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Chang YH, Chien YW, Chang CH, Chen PL, Lu TH, Hsu IL, Li CY. Associations of maternal motor vehicle crashes during pregnancy with offspring's neonatal birth outcomes. Int J Epidemiol 2023; 52:1774-1782. [PMID: 37738433 DOI: 10.1093/ije/dyad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Adverse events in fetuses are well researched but studies on the follow-up health outcomes of infants exposed to maternal motor vehicle crashes (MVCs) during pregnancy have yielded inconsistent results. This study aimed to investigate the association of maternal exposure to MVCs during pregnancy with the risk of adverse neonatal outcomes. METHODS This population-based cohort study used data from birth notifications in Taiwan. A total of 19 277 offspring with maternal exposure to MVCs during pregnancy and 76 015 randomly selected comparison offspring without such exposure were selected. Neonatal adverse outcomes were identified from National Health Insurance medical claims data. Conditional logistic regression was used to estimate the unadjusted and adjusted odds ratios (aORs) of neonatal adverse outcomes. RESULTS Offspring exposed to maternal MVCs during pregnancy had a higher risk of birth defects (aOR, 1.21; 95% CI, 1.04-1.41) than offspring without such exposure. This positive association was sustained with exposure to an MVC during the first or second trimester. A dose-response relationship (P = 0.0023) was observed between the level of injury severity and the risk of birth defects. CONCLUSIONS In the early stages of pregnancy, maternal exposure to MVCs may entail a risk of birth defects in the offspring. The potential mechanisms for the associations of maternal exposure to MVCs with birth defects need further investigation.
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Affiliation(s)
- Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiung-Hsin Chang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Lin Hsu
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Aryan N, Grigorian A, Lucas AN, Tay-Lasso E, Zezoff DC, Fierro N, Dhillon NK, Ley EJ, Smith J, Dahan A, Johnson A, Ganske W, Biffl WL, Bayat D, Castelo M, Wintz D, Schaffer KB, Zheng DJ, Tillou A, Coimbra R, Santorelli JE, Schellenberg M, Inaba K, Emigh B, Duncan TK, Diaz G, Burruss S, Tuli R, Nahmias J. Outcomes for advanced aged (35 and older) versus younger aged pregnant trauma patients: A multicenter study. Am J Surg 2023; 226:798-802. [PMID: 37355376 DOI: 10.1016/j.amjsurg.2023.06.004] [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: 03/24/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Effects of advanced maternal age (AMA) pregnancies (defined as ≥35 years) on pregnant trauma patients (PTPs) are unknown. This study compared AMA versus younger PTPs, hypothesizing AMA PTPs have increased risk of fetal delivery (FD). METHODS A retrospective (2016-2021) multicenter study included all PTPs. Multivariable logistic regression was used to evaluate risk of FD after trauma. RESULTS A total of 950 PTPs were included. Both cohorts had similar gestational age and injury severity scores. The AMA group had increased injuries to the pancreas, bladder, and stomach (p < 0.05). There was no difference in rate or associated risk of FD between cohorts (5.3% vs. 11.4%; OR 0.59, CI 0.19-1.88, p > 0.05). CONCLUSION Compared to their younger counterparts, some intra-abdominal injuries (pancreas, bladder, and stomach) were more common among AMA PTPs. However, there was no difference in rate or associated risk of FD in AMA PTPs, thus they do not require increased observation.
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Affiliation(s)
- Negaar Aryan
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Alexa N Lucas
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Erika Tay-Lasso
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Danielle C Zezoff
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Nicole Fierro
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Navpreet K Dhillon
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Eric J Ley
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Jennifer Smith
- Division of Trauma and Critical Care, Harbor-UCLA Hospital, Torrance, CA, USA.
| | - Alden Dahan
- University of California, Riverside School of Medicine, Riverside, CA, USA.
| | - Arianne Johnson
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
| | - William Ganske
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
| | - Walter L Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
| | - Dunya Bayat
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
| | - Matthew Castelo
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA.
| | | | - Dennis J Zheng
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Areti Tillou
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, CA, USA.
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA, USA.
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
| | - Kenji Inaba
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
| | - Brent Emigh
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA; Warren Alpert Medical School at Brown University, Department of Surgery, Division of Trauma, USA.
| | - Thomas K Duncan
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA.
| | - Graal Diaz
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA.
| | - Sigrid Burruss
- Department of Trauma, Acute Care Surgery, Surgical Critical Care, Loma Linda Medical Center, Loma Linda, CA, USA.
| | - Rahul Tuli
- Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, University of California Riverside School of Medicine, CA, USA.
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
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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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Chang YH, Chien YW, Chang CH, Chen PL, Lu TH, Hsu IL, Li CY. Maternal outcomes in association with motor vehicle crashes during pregnancy: a nationwide population-based retrospective study. Inj Prev 2023; 29:166-172. [PMID: 36941051 DOI: 10.1136/ip-2022-044810] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/29/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Limited studies have assessed the association of motor vehicle crashes (MVCs) during pregnancy with adverse maternal outcomes using a population-based nationwide dataset that covers all MVCs. METHODS A total of 20 844 births from women who had been involved in MVCs during pregnancy were obtained from the National Birth Notification (BN) Database in Taiwan. We randomly selected 83 274 control births from women in the BN matched on age, gestational age and crash date. All study subjects were linked to medical claims and the Death Registry to identify the maternal outcomes after crashes. Conditional logistic regression models were used to estimate the adjusted odds ratio (aOR) and 95% CI of adverse outcomes associated with MVCs during pregnancy. RESULTS Pregnant women involved in MVCs had significantly higher risks of placental abruption (aOR=1.51, 95% CI 1.30 to 1.74), prolonged uterine contractions (aOR=1.31, 95% CI 1.11 to 1.53), antepartum haemorrhage (aOR=1.19, 95% CI 1.12 to 1.26) and caesarean delivery (aOR=1.05, 95% CI 1.02 to 1.09) than the controls. Such elevated risks tended to be higher in the MVCs with greater severity. Scooter riders had higher ORs of various adverse maternal outcomes than car drivers. CONCLUSIONS Women involved in MVCs during pregnancy were at increased risk of various adverse maternal outcomes, especially in those with severe MVCs and riding scooters at MVCs. These findings suggest that clinicians should be aware of these effects, and educational materials that include the above information should be provided as part of prenatal care.
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Affiliation(s)
- Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiung-Hsin Chang
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Lin Hsu
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Mulder MB, Quiroz HJ, Yang WJ, Lasko DS, Perez EA, Proctor KG, Sola JE, Thorson CM. The unborn fetus: The unrecognized victim of trauma during pregnancy. J Pediatr Surg 2020; 55:938-943. [PMID: 32061362 DOI: 10.1016/j.jpedsurg.2020.01.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Trauma is the leading cause of non-obstetric death in pregnancy. While maternal management is defined, few studies have examined the effects on the fetus. METHODS Following IRB approval, all pregnant females (2010-2017) at a level-1 trauma center were retrospectively reviewed. Maternal and fetal demographics, interventions, and clinical outcomes were analyzed. RESULTS There were 188 pregnancies in 5654 females. Maternal demographics were 26 ± 7 years old, gestational age at trauma 21 ± 12 weeks, 81% blunt mechanism, and maternal mortality 6%. Forty-one (22%) fetuses were immediately affected by the trauma including 20 (11%) born alive, 12 (7%) fetal demise, and 9 (5%) stillbirths. Of those that initially survived (n = 20), 5 (25%) expired during neonatal hospitalization. Two mothers returned immediately after trauma discharge with stillbirths for an overall infant mortality of 14% (n = 26). There were 84 patients with complete data to delivery including the 41 born at trauma and 43 born on a subsequent hospitalization. Those born at the time of trauma had significantly more delivery/neonatal complications and worse outcomes. Overall trauma burden to the fetus (preterm delivery, stillbirth, delivery/neonatal complication, or long-term disability) was 66% (56/84). CONCLUSIONS Trauma during pregnancy has significant immediate mortality and delayed effects on the unborn fetus. This study has uncovered a previously hidden burden and mortality of trauma during pregnancy. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Michelle B Mulder
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Hallie J Quiroz
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Wendy J Yang
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Davis S Lasko
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Eduardo A Perez
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Kenneth G Proctor
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Juan E Sola
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Chad M Thorson
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136.
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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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Harold JA, Isaacson E, Palatnik A. Femoral fracture in pregnancy: a case series and review of clinical management. Int J Womens Health 2019; 11:267-271. [PMID: 31114393 PMCID: PMC6497842 DOI: 10.2147/ijwh.s198345] [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: 12/30/2018] [Accepted: 03/16/2019] [Indexed: 11/23/2022] Open
Abstract
Femoral fractures in pregnancy are a rare complication, with an incidence of approximately 1%. Case reports and small trials leave perioperative obstetric management and route of delivery largely unclear. Three cases of femoral fracture are presented that occurred at 24, 30, and 31 weeks of gestation. The causes of femoral fracture were gunshot, motor vehicle collision, and fragility fracture. All fractures were surgically repaired, 1 utilizing neuraxial anesthesia and the others with general anesthesia. A 30-day postoperative course of low-molecular-weight heparin was prescribed, and all patients subsequently had vaginal deliveries. Femoral fractures in the viable pregnancy confer high maternal and fetal morbidity and mortality. Intraoperative fetal monitoring and postoperative anticoagulation should be considered, and vaginal delivery should not be contraindicated.
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Affiliation(s)
- Justin A Harold
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Erin Isaacson
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
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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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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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10
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Traumatic injuries to the pregnant patient: a critical literature review. Eur J Trauma Emerg Surg 2017; 45:383-392. [DOI: 10.1007/s00068-017-0839-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/12/2017] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE There is little medical knowledge about the risks of skydiving during pregnancy. Some national parachuting associations ask for a doctor's permission; others recommend not jumping at all during pregnancy. This article provides survey data and a literature review of pregnancy and parachuting/skydiving related issues to help the pregnant skydiver and her obstetrician make an informed decision. Survey data presented include pregnancy, delivery, and parachuting information from skydivers who jumped during pregnancy. DESIGN International retrospective anonymous online questionnaire considering the Checklist for Reporting Results of Internet E-Surveys (CHERRIE). The PubMed database was searched with using the terms "skydive," "pregnancy," and "parachute" (query April 2013). SETTING Web page questionnaire on skydivers' epidemiology, experience, and pregnancy-related information. PARTICIPANTS Fifty-seven parous female skydivers. ASSESSMENT OF RISK FACTORS Information on athletes' experience, weather conditions, obstetric history (gravida, gestational week), delivery mode was obtained. MAIN OUTCOME MEASURES Epidemiology of pregnant skydivers and literature review to provide information on skydiving risks. RESULTS Women do actively decide to skydive while pregnant. The majority of our participants were between 25-year-old and 35-year-old primips with 100 to 1000 jumps experience, answering the questionnaire from a European IP address. Precautions are taken in terms of weather conditions, gear, or sports partner. The literature review found no relevant literature regarding the question. Literature is searched for risk factors that come close to the ones in skydiving (ie, oxygen saturation, shock forces, and others). Further studies are needed to show the long-term effect of stress or low O2 saturation on antenatal programming, or short-term hypoxia and pregnancy outcome in pregnant skydiving women and their offspring. CONCLUSIONS Pregnancy itself is a risk factor for injuries. Injuries in pregnancy are clearly associated with an unfavorable pregnancy outcome. The recommendation "do not skydive during pregnancy" is the safest approach. A possible lesser risk alternative to skydiving could be wind-tunnel training. CLINICAL RELEVANCE This article provides insights into the pregnant skydiver's decision making regarding the sports. In combination with the literature review, we provide up-to-date easy to understand information on the possible risk factors. This is a valuable source of information for the care providers of female skydivers to understand and compare the risk factors of this sport. With this information, the professional recommendation and relationship are strengthened. This article also guides the need for further research. Possible research areas include pregnancy and sports-related risk factors, placentation and prenatal programming, physical and psychological factors associated with skydiving.
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Mendez-Figueroa H, Dahlke JD, Vrees RA, Rouse DJ. Trauma in pregnancy: an updated systematic review. Am J Obstet Gynecol 2013; 209:1-10. [PMID: 23333541 DOI: 10.1016/j.ajog.2013.01.021] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/10/2013] [Accepted: 01/14/2013] [Indexed: 11/24/2022]
Abstract
We reviewed recent data on the prevalence, risk factors, complications, and management of trauma during pregnancy. Using the terms "trauma" and "pregnancy" along with specified mechanisms of injury, we queried the PubMed database for studies reported from Jan. 1, 1990, through May 1, 2012. Studies with the largest number of patients for a given injury type and that were population-based and/or prospective were included. Case reports and case series were used only when more robust studies were lacking. A total of 1164 abstracts were reviewed and 225 met criteria for inclusion. Domestic violence/intimate partner violence and motor vehicle crashes are the predominant causes of reported trauma during pregnancy. Management of trauma during pregnancy is dictated by its severity and should be initially geared toward maternal stabilization. Minor trauma can often be safely evaluated with simple diagnostic modalities. Pregnancy should not lead to underdiagnosis or undertreatment of trauma due to unfounded fears of fetal effects. More studies are required to elucidate the safest and most cost-effective strategies for the management of trauma in pregnancy.
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Amorosa LF, Amorosa JH, Wellman DS, Lorich DG, Helfet DL. Management of pelvic injuries in pregnancy. Orthop Clin North Am 2013; 44:301-15, viii. [PMID: 23827834 DOI: 10.1016/j.ocl.2013.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pelvic fractures in pregnant women are usually high-energy injuries associated with risk of mortality to both mother and fetus. The mother's life always takes priority in the acute setting as it offers the best chance of survival to both the mother and the fetus. Indications for operative intervention of acute pubic symphysis rupture depend on presence of an open disruption, amount of displacement, and degree of disability. Chronic symphyseal instability related to pregnancy is a challenging problem and the first line of treatment is nonoperative care. A previous pelvic fracture is not a contraindication by itself to vaginal delivery.
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Affiliation(s)
- Louis F Amorosa
- Department of Orthopaedic Surgery, New York Medical College, 19 Bradhurst Ave, Suite 1300, Hawthorne, NY 10532, USA.
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14
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Virk J, Hsu P, Olsen J. Socio-demographic characteristics of women sustaining injuries during pregnancy: a study from the Danish National Birth Cohort. BMJ Open 2012; 2:bmjopen-2012-000826. [PMID: 22761281 PMCID: PMC3391365 DOI: 10.1136/bmjopen-2012-000826] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To describe adverse birth outcomes associated with hospital-treated injuries that took place among women in the Danish National Birth Cohort. DESIGN Longitudinal cohort study. SETTING Denmark. PARTICIPANTS 90 452 women and their offspring selected from the Danish National Birth Cohort. PRIMARY AND SECONDARY OUTCOME MEASURES To determine if injured women were more likely to deliver an infant preterm, with low birth weight, stillborn or have a spontaneous abortion, the authors estimated HRs. ORs were generated to assess APGAR scores and infants born small for gestational age (SGA). Models were adjusted for maternal smoking and drinking during pregnancy, household socioeconomic status, eclampsia/pre-eclampsia or gestational diabetes status during pregnancy and maternal age at birth; estimates for preterm birth were also adjusted for prior history of preterm birth. RESULTS In the cohort of 90 452 pregnant women, 3561 (3.9%) received medical treatment for an injury during pregnancy. Injured pregnant women were more likely to deliver infants that were stillborn or have pregnancies terminated by spontaneous abortion. The authors did not detect an adverse effect between injuries sustained during pregnancy and delivery of preterm, low birth weight or SGA infants, or infants with an APGAR score of <7. CONCLUSIONS The study shows that injuries occurring among women from an unselected population may not have an adverse effect on birth weight, gestational age, APGAR score or SGA status but may adversely affect the risk of stillbirth and spontaneous abortions in some situations.
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Affiliation(s)
- Jasveer Virk
- Department of Epidemiology, Southern California Injury Prevention Research Center, University of California Los Angeles (UCLA), Los Angeles, UK
| | - Paul Hsu
- Department of Epidemiology, Southern California Injury Prevention Research Center, University of California Los Angeles (UCLA), Los Angeles, UK
| | - Jørn Olsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Injury: A Major Cause of Pregnancy‐Associated Morbidity in Massachusetts. J Midwifery Womens Health 2010; 53:3-10. [PMID: 18164428 DOI: 10.1016/j.jmwh.2007.07.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Trauma complicates approximately 6-7% of all pregnancies and is associated with significant maternal and fetal morbidity and mortality. While the majority of trauma is minor, it is minor trauma that contributes to the majority of fetal mortality. Since virtually every organ system is affected anatomically and physiologically by pregnancy, it is important for healthcare providers who care for trauma victims to be aware of these changes. While assessment and resuscitation considers the existence of two patients, stabilization of the mother takes priority. Diagnostic and radiologic procedures should be used as indicated, with fetal exposure to radiation limited as much as possible. Management of the pregnant trauma victim requires a multidisciplinary approach in order to optimize outcome for mother and fetus. This review discusses the epidemiology, assessment and treatment of pregnant trauma patients and reviews areas where prevention efforts may be focused.
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Affiliation(s)
- Christina C Hill
- Department of Obstetrics & Gynecology, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859-5000, USA.
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18
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Bharathan R, Duckett J, Jain S. An unusual indication for caesarean section: lower limb fracture. J OBSTET GYNAECOL 2009; 28:648-9. [PMID: 19003670 DOI: 10.1080/01443610802378298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- R Bharathan
- Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Gillingham, UK
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20
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Abstract
The care of the pregnant trauma patient provides unique challenges and holds profound implications for both fetal and maternal outcomes. The management of these patients is influenced by unique anatomic and physiologic changes, increased concern for deleterious radiation and medication exposures, and the need for multidisciplinary care. This article reviews the critical features necessary in the assessment, diagnosis, treatment, and disposition of pregnant trauma patients with a focus on recent developments reported in the literature as pertinent to emergency management.
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Affiliation(s)
- Seric S Cusick
- Department of Emergency Medicine, UC Davis School of Medicine, PSSB, 4150 V Street, #2100, Sacramento, CA 95817, USA
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21
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Abstract
Traumatic injuries although uncommon (affect 6% to 7% of all pregnancies) are associated with poor maternal, fetal, neonatal, and infant outcomes. The magnitude of the problem is most likely largely underestimated secondary to lack of standardized reporting. Newer data are available that stratify maternal risk by type of injury sustained, and may assist in evaluation of the pregnant trauma victim. Long-term adverse events after maternal discharge for a traumatic injury are emerging, and suggest closer monitoring of the patient for preterm labor, growth restriction, and placental abruption during the affected pregnancy.
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Affiliation(s)
- Dina El Kady
- North Shore University Hospital, New York University, Manhasset, New York 11030, USA.
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