185-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/24/2021] [Accepted: 07/29/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the diagnostic and screening utility of Kleihauer-Betke (KB) testing as a triage tool in predicting adverse fetal outcomes associated with fetomaternal hemorrhage (FMH). STUDY DESIGN Single center retrospective cohort study evaluated a primary composite outcome of fetal complications associated with FMH between KB-negative and KB-positive test groups. Screening tests for sensitivity, specificity, positive predictive value and negative predictive value were determined. RESULTS 641 women (97%) had KB-negative and 22 (3%) had KB-positive tests. The primary composite outcome between KB-negative and KB-positive pregnancies was similar (30% vs. 36%, p = 0.54). Screening exhibited high specificity (97%), however, test sensitivity was poor (4%) with only moderate positive and negative predictive values (36.4 and 69.7%). CONCLUSION Fetal outcomes associated with FMH were not significantly different between KB-positive and KB-negative test cohorts; KB testing offers no diagnostic precision in the emergency triage evaluation of women with suspected FMH.
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Tanaka K, Motozawa Y, Takahashi K, Maki T, Hitosugi M. Factors Affecting the Severity of Placental Abruption in Pregnant Vehicle Drivers: Analysis with a Novel Finite Element Model. Healthcare (Basel) 2021; 10:healthcare10010027. [PMID: 35052190 PMCID: PMC8775634 DOI: 10.3390/healthcare10010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
We clarified factors affecting the severity of placental abruption in motor vehicle collisions by quantitively analyzing the area of placental abruption in a numerical simulation of an unrestrained pregnant vehicle driver at collision velocities of 3 and 6 m/s. For the simulation, we constructed a novel finite element model of a small 30-week pregnant woman, which was validated anthropometrically using computed tomography data and biomechanically using previous examinations of post-mortem human subjects. In the simulation, stress in the elements of the utero–placental interface was computed, and those elements exceeding a failure criterion were considered to be abrupted. It was found that a doubling of the collision velocity increased the area of placental abruption 10-fold, and the abruption area was approximately 20% for a collision velocity of 6 m/s, which is lower than the speed limit for general roads. This result implies that even low-speed vehicle collisions have negative maternal and fetal outcomes owing to placental abruption without a seatbelt restraint. Additionally, contact to the abdomen, 30 mm below the umbilicus, led to a larger placental abruption area than contact at the umbilicus level when the placenta was located at the uterus fundus. The results support that a reduction in the collision speed and seatbelt restraint at a suitable position are important to decrease the placental abruption area and therefore protect a pregnant woman and her fetus in a motor vehicle collision.
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Affiliation(s)
- Katsunori Tanaka
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.T.); (Y.M.)
| | - Yasuki Motozawa
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.T.); (Y.M.)
| | | | - Tetsuo Maki
- Department of Mechanical Engineering, Tokyo City University, Tokyo 158-8557, Japan;
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.T.); (Y.M.)
- Correspondence: ; Tel./Fax: +81-77-581-2200
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15
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Mehraban SS, Lagodka S, Kydd J, Mehraban S, Cabbad M, Chendrasekhar A, Lakhi NA. Predictive risk factors of adverse perinatal outcomes following blunt abdominal trauma in pregnancy. J Matern Fetal Neonatal Med 2021; 35:8929-8935. [PMID: 34852716 DOI: 10.1080/14767058.2021.2007876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The primary objective was to identify predictive risk factors of preterm delivery following blunt abdominal trauma. The secondary objective was to identify risk factors of other adverse outcomes, Neonatal Intensive Care Unit (NICU) admission, placental abruption, fetal demise, and Cesarean Delivery (CD). METHODS This retrospective study included pregnant patients with gestational age (GA) ≥23 weeks who presented after blunt abdominal trauma to Richmond University Medical Center from October 2015 to January 2020. Patients were identified using the following diagnostic International diagnostic classification (ICD-10) codes: O9A.212, O9A.213, and 071.89, and excluded if trauma did not involve the abdomen, penetrating, <23 weeks, or incomplete records. Collected data points included maternal demographic factors, clinical laboratory values, maternal clinical findings at presentation, abdominal ultrasound, results of fetal monitoring, Abbreviated Injury Score (AIS) for abdomen, and Injury Severity Score (ISS). Univariate analyses were compared using the Student's t-test or Mann-Whitney U-test. Categorical data were compared using the chi-squared test or Fisher's exact test with P-value < .05 as significant. RESULTS 154 patients were included in the final analysis. The incidence of the primary outcome, preterm delivery before 37 weeks, was 11.0% (17/154). The incidence of secondary outcomes following blunt abdominal trauma were abruption 0% (0/154), fetal demise 0.6% (1/154), CD 44% (68/154), NICU admission 24% (37/154). Maternal demographic factors, presence of uterine contractions, maternal clinical conditions (abdominal pain, abdominal tenderness, vaginal bleeding), hematologic and coagulation studies, ultrasound findings, fetal heart rate tracing category, AIS score for abdomen, and ISS score were not predictive of preterm delivery or other secondary outcomes. CONCLUSION The incidence of adverse maternal and neonatal outcomes is low following blunt abdominal trauma. Extended monitoring of asymptomatic patients including laboratory tests and coagulation profiles were not predictive of preterm labor or secondary adverse perinatal outcomes. LEVEL OF EVIDENCE Therapeutic/Care management, Level III.
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Affiliation(s)
- Shadan S Mehraban
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, New York, USA
| | - Sylvie Lagodka
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, New York, USA
| | - Jessica Kydd
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, New York, USA
| | - Shadi Mehraban
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, New York, USA
| | - Michael Cabbad
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, New York, USA
| | - Akella Chendrasekhar
- Department of Trauma Surgery, Richmond University Medical Center, Staten Island, New York, USA
| | - Nisha A Lakhi
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, New York, USA.,Department of Trauma Surgery, Richmond University Medical Center, Staten Island, New York, USA.,Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York, USA
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16
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Hörauf JA, El Saman A, Nau C, Enterlein G, Marzi I, Störmann P. Motor Vehicle Accident during Pregnancy with Two Lifes at Risk: A Case Report. J Orthop Case Rep 2021; 11:65-69. [PMID: 34790607 PMCID: PMC8576764 DOI: 10.13107/jocr.2021.v11.i07.2320] [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: 06/03/2021] [Revised: 06/20/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Major trauma is the leading non-pregnancy-related cause of maternal and fetal deaths. In particular, traffic accidents account for the majority of accident causes and present the highest mortality for the mother and fetus. Seat belt use has reduced mortality rates for both the mother and the unborn child, however, certain potential patterns of injury occur due to the restraining mechanical forces of the worn seat belts on the body. Since life-threatening injuries in pregnancy are nevertheless rare, trauma care of pregnant women continues to be an exceptional situation and a particularly stressful situation for the attending physicians, including the fact that two lives are potentially at stake. Case Report: In this article, we report on a patient in the 37th week of pregnancy who was involved in a high-speed trauma as a front passenger of a car. Initially awake as well as responsive and hemodynamically stable, the patient’s condition deteriorated on the way to the emergency room (ER). On arrival in the ER, according to the Advanced Trauma Life Support concept, interdisciplinary consensus had to be reached between the departments involved regarding further diagnostic and therapeutic procedures. With the knowledge of the special anatomical and physiological changes in the context of pregnancy, both the mother and the child could be stabilized in order to subsequently gain further important information about the present injury pattern during the performed diagnostics and finally to be able to adequately treat the trauma sequelae. Conclusion: Because the care of traumatic life-threatening injuries in pregnancy is rare overall, it poses a special challenge for the attending trauma team in the ER. In order to avert the fatal fate of both the mother and the unborn child, a structured, symptom and patient-oriented interdisciplinary approach is indispensable, especially in these exceptional situations, in order to achieve the best possible outcome for those affected.
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Affiliation(s)
- Jason-Alexander Hörauf
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe - University Frankfurt am Main, Germany
| | - André El Saman
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe - University Frankfurt am Main, Germany
| | - Christoph Nau
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe - University Frankfurt am Main, Germany
| | - Gernot Enterlein
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Hospital of the Johann Wolfgang Goethe - University Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe - University Frankfurt am Main, Germany
| | - Philipp Störmann
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe - University Frankfurt am Main, Germany
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17
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Trauma and pregnancy: Is flow cytometry detection and quantification of fetal red blood cells useful? Eur J Obstet Gynecol Reprod Biol 2021; 266:48-54. [PMID: 34592649 DOI: 10.1016/j.ejogrb.2021.09.012] [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: 05/11/2021] [Revised: 08/19/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess whether positive flow cytometry quantification of fetal red blood cells is associated with adverse maternal and neonatal outcomes in cases of mild trauma during pregnancy. STUDY DESIGN A retrospective database study was conducted at a single tertiary center between 2013 and 2019. All pregnant women with viable gestation involved in trauma who underwent flow cytometry quantification of fetal red blood cells were included in the study. Flow cytometry was considered positive (≥0.03/≥30 ml). Composite adverse maternal and neonatal outcome was defined as one or more of the following: intrauterine fetal death, placental abruption, pre-term birth <37 weeks of gestation, immediate premature rupture of the membranes, and immediate delivery following trauma. Univariate analysis was performed followed by multivariate logistic regression analysis controlling for potential confounders, to assess the role of flow cytometry in predicting adverse maternal and neonatal outcome. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS During the study period 1023 women met inclusion and exclusion criteria. The mechanisms of injury were motor vehicle accident in 387 women (38%), falls in 367 (36%), direct abdominal injury in 353 (35%) and in 14 women (1%) other mechanism of injury. Flow cytometry was considered positive (≥0.03/≥30 ml) in 119 women (11.6%) with median result of 0.03 [0.03-0.04], and negative in 904 women (88.4%) ((≤0.03/≤30 ml) with median result of 0.01 [0.01-0.02]. Composite adverse outcome occurred in 8% of the women involved in trauma during pregnancy, with no difference between the groups with vs. without positive flow cytometry (4.2% vs. 8.5%; p = 0.1). Positive flow cytometry was not associated with any adverse maternal or neonatal outcome. This was confirmed on multivariate analysis controlling for potential confounders. CONCLUSION Flow cytometry result is not related to adverse maternal and fetal/neonatal outcome of women involved in minor trauma during pregnancy. We suggest that flow cytometry should not be routinely assessed in pregnant women involved in minor trauma.
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18
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Shashy LN, Craig AM, Sanlorenzo LA, Osmundson SS. Case 1: Neonatal Trauma Following Motor Vehicle Collision in Pregnancy. Neoreviews 2021; 21:e342-e344. [PMID: 32358147 DOI: 10.1542/neo.21-5-e342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Laura N Shashy
- Division of Neonatology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Amanda M Craig
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Lauren A Sanlorenzo
- Division of Neonatology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Sarah S Osmundson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
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19
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Weißleder A, Kulla M, Annecke T, Beese A, Lang P, Beinkofer D, Lefering R, Trentzsch H, Jost C, Treffer D. [Acute treatment of pregnant women after severe trauma-a retrospective multicenter analysis]. Unfallchirurg 2020; 123:944-953. [PMID: 33180155 DOI: 10.1007/s00113-020-00915-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND For the medical team, the management of pregnant trauma patients is a particular challenge. The aim of this study is to compile this data and to determine differences between pregnant and not pregnant trauma patients. MATERIALS AND METHODS We carried out a retrospective data analysis from the TraumaRegister DGU® with a comparison of 102 pregnant and 3135 not pregnant women of child-bearing age (16-45 years) from 2016-2018 who were treated in a trauma center. All patients were delivered to the resuscitation room and received intensive care treatment. RESULTS In Germany, Austria and Switzerland 3.2% of all trauma patients (102 women) were pregnant. Women with an average age of 29 years suffered most often trauma as a result of a road traffic accident. Major trauma (Injury Severity Score [ISS] ≥16 points) was seen in 24.5% of the pregnant women and 37.4% of the nonpregnant women. A computer tomography (whole body computer tomography) was carried out in 32.7% of all pregnant women but in 79.8% of the nonpregnant women. As a result of the trauma, 2.9% of the pregnant and 3.5% of the not pregnant women died. The standardised mortality rate (SMR) was 0.42 in pregnant women and 0.63 in nonpregnant women. CONCLUSION For the first time there is data regarding incidence, trauma mechanism, prehospital and in-hospital care as well as intensive care of pregnant trauma patients in Germany, Austria and Switzerland. Further research regarding foetal outcome and trauma-related injuries in pregnant women is needed to develop an adjusted management for these patients ready to implement in trauma centres. Gynaecologists and obstetricians should be implemented in the trauma room team when needed.
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Affiliation(s)
- A Weißleder
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
- Klinik XX Gynäkologie, Bundeswehrkrankenhaus Westerstede, Westerstede, Deutschland.
| | - M Kulla
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - T Annecke
- Universität zu Köln, Medizinische Fakultät und Uniklinik, Klinik für Anästhesiologie und Operative Intensivmedizin, Kerpener Straße 62, 50937, Köln, Deutschland
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke - Krankenhaus Köln-Merheim, Köln, Deutschland
| | - A Beese
- Praxis für Frauenheilkunde & Geburtshilfe Jena, Jena, Deutschland
| | - P Lang
- Klinik für Unfallchirurgie und Orthopädie, Septische und Rekonstruktive Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
- Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke am Campus Köln-Merheim, Köln-Merheim, Deutschland
| | - D Beinkofer
- Klinik XX Gynäkologie, Bundeswehrkrankenhaus Westerstede, Westerstede, Deutschland
| | - R Lefering
- Klinik für Unfallchirurgie und Orthopädie, Septische und Rekonstruktive Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
- Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke am Campus Köln-Merheim, Köln-Merheim, Deutschland
| | - H Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstraße 53, 80336, München, Deutschland
| | - C Jost
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - D Treffer
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
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20
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Hill KL, Gross ME, Sutton KM, Mulcahey MK. Evaluation and Resuscitation of the Pregnant Orthopaedic Trauma Patient: Considerations for Maternal and Fetal Outcomes. JBJS Rev 2020; 7:e3. [PMID: 31841448 DOI: 10.2106/jbjs.rvw.19.00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Kelly L Hill
- Department of Orthopaedic Surgery (K.L.H. and M.K.M.), Tulane University School of Medicine (M.E.G.), New Orleans, Louisiana
| | - Maya E Gross
- Department of Orthopaedic Surgery (K.L.H. and M.K.M.), Tulane University School of Medicine (M.E.G.), New Orleans, Louisiana
| | | | - Mary K Mulcahey
- Department of Orthopaedic Surgery (K.L.H. and M.K.M.), Tulane University School of Medicine (M.E.G.), New Orleans, Louisiana
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21
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Abstract
Trauma is the leading cause of nonobstetric maternal mortality and affects up to 8% of all pregnancies. Pregnant patients with traumatic brain injury (TBI) are an especially vulnerable population, and their management is complex, with multiple special considerations that must be taken into account. These include but are not limited to alterations in maternal physiology that occur with pregnancy, potential teratogenicity of pharmacologic therapies and diagnostic studies using ionizing radiation, need for fetal monitoring, Rh immunization status, placental abruption, and preterm labor. Despite these challenges, evidence regarding management of the pregnant patient with a TBI is lacking, limited to only case reports/series and retrospective analyses. Despite this uncertainty, expert opinion on management of these patients seems to be that, overall, the standard therapies for management of TBI are safe and effective in pregnancy, with a few notable exceptions described in this chapter. Significant work is needed to continue to develop best-practice and evidence-based guidelines for the management of TBI pregnancy.
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Affiliation(s)
- Matthew R Leach
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Christopher G Zammit
- Department of Critical Care Medicine and Neuroscience Institute, TriHealth, Cincinnati, OH, United States.
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22
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Greco PS, Day LJ, Pearlman MD. Guidance for Evaluation and Management of Blunt Abdominal Trauma in Pregnancy. Obstet Gynecol 2019; 134:1343-1357. [PMID: 31764749 DOI: 10.1097/aog.0000000000003585] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Blunt abdominal trauma is the leading type of traumatic injury in pregnancy, with motor vehicle crashes, falls, and assault being the most common etiologies. Several adverse outcomes can occur in pregnancy, including placental abruption, preterm labor and preterm delivery, uterine rupture, and pelvic fracture. Understanding and integration of key anatomic and physiologic changes in pregnancy are key when evaluating a pregnant trauma patient. Pregnant women should be managed in a medical center with the ability to provide adequate care to both trauma patients-the pregnant woman and fetus. Multiple clinical providers are usually involved in the care of pregnant trauma patients, but obstetric providers should play a central role in the evaluation and management of a pregnant trauma patient given their unique training, knowledge, and clinical skills. An algorithm for management of trauma in pregnancy should be used at all sites caring for pregnant women. An alignment of policies within each system optimizes appropriate triage, integration of care, management, and monitoring of pregnant trauma patients and their fetuses. Ensuring effective protocols for prehospital and hospital treatment, as well as thorough training of involved health care providers, is essential in ensuring that optimal care is provided.
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Affiliation(s)
- Patricia S Greco
- University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, Michigan
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23
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Chauhan V, Chauhan A. Traumatic injury in female Drosophila melanogaster affects the development and induces behavioral abnormalities in the offspring. Behav Brain Funct 2019; 15:11. [PMID: 31653253 PMCID: PMC6815055 DOI: 10.1186/s12993-019-0163-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/09/2019] [Indexed: 12/26/2022] Open
Abstract
Traumatic injury (TI) during pregnancy increases the risk for developing neurological disorders in the infants. These disorders are a major concern for the well-being of children born after TI during pregnancy. TI during pregnancy may result in preterm labor and delivery, abruptio placentae, and/or fetomaternal hemorrhage. Drosophila melanogaster (fruit fly) is a widely used model to study brain and behavioral disorders in humans. In this study, we analyzed the effects of TI to female fruit flies on the development timing of larvae, social interaction and the behavior of offspring flies. TI to the female flies was found to affect the development of larvae and the behavior of offspring flies. There was a significant increase in the length of larvae delivered by traumatically injured maternal flies as compared to larvae from control maternal flies (without TI). The pupae formation from larvae, and the metamorphosis of pupae to the first generation of flies were faster in the TI group than the control group. Negative geotaxis and distance of the fly to its nearest neighbor are parameters of behavioral assessment in fruit flies. Negative geotaxis significantly decreased in the first generation of both male (p = 0.0021) and female (p = 0.0426) flies. The distance between the first generation of flies to its nearest neighbor was shorter in both male and female offspring flies in the TI group as compared to control group flies. These results indicate that TI to the female flies affected the development of larvae and resulted in early delivery, impaired social interaction and behavioral alterations in the offspring.
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Affiliation(s)
- Ved Chauhan
- Department of Neurochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, NY, 10314, USA.
| | - Abha Chauhan
- Department of Neurochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, NY, 10314, USA
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24
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Fabricant SP, Greiner KS, Caughey AB. Trauma in pregnancy and severe adverse perinatal outcomes. J Matern Fetal Neonatal Med 2019; 34:3070-3074. [PMID: 31619114 DOI: 10.1080/14767058.2019.1678129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Trauma, including accidental and violent trauma, is a rare but severe complication of pregnancy. The incidence of adverse perinatal outcomes in pregnancies affected by traumatic injury has not been well-studied. OBJECTIVE We sought to characterize the association between traumatic injury during pregnancy and severe adverse perinatal outcomes in a large population. STUDY DESIGN We performed a retrospective cohort study of California Birth Registry data from 2007 to 2011. ICD-9 diagnosis and procedure codes were used to categorize patients into trauma and non-trauma cohorts and to assess the prevalence of severe adverse fetal and neonatal outcomes. Chi-square tests were used to characterize maternal demographics and perform univariate analyses, and logistic regression was used to control for potential confounders. RESULTS Of 2,406,605 singleton nonanomalous pregnancies, 1262 (0.05%) experienced trauma prior to delivery. The rate of composite perinatal outcomes was higher in pregnancies with trauma compared to those without (3.1 versus 0.87%, p < .001). Trauma was associated with higher occurrences of preterm birth <37 weeks, preterm birth <32 weeks, very low birth weight and neonatal death. Fetal demise at any gestational age was more common among trauma patients (1.9 versus 0.53%, p < .001), though this difference was not statistically significant among term fetuses (0.28 versus 0.14%, p = .21). A difference in composite adverse perinatal outcomes was seen even after controlling for important maternal characteristics (aOR 3.2, 95% CI). Trauma patients with severe morbidity compared to those without had higher rates of preterm birth <37 weeks, preterm birth <32 weeks, and composite severe perinatal outcomes. CONCLUSION Trauma in pregnant women is associated with an increased risk of severe adverse perinatal outcomes, including fetal and neonatal demise. Prevalence of fetal demise is not different between trauma and non-trauma mothers when looking at term fetuses only, suggesting that the greatest risk of fetal demise in the setting of trauma occurs in the preterm period. These data can be used to counsel patients and to inform more detailed research into the mechanisms of trauma in pregnancy outcomes.
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Affiliation(s)
- Sonya P Fabricant
- Department of Obstetrics and Gynecology, University of Southern California/LAC+USC Medical Center, Los Angeles, CA, USA
| | - Karen S Greiner
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
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Chest compression of a pregnant woman by a seatbelt might affect fetal outcome, even in minor to moderate frontal vehicle collisions. Forensic Sci Int 2019; 302:109888. [PMID: 31400617 DOI: 10.1016/j.forsciint.2019.109888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Pregnant women often suffer from negative fetal outcomes, despite wearing a seatbelt correctly. When restrained vehicle passengers are involved in a frontal collision without suffering from any injuries, the forces they experience are particularly concentrated in the chest because of the seatbelt. We analyzed the biomechanics of chest injuries sustained by restrained pregnant drivers and possible effects of these injuries on the fetus. MATERIAL AND METHODS The Maternal Anthropometric Measurement Apparatus dummy, version 2B, representing a pregnant woman at 30 weeks of gestation, was used. Sled tests were performed for recreating frontal impact situations with vector velocity changes at impact speeds of 13, 26, and 40km/h. Overall kinematics of the dummy were examined using high-speed video imaging. Quantitative dummy responses, such as time course of acceleration of the sled and chest, pressure of the belt, and deflection of the chest (right and left) during impact were also measured. RESULTS Although collision velocities were different, the distances of forward movement of the dummy were similar (121-129mm) owing to the safety devices. However, maximum deflection of the chest (35.4mm to the left and 15.7mm to the right) was obtained at a 26-km/h collision. Additionally, maximum deflection of 28.7mm to the left and 10.9mm to the right of the chest were obtained at 40km/h. CONCLUSIONS Because the uterus enlarges and the fundus reaches the lower part of the rib cage during late pregnancy, we consider that the reason for negative fetal outcomes is partly owing to chest compression and subsequent applied forces on the uterus, even in minor to moderate frontal collisions. This knowledge may be useful for forensic scientists who determine the causes and mechanisms of a fetal death or the offenders' responsibilities for both maternal and fetal outcomes when the mother is involved in a frontal vehicle collision.
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Karafin MS, Glisch C, Souers RJ, Hudgins J, Park YA, Ramsey GE, Lockhart E, Pagano MB. Use of Fetal Hemoglobin Quantitation for Rh-Positive Pregnant Females: A National Survey and Review of the Literature. Arch Pathol Lab Med 2019; 143:1539-1544. [PMID: 31173529 DOI: 10.5858/arpa.2018-0523-cp] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The Kleihauer-Betke (KB) test is validated for estimating the dose of Rh immune globulin needed for Rh-negative pregnant females. However, some clinicians are also ordering the test for Rh-positive women. The degree to which this practice occurs is unknown. OBJECTIVE.— To evaluate the number of laboratories that perform the KB test on Rh-positive pregnant women, and to establish current ordering practices for this indication. DESIGN.— We added 9 supplemental questions regarding KB test use for fetomaternal hemorrhage to the 2016 College of American Pathologists proficiency test survey. We also reviewed the available literature regarding the diagnostic utility of the KB test for Rh-positive women. RESULTS.— A total of 1578 surveys were evaluated and revealed that 52% (824) of respondents perform these tests for Rh-positive women, and more than 50% (440 of 819; 53.7%) of these laboratories report that the results for Rh-positive women are treated as important or very important. CONCLUSIONS.— The KB test is commonly used for Rh-positive women, and the information obtained from the test is considered as urgent and important. However, the available literature in support of this practice is still nonconclusive.
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Affiliation(s)
- Matthew S Karafin
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
| | - Chad Glisch
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
| | - Rhona J Souers
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
| | - Jay Hudgins
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
| | - Yara A Park
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
| | - Glenn E Ramsey
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
| | - Evelyn Lockhart
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
| | - Monica B Pagano
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
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Abstract
Although trauma in pregnancy is rare, it is one of the most common causes of morbidity and mortality to pregnant women and fetus. Pathophysiology of trauma is generally time sensitive, and this is still true in pregnant patients, with the additional challenge of rare presentation and balancing the management of two patients concurrently. Successful resuscitation requires understanding the physiologic changes to the woman throughout the course of pregnancy. Ultimately, trauma management is best approached by prioritizing maternal resuscitation.
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Affiliation(s)
- Jeffrey Sakamoto
- Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA 94304, USA
| | - Collin Michels
- Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA 94304, USA
| | - Bryn Eisfelder
- Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA 94304, USA
| | - Nikita Joshi
- Alameda Health Systems, 490 Grand Avenue, Oakland, CA 94610, USA.
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Weinberg L, Steele RG, Pugh R, Higgins S, Herbert M, Story D. The Pregnant Trauma Patient. Anaesth Intensive Care 2019; 33:167-80. [PMID: 15960398 DOI: 10.1177/0310057x0503300204] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trauma is the leading non-obstetric cause of maternal death. Optimal management of the pregnant trauma patient requires a multidisciplinary approach. The anaesthetist and critical care physician play a pivotal role in the entire continuum of fetomaternal care, from initial assessment, resuscitation and intraoperative management, to postoperative care that often involves critical care support and patient transfer. Primary goals are aggressive resuscitation of the mother and maintenance of uteroplacental perfusion and fetal oxygenation by the avoidance of hypoxia, hypotension, hypocapnia, acidosis and hypothermia. Recognizing and understanding the mechanisms of injury, the factors that may predict fetal outcome, and the pathophysiological changes that can result from trauma, will allow early identification and treatment of fetomaternal injury. This in turn should improve morbidity and mortality. A framework for the acute care of the pregnant trauma patient is presented.
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Affiliation(s)
- L Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria
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Safdari M, Safdari Z, Pishjoo M. Intrauterine Fetal Traumatic Brain Injury Following Motor Vehicle Accident; A Case Report and Review of the Literature. Bull Emerg Trauma 2018; 6:372-375. [PMID: 30402529 PMCID: PMC6215071 DOI: 10.29252/beat-060417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Trauma, especially traumatic injuries due to car accidents are one of the causes of maternal and fetal mortality and morbidity during pregnancy. Fetus brain injuries are usually caused fetus death. We herein report a pregnant woman in 28 weeks of gestation. The fetus was found to be normal during in-hospital. At birth, the female neonate demonstrated developmental delay and neurological deficits (hypotonicity). Neuroimaging after birth revealed extreme dilatation of lateral ventricles, hypoplasia and aplasia of the brain. In 4 months, she had multiple morbidities including developmental delay, hypotonia, blindness, oropharyngeal dysphagia and simple partial seizure. Motor and response to stimulation was normal. Appropriate seatbelt usage can protect the fetus from sustaining severe intracranial injuries.
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Affiliation(s)
- Mohammad Safdari
- Department of Neurosurgery, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zohre Safdari
- Department of Radiology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Masoud Pishjoo
- Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
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30
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Lebrun B, Jacquemyn Y. Usefulness of maternal fetal red blood cell count in rhesus-positive pregnant women. Horm Mol Biol Clin Investig 2018; 35:/j/hmbci.ahead-of-print/hmbci-2018-0028/hmbci-2018-0028.xml. [PMID: 30059348 DOI: 10.1515/hmbci-2018-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/19/2018] [Indexed: 11/15/2022]
Abstract
Background Fetal red blood cells (FRBC) in maternal blood are counted in rhesus-negative women to determine the amount of anti-D immunoglobulin to be administered in the case of a rhesus-positive fetus. In rhesus-positive pregnant women this is done in not always very well-defined indications including trauma, miscarriage, fetal death and diminished fetal movements. The aim of this study is to determine if the detection of FRBC is useful in rhesus-positive pregnant woman. This was done by assessing maternal and fetal characteristics that are more likely to give a positive test. Materials and methods This was a retrospective cohort study. Results A total of 169 FRBC tests were performed in 161 rhesus-positive pregnant women. FRBC were found in 45 (26.6%) of the women. Three patients experienced a miscarriage although their FRBC tests were negative (p = 0.295). Of the seven patients who experienced unexpected stillbirths, three tested positive. The deaths were not less likely to occur if the results had been negative (p = 0.631). There was a statistically significant difference between the different types of trauma indications (p = 0.025): the test was more likely positive if there had been a fall on the ground or staircase or blunt trauma (p = 0.041, 0.026 and 0.018, respectively). FRBC were not more frequently present in the absence of fetal movements (n = 16, p = 0.693). Conclusion FRBC in maternal blood were more likely positive in the case of a fall on the ground, or from a staircase. However, a positive test does not necessarily imply fetal pathology and, therefore, does not contribute to clinical management.
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Affiliation(s)
- Benjamin Lebrun
- UZA Antwerp University Hospital, Department of Gynecology and Obstetrics, Wilrijkstraat 10 2650 Edegem, Belgium
| | - Yves Jacquemyn
- UZA Antwerp University Hospital, Departement of Gynecology and Obstetrics, Edegem, Belgium
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31
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Gurney D. Hemorrhage in the Pregnant Trauma Patient. J Emerg Nurs 2018; 44:532-534. [PMID: 30055767 DOI: 10.1016/j.jen.2018.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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32
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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]
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Abstract
OBJECTIVE Severe motor vehicle accidents involving pregnant women can result in fetal and neonatal death. We describe a case in which fetal death occurred due to relatively mild seatbelt injuries and present the characteristic magnetic resonance imaging (MRI) findings of the placenta. CASE REPORT A 26-year-old primigravid woman at 20 weeks gestation was involved in an automobile accident. Although she suffered only a seatbelt injury, fetal death subsequently occurred. Contrast-enhanced MRI showed the region compressed by the seatbelt as a low-intensity band without enhancement, and serum alpha-fetoprotein and hemoglobin F levels were elevated. CONCLUSION Careful monitoring, including blood and abdominal examinations, should be performed when pregnant women suffer seatbelt injuries.
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Al-Thani H, El-Menyar A, Sathian B, Mekkodathil A, Thomas S, Mollazehi M, Al-Sulaiti M, Abdelrahman H. Blunt traumatic injury during pregnancy: a descriptive analysis from a level 1 trauma center. Eur J Trauma Emerg Surg 2018; 45:393-401. [DOI: 10.1007/s00068-018-0948-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
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35
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Girard M, Marchand F, Uch R, Bretelle F. [Trauma and pregnancy: Is the Kleihauer-Betke test really useful?]. ACTA ACUST UNITED AC 2017; 45:584-589. [PMID: 28967599 DOI: 10.1016/j.gofs.2017.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the pertinence of Kleihauer-Betke (KB) test, in case of abdominal trauma during pregnancy in forecast of fetal outcomes, according to trauma severity. METHODS A single-center retrospective study conducted between January 2014 and April 2016 in a maternity type III and a trauma center, which included the pregnant women admitted for abdominal trauma. The trauma's severity was assessed using the guidelines of the Society of Obstetricians and Gynaecologists of Canada. The impact of a positive KB test, defined as>0.1%, was analyzed. Adverse outcome was defined as one or more of the following complications: intrauterine fetal death, placental abruption, pre-term birth<37 weeks of gestation, and fetal or neonatal anemia. RESULTS During the study period, 265 pregnancies involved into an abdominal trauma were included: 69% with a minor trauma and 31% with a severe trauma. Of all patients, 5.6% presented a positive KB test, among then 15.4% had an adverse outcome. There was no significant difference in the rate of adverse outcomes in the positive KB group and the KB negative group either in the overall population (P=0.16), in the minor trauma population (P=1) or in the major trauma population (P=0.14). The predictive positive values were respectively in the global population, in the minor trauma group and in the severe trauma group 15.4%, 0% and 25%. CONCLUSIONS The KB test does not seem to be useful in case of trauma during pregnancy to define adverse outcome.
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Affiliation(s)
- M Girard
- Pôle femme-enfant, Department of gynecology and obstetrics, hôpital Nord, Aix-Marseille université (AMU), Assistance publique-Hôpitaux de Marseille, 13015 Marseille, France.
| | - F Marchand
- Pôle femme-enfant, Department of gynecology and obstetrics, hôpital Nord, Aix-Marseille université (AMU), Assistance publique-Hôpitaux de Marseille, 13015 Marseille, France
| | - R Uch
- Établissement français du sang, Alpes-Méditerranée, Marseille Nord, chemin des Bourrely, 13015 Marseille, France
| | - F Bretelle
- Pôle femme-enfant, Department of gynecology and obstetrics, hôpital Nord, Aix-Marseille université (AMU), Assistance publique-Hôpitaux de Marseille, 13015 Marseille, France; A*MIDEX « CREER », unité de recherche sur les maladies infectieuses tropicales et émergentes, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix-Marseille université, 13015 Marseille, France
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van der Knoop BJ, Zonnenberg I.A, Otten VM, van Weissenbruch MM, de Vries JIP. Trauma in pregnancy, obstetrical outcome in a tertiary centre in the Netherlands. J Matern Fetal Neonatal Med 2017; 31:339-346. [DOI: 10.1080/14767058.2017.1285891] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- B. J. van der Knoop
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - I .A. Zonnenberg
- Department of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
| | - V. M. Otten
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - J. I. P. de Vries
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
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Jain V, Chari R, Maslovitz S, Farine D. Lignes directrices pour la prise en charge d'une patiente enceinte ayant subi un traumatisme. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S665-S687. [PMID: 28063573 DOI: 10.1016/j.jogc.2016.09.070] [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: 11/29/2022]
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Sousa VPSD, Santos ADS, Spaniol AP, Viana EDSR. Influence of physical activity and different sensory conditions on static and dynamic balance of pregnant women. MOTRIZ: REVISTA DE EDUCACAO FISICA 2016. [DOI: 10.1590/s1980-6574201600040006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Trauma complicates 6% to 7% of all pregnancies and requires multidisciplinary education and training for both trauma and obstetric teams to achieve the best outcome. It is important to understand the mechanisms of certain adverse maternal and fetal/neonatal outcomes incurred as a result of trauma, as well as caveats to pregnancy physiology that make some injuries more likely and detection of maternal compromise more difficult. This article focuses on these caveats and how to incorporate these into ongoing trauma protocols and offers suggestions for the formation of obstetric trauma response team.
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Affiliation(s)
- Christy Pearce
- Southern Colorado Maternal Fetal Medicine, Colorado Springs, CO, USA; Outreach Services, Centura South State, Colorado Springs, CO, USA.
| | - Stephanie R Martin
- Southern Colorado Maternal Fetal Medicine, Colorado Springs, CO, USA; Maternal Fetal Medicine Services, Centura South State, Colorado Springs, CO, USA
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40
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Abstract
Management of a pregnant trauma victim is a relatively rare but stressful event, not least due to the need to consider two patients. Initial management by a trauma team should follow a structured approach applicable to all trauma patients, combined with knowledge of the specific problems encountered in pregnancy. This review outlines important anatomical and physiological changes that occur during pregnancy and their relevance to initial assessment and treatment. It discusses the epidemiology of trauma in pregnancy, the presentation and manage ment of specific problems and the methods of fetal assessment.
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Affiliation(s)
- Duncan J McAuley
- Department of Accident and Emergency Medicine, Royal London Hospital, London, UK,
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41
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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]
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Brown HL, Harris B, Grotegut CA. Seatbelt use during pregnancy. Am J Emerg Med 2015; 34:326-8. [PMID: 26682675 DOI: 10.1016/j.ajem.2015.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 11/13/2015] [Accepted: 11/14/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Haywood L Brown
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC 27710.
| | - Benjamin Harris
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC 27710
| | - Chad A Grotegut
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC 27710
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43
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Jain V, Chari R, Maslovitz S, Farine D, Bujold E, Gagnon R, Basso M, Bos H, Brown R, Cooper S, Gouin K, McLeod NL, Menticoglou S, Mundle W, Pylypjuk C, Roggensack A, Sanderson F. Guidelines for the Management of a Pregnant Trauma Patient. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:553-74. [PMID: 26334607 DOI: 10.1016/s1701-2163(15)30232-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Physical trauma affects 1 in 12 pregnant women and has a major impact on maternal mortality and morbidity and on pregnancy outcome. A multidisciplinary approach is warranted to optimize outcome for both the mother and her fetus. The aim of this document is to provide the obstetric care provider with an evidence-based systematic approach to the pregnant trauma patient. OUTCOMES Significant health and economic outcomes considered in comparing alternative practices. EVIDENCE Published literature was retrieved through searches of Medline, CINAHL, and The Cochrane Library from October 2007 to September 2013 using appropriate controlled vocabulary (e.g., pregnancy, Cesarean section, hypotension, domestic violence, shock) and key words (e.g., trauma, perimortem Cesarean, Kleihauer-Betke, supine hypotension, electrical shock). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English between January 1968 and September 2013. Searches were updated on a regular basis and incorporated in the guideline to February 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS This guideline is expected to facilitate optimal and uniform care for pregnancies complicated by trauma. Summary Statement Specific traumatic injuries At this time, there is insufficient evidence to support the practice of disabling air bags for pregnant women. (III) Recommendations Primary survey 1. Every female of reproductive age with significant injuries should be considered pregnant until proven otherwise by a definitive pregnancy test or ultrasound scan. (III-C) 2. A nasogastric tube should be inserted in a semiconscious or unconscious injured pregnant woman to prevent aspiration of acidic gastric content. (III-C) 3. Oxygen supplementation should be given to maintain maternal oxygen saturation > 95% to ensure adequate fetal oxygenation. (II-1B) 4. If needed, a thoracostomy tube should be inserted in an injured pregnant woman 1 or 2 intercostal spaces higher than usual. (III-C) 5. Two large bore (14 to 16 gauge) intravenous lines should be placed in a seriously injured pregnant woman. (III-C) 6. Because of their adverse effect on uteroplacental perfusion, vasopressors in pregnant women should be used only for intractable hypotension that is unresponsive to fluid resuscitation. (II-3B) 7. After mid-pregnancy, the gravid uterus should be moved off the inferior vena cava to increase venous return and cardiac output in the acutely injured pregnant woman. This may be achieved by manual displacement of the uterus or left lateral tilt. Care should be taken to secure the spinal cord when using left lateral tilt. (II-1B) 8. To avoid rhesus D (Rh) alloimmunization in Rh-negative mothers, O-negative blood should be transfused when needed until cross-matched blood becomes available. (I-A) 9. The abdominal portion of military anti-shock trousers should not be inflated on a pregnant woman because this may reduce placental perfusion. (II-3B) Transfer to health care facility 10. Transfer or transport to a maternity facility (triage of a labour and delivery unit) is advocated when injuries are neither life- nor limb-threatening and the fetus is viable (≥ 23 weeks), and to the emergency room when the fetus is under 23 weeks' gestational age or considered to be non-viable. When the injury is major, the patient should be transferred or transported to the trauma unit or emergency room, regardless of gestational age. (III-B) 11. When the severity of injury is undetermined or when the gestational age is uncertain, the patient should be evaluated in the trauma unit or emergency room to rule out major injuries. (III-C) Evaluation of a pregnant trauma patient in the emergency room 12. In cases of major trauma, the assessment, stabilization, and care of the pregnant women is the first priority; then, if the fetus is viable (≥ 23 weeks), fetal heart rate auscultation and fetal monitoring can be initiated and an obstetrical consultation obtained as soon as feasible. (II-3B) 13. In pregnant women with a viable fetus (≥ 23 weeks) and suspected uterine contractions, placental abruption, or traumatic uterine rupture, urgent obstetrical consultation is recommended. (II-3B) 14. In cases of vaginal bleeding at or after 23 weeks, speculum or digital vaginal examination should be deferred until placenta previa is excluded by a prior or current ultrasound scan. (III-C) Adjunctive tests for maternal assessment 15. Radiographic studies indicated for maternal evaluation including abdominal computed tomography should not be deferred or delayed due to concerns regarding fetal exposure to radiation. (II-2B) 16. Use of gadolinium-based contrast agents can be considered when maternal benefit outweighs potential fetal risks. (III-C) 17. In addition to the routine blood tests, a pregnant trauma patient should have a coagulation panel including fibrinogen. (III-C) 18. Focused abdominal sonography for trauma should be considered for detection of intraperitoneal bleeding in pregnant trauma patients. (II-3B) 19. Abdominal computed tomography may be considered as an alternative to diagnostic peritoneal lavage or open lavage when intra-abdominal bleeding is suspected. (III-C) Fetal assessment 20. All pregnant trauma patients with a viable pregnancy (≥ 23 weeks) should undergo electronic fetal monitoring for at least 4 hours. (II-3B) 21. Pregnant trauma patients (≥ 23 weeks) with adverse factors including uterine tenderness, significant abdominal pain, vaginal bleeding, sustained contractions (> 1/10 min), rupture of the membranes, atypical or abnormal fetal heart rate pattern, high risk mechanism of injury, or serum fibrinogen < 200 mg/dL should be admitted for observation for 24 hours. (III-B) 22. Anti-D immunoglobulin should be given to all rhesus D-negative pregnant trauma patients. (III-B) 23. In Rh-negative pregnant trauma patients, quantification of maternal-fetal hemorrhage by tests such as Kleihauer-Betke should be done to determine the need for additional doses of anti-D immunoglobulin. (III-B) 24. An urgent obstetrical ultrasound scan should be undertaken when the gestational age is undetermined and need for delivery is anticipated. (III-C) 25. All pregnant trauma patients with a viable pregnancy who are admitted for fetal monitoring for greater than 4 hours should have an obstetrical ultrasound prior to discharge from hospital. (III-C) 26. Fetal well-being should be carefully documented in cases involving violence, especially for legal purposes. (III-C) Obstetrical complications of trauma 27. Management of suspected placental abruption should not be delayed pending confirmation by ultrasonography as ultrasound is not a sensitive tool for its diagnosis. (II-3D) Specific traumatic injuries 28. Tetanus vaccination is safe in pregnancy and should be given when indicated. (II-3B) 29. Every woman who sustains trauma should be questioned specifically about domestic or intimate partner violence. (II-3B) 30. During prenatal visits, the caregiver should emphasize the importance of wearing seatbelts properly at all times. (II-2B) Perimortem Caesarean section 31. A Caesarean section should be performed for viable pregnancies (≥ 23 weeks) no later than 4 minutes (when possible) following maternal cardiac arrest to aid with maternal resuscitation and fetal salvage. (III-B).
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van der Knoop BJ, van Schie PEM, Vermeulen RJ, Pistorius LR, van Weissenbruch MM, de Vries JIP. Effect of (minor or major) maternal trauma on fetal motility: A prospective study. Early Hum Dev 2015; 91:511-7. [PMID: 26132633 DOI: 10.1016/j.earlhumdev.2015.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/05/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Fetal motility represents the spontaneous activity of the central nervous system and as such can be used to evaluate its functional integrity. Maternal mechanical trauma in pregnancy is a risk factor for hypoxic ischemic brain injury and can potentially affect the CNS and fetal motility. AIM To study motility in fetuses after maternal trauma. STUDY DESIGN Prospective study; 1-h sonographic observations at 2-8h (T1), 24-72h (T2) and >72h (T3) after trauma. SUBJECTS Fetuses exposed to trauma after 20weeks gestational age. OUTCOME MEASURES Motor aspects; differentiation into specific movement patterns, quality and quantity of general movements were compared to a normal population. Obstetrical outcome; neurological outcome at term and 1year of age. RESULTS Sixteen fetuses were examined between 2012 and 2014. Median gestational age at time of trauma was 25+6 (range 20-38) weeks. Most traumas were traffic accidents or falls, injuries were mainly minor. Motility assessment showed abnormal differentiation in 2/16; 2/14 and 0/16; abnormal quality in 2/16; 3/14 and 6/16; and abnormal quantity in 6/16, 9/14 and 9/16 at T1, T2 and T3 respectively. Preterm delivery occurred once. Neurological development was normal in 13/14 infants at term and 14/14 at one year. CONCLUSIONS This study shows that maternal trauma affected fetal motility in the majority of the fetuses. The changes in motility support the concern that even minor mechanical trauma may have influence on the functional integrity of the central nervous system, although no neurological sequelae were present at 1year.
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Affiliation(s)
- Bloeme J van der Knoop
- Department of Obstetrics and Gynaecology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Petra E M van Schie
- Department of Rehabilitation Medicine and Physical Therapy, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Roland J Vermeulen
- Department of Child Neurology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Lourens R Pistorius
- Department of Obstetrics and Gynaecology, University Medical Center, Utrecht, Utrecht, The Netherlands.
| | - Mirjam M van Weissenbruch
- Department of Neonatology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Johanna I P de Vries
- Department of Obstetrics and Gynaecology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Research Institute MOVE, VU University, Amsterdam, The Netherlands.
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Opala-Berdzik A, Błaszczyk JW, Bacik B, Cieślińska-Świder J, Świder D, Sobota G, Markiewicz A. Static Postural Stability in Women during and after Pregnancy: A Prospective Longitudinal Study. PLoS One 2015; 10:e0124207. [PMID: 26053046 PMCID: PMC4460040 DOI: 10.1371/journal.pone.0124207] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/10/2015] [Indexed: 11/23/2022] Open
Abstract
This longitudinal study aimed to compare static postural stability in women between early pregnancy, advanced pregnancy, and at 2 and 6 months postpartum. Forty-five pregnant women were enrolled and 31 completed the protocol. Data were collected at 7-16 and 34-39 weeks gestation, and at 6-10 and 26-30 weeks postpartum. For each subject, the center of foot pressure path length and mean velocity (with directional subcomponents) were computed from 30-s long quiet-standing trials on a stationary force plate with eyes open or closed. The body mass, stance width, and sleep duration within 24 h before testing were also recorded. Static postural stability was not different between pregnancy and postpartum, except for the anterior posterior sway tested in the eyes-closed condition, which was significantly increased in late pregnancy compared to that at 2 and 6 months postpartum. Pregnant/postpartum women's body mass weakly positively correlated with anterior-posterior sway in the eyes-closed condition and their stance width weakly positively correlated with the anterior-posterior sway in the eyes-open condition. No effect of sleep duration on postural sway was found. Our findings indicate that under visual deprivation conditions women in advanced pregnancy may have decreased static stability compared to their non-pregnant state.
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Affiliation(s)
- Agnieszka Opala-Berdzik
- Department of Physiotherapy in Internal Diseases, Academy of Physical Education, Katowice, Poland
| | - Janusz W. Błaszczyk
- Department of Human Motor Behavior, Academy of Physical Education, Katowice, Poland
- Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Bogdan Bacik
- Department of Human Motor Behavior, Academy of Physical Education, Katowice, Poland
| | - Joanna Cieślińska-Świder
- Department of Physiotherapy of the Nervous and Locomotor Systems, Academy of Physical Education, Katowice, Poland
| | - Dariusz Świder
- Institute of Computer Science, Silesian University of Technology, Gliwice, Poland
| | - Grzegorz Sobota
- Department of Human Motor Behavior, Academy of Physical Education, Katowice, Poland
| | - Andrzej Markiewicz
- Department of Physiotherapy in Internal Diseases, Academy of Physical Education, Katowice, Poland
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An Autopsy Case of a Pregnant Woman With Severe Placental and Fetal Damage From Domestic Violence. Am J Forensic Med Pathol 2015; 36:125-6. [PMID: 25946087 DOI: 10.1097/paf.0b013e318219c8bb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We present an autopsy case of a pregnant woman who was a victim of domestic violence. The deceased showed injuries mainly to her head and abdomen. Postmortem examination revealed 1400 mL of abdominal hemorrhage, ablation of the perimetrium, placental avulsion, and intracranial hematoma. The cause of death was diagnosed as hemorrhagic shock. The uterus contained a fetus of 7 months' gestational age. Fetal autopsy revealed laceration of the lungs, laceration and avulsion of the liver, and 15 mL of hemoperitoneum. Both placental and fetal injuries suggested repeated severe attacks to the abdomen, such as those expected to result from kicking or hitting.
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Opala-Berdzik A, Bacik B, Markiewicz A, Cieślińska-Świder J, Swider D, Sobota G, Błaszczyk JW. Comparison of static postural stability in exercising and non-exercising women during the perinatal period. Med Sci Monit 2014; 20:1865-70. [PMID: 25293983 PMCID: PMC4199463 DOI: 10.12659/msm.890846] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of the study was to determine whether women who exercised during and after pregnancy had better static postural stability compared to those who did not exercise. MATERIAL AND METHODS Posturographic tests were performed in 31 women at 34-39 weeks gestation, and again at 6-10 weeks postpartum. The center of pressure mean velocity (with directional subcomponents) and sway area were computed from 30-s quiet standing trials on a stationary force plate with eyes open or closed. The women were surveyed about their lifestyle and physical activity in the perinatal period. Based on the survey, 12 of the women were assigned as regular exercisers and 19 as non-exercisers. A Mann-Whitney U test was used to compare data of the exercisers and the non-exercisers in their advanced pregnancy and again at 2 months postpartum. RESULTS Postural sway measures were not significantly different between the exercisers and the non-exercisers in advanced pregnancy and at 2 months postpartum (p>0.05). CONCLUSIONS Individually performed physical activity during the perinatal period did not affect pregnant/postpartum women's postural stability characteristics of quiet standing.
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Affiliation(s)
- Agnieszka Opala-Berdzik
- Department of Physiotherapy in Internal Diseases, Academy of Physical Education, Katowice, Poland
| | - Bogdan Bacik
- Department of Human Motor Behavior, Academy of Physical Education, Katowice, Poland
| | - Andrzej Markiewicz
- Department of Physiotherapy in Internal Diseases, Academy of Physical Education, Katowice, Poland
| | - Joanna Cieślińska-Świder
- Department of Physiotherapy of the Nervous and Locomotor Systems, Academy of Physical Education, Katowice, Poland
| | - Dariusz Swider
- Institute of Computer Science, Silesian University of Technology, Gliwice, Poland
| | - Grzegorz Sobota
- Department of Human Motor Behavior, Academy of Physical Education, Katowice, Poland
| | - Janusz W Błaszczyk
- Department of Neurophysiology, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
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Does minor trauma in pregnancy affect perinatal outcome? Arch Gynecol Obstet 2014; 290:635-41. [DOI: 10.1007/s00404-014-3256-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 04/11/2014] [Indexed: 10/25/2022]
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Periyanayagam U, Crandall M. The cost of injury: hospital charges for pregnant trauma patients, 1999 to 2003. Am J Surg 2014; 208:130-5. [PMID: 24530040 DOI: 10.1016/j.amjsurg.2013.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 10/10/2013] [Accepted: 10/22/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Traumatic injuries during pregnancy are the leading cause of nonobstetric maternal mortality. We aimed to determine hospital charges for trauma activations during pregnancy. METHODS We used the Illinois State Trauma Registry data from 1999 to 2003. Using STATA for bivariate and regression analyses, we compared total hospital costs for women more than 24 weeks pregnant with nonpregnant women. RESULTS Six hundred thirty-five pregnant women (2.4% of 26,806 female trauma patients) were admitted during the study period. In multivariate regression, pregnancy was associated with lower hospital charges; however, for any given length of stay, pregnancy increased hospital charges (α = $17,864.80, P = .001). Pregnancy also independently predicted increased length of stay for similar injury severity. CONCLUSIONS When controlling for injury severity, pregnancy independently predicted an increased duration of hospitalization and hospital charges. These findings have important implications for resource allocation and care of trauma in pregnancy.
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Affiliation(s)
- Usha Periyanayagam
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, 676 North St Clair, Suite 650, Chicago, IL 60611, USA
| | - Marie Crandall
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North St Clair, Suite 650, Chicago, IL 60611, USA.
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