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Demetriou C, Eardley W, Rebeiz MC, Hing CB. National variation in guidance for the management of pregnant women presenting with major trauma. Ann R Coll Surg Engl 2024; 106:528-533. [PMID: 38563081 PMCID: PMC11214853 DOI: 10.1308/rcsann.2024.0011] [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] [Accepted: 01/20/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION The initial assessment of pregnant women presenting with significant injuries is more complicated than that of non-pregnant women because of physiological and anatomical changes, and the presence of the fetus. The aim of this study was to determine whether guidelines for the early management of severely injured pregnant women exist, which aspects of assessment/management they cover and to what extent there is national consistency. METHODS A freedom of information request was submitted to 125 acute National Health Service trusts in England and six in Wales. The trusts were asked to confirm whether they have a guideline for the management of major trauma in pregnant women presenting to the emergency department and what the guidelines were. RESULTS In total, 96.2% of trusts responded, of which 19% have a specific guideline and 7.9% have a generic guideline for assessing pregnant women in the emergency department, irrespective of injury severity. Of the responding trusts, 19.8% have a protocol that specifies when an obstetric trauma call should be put out by the emergency department and when a pregnant woman should be transferred to a major trauma centre for definitive management. Our results found that 69.8% routinely call obstetrics or gynaecology to the trauma call compared with 36.5% calling paediatrics. CONCLUSIONS The heterogeneity evident across trusts necessitates the establishment of national guidelines for the assessment of pregnant women with major trauma to standardise communication and delivery of care.
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Affiliation(s)
| | - W Eardley
- South Tees Hospitals NHS Foundation Trust, UK
| | - M-C Rebeiz
- St George’s University Hospitals NHS Foundation Trust, UK
| | - CB Hing
- St George’s University Hospitals NHS Foundation Trust, UK
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Qamar SR, Green CR, Ghandehari H, Holmes S, Hurley S, Khumalo Z, Mohammed MF, Ziesmann M, Jain V, Thavanathan R, Berger FH. CETARS/CAR Practice Guideline on Imaging the Pregnant Trauma Patient. Can Assoc Radiol J 2024:8465371241254966. [PMID: 38813997 DOI: 10.1177/08465371241254966] [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: 05/31/2024] Open
Abstract
Imaging of pregnant patients who sustained trauma often causes fear and confusion among patients, their families, and health care professionals regarding the potential for detrimental effects from radiation exposure to the fetus. Unnecessary delays or potentially harmful avoidance of the justified imaging studies may result from this understandable anxiety. This guideline was developed by the Canadian Emergency, Trauma and Acute Care Radiology Society (CETARS) and the Canadian Association of Radiologists (CAR) Working Group on Imaging the Pregnant Trauma Patient, informed by a literature review as well as multidisciplinary expert panel opinions and discussions. The working group included academic subspecialty radiologists, a trauma team leader, an emergency physician, and an obstetriciangynaecologist/maternal fetal medicine specialist, who were brought together to provide updated, evidence-based recommendations for the imaging of pregnant trauma patients, including patient safety aspects (eg, radiation and contrast concerns) and counselling, initial imaging in maternal trauma, specific considerations for the use of fluoroscopy, angiography, and magnetic resonance imaging. The guideline strives to achieve clarity and prevent added anxiety in an already stressful situation of injury to a pregnant patient, who should not be imaged differently.
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Affiliation(s)
- Sadia R Qamar
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Hournaz Ghandehari
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Signy Holmes
- Department of Radiology, University of Manitoba, Max Rady College of Medicine, Winnipeg, MB, Canada
| | - Sean Hurley
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Zonah Khumalo
- Department of Medical Imaging, McGill University Health Centre, Montreal Children's Hospital, Montreal, QC, Canada
| | - Mohammed F Mohammed
- Department of Radiology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Markus Ziesmann
- Department of Surgery, University of Manitoba, Max Rady College of Medicine, Winnipeg, MB, Canada
| | - Venu Jain
- Department of Obstetrics & Gynaecology, University of Alberta, Edmonton, AB, Canada
| | - Rajiv Thavanathan
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ferco H Berger
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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3
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Wallace ME, Stoecker C, Sauter S, Vilda D. States' Abortion Laws Associated With Intimate Partner Violence-Related Homicide Of Women And Girls In The US, 2014-20. Health Aff (Millwood) 2024; 43:682-690. [PMID: 38709960 DOI: 10.1377/hlthaff.2023.01098] [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: 05/08/2024]
Abstract
Women who are pregnant or recently gave birth are significantly more likely to be killed by an intimate partner than nonpregnant, nonpostpartum women of reproductive age, implicating the risk of fatal violence conferred by pregnancy itself. The rapidly increasing passage of state legislation has restricted or banned access to abortion care across the US. We used the most recent and only source of population-based data to examine the association between state laws that restrict access to abortion and trends in intimate partner violence-related homicide among women and girls ages 10-44 during the period 2014-20. Using robust difference-in-differences ecologic modeling, we found that enforcement of each additional Targeted Regulation of Abortion Providers (TRAP) law was associated with a 3.4 percent increase in the rate of intimate partner violence-related homicide in this population. We estimated that 24.3 intimate partner violence-related homicides of women and girls ages 10-44 were associated with TRAP laws implemented in the states and years included in this analysis. Assessment of policies that restrict access to abortion should consider their potential harm to reproductive-age women through the risk for violent death.
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Affiliation(s)
- Maeve E Wallace
- Maeve E. Wallace , Tulane University, New Orleans, Louisiana
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Skochko S, Nahmias J, Lekawa M, Kong A, Schubl S, Swentek L, Grigorian A. Blunt Abdominal Trauma in Pregnancy: Higher Rates of Severe Abdominal Injuries. Am Surg 2024:31348241248790. [PMID: 38676625 DOI: 10.1177/00031348241248790] [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: 04/29/2024]
Abstract
BACKGROUND Previous studies suggest increased abdominal girth in obese individuals provides a "cushion effect," against severe abdominal trauma. In comparison, the unique anatomic/physiological condition of pregnancy, such as the upward displacement of organs by an expanding uterus, may decrease risk of abdominal injury. However, increased overall blood volume and vascularity of organs during pregnancy raise concerns for increased bleeding and potentially more severe injuries. Therefore, this study aimed to elucidate whether the "cushion effect" observed in obese patients extends to pregnant trauma patients (PTPs). We hypothesized a lower risk of blunt solid organ injury (BSOI) (liver, spleen, and kidney) in pregnant vs non-pregnant blunt trauma patients. METHODS The 2020-2021 Trauma Quality Improvement Program was queried for all female blunt trauma patients (age<50 years) involved in motor vehicle collisions (MVCs). We compared pregnant vs non-pregnant patients. The primary outcomes were incidence of BSOI, and severity of abdominal trauma defined by abbreviated injury scale (AIS). RESULTS From 94,831 female patients, 2598 (2.7%) were pregnant. When compared to non-pregnant patients, PTPs had lower rates of liver (5.5% vs 7.6%, P < .001) and kidney (1.8% vs 2.6%, P = .013) injury. However, PTPs had higher rates of serious (13.4% vs 9.0%, P < .001) and severe abdominal injury (7.5% vs 4.3%, P < .001). DISCUSSION BSOI occurred at a lower rate in PTPs compared to non-PTPs; however, contrary to the "cushion effect" observed in obese populations, pregnant women had a higher rate of severe abdominal injuries. These data support comprehensive evaluations for PTPs presenting after a MVC. LEVEL OF EVIDENCE IV (therapeutic).
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Affiliation(s)
- Shannon Skochko
- Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Orange, CA, USA
| | - Jeffry Nahmias
- Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Orange, CA, USA
| | - Michael Lekawa
- Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Orange, CA, USA
| | - Allen Kong
- Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Orange, CA, USA
| | - Sebastian Schubl
- Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Orange, CA, USA
| | - Lourdes Swentek
- Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Orange, CA, USA
| | - Areg Grigorian
- Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Orange, CA, USA
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5
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Huibregtse ME, Wallace S, Ravi M, Karra S, McAfee EE, Hinojosa CA, Mekawi Y, Powers A, Michopoulos V, Lathan EC. The Relations Among Childhood Maltreatment and Later Intimate Partner Violence Victimization With and Without a Weapon in a Sample of Pregnant Black Individuals. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241245386. [PMID: 38622881 DOI: 10.1177/08862605241245386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Black pregnant and postpartum individuals are at risk for intimate partner violence (IPV), and those with a history of childhood maltreatment and IPV are even more likely to be re-victimized during pregnancy. However, it is unknown if specific types of child maltreatment predict later IPV with and without a weapon better than others. The current study sought to (i) document the prevalence of childhood maltreatment and IPV and (ii) examine the relations among types of childhood maltreatment and later IPV with and without a weapon within a sample of Black individuals seeking prenatal care at a large public hospital in the southeastern United States. Participants (n = 186; mean age = 27.2 years, SD = 5.3) completed measures assessing childhood maltreatment and IPV with and without a weapon. Approximately 68.5% of participants (n = 124) endorsed experiencing childhood maltreatment, while 42.6% (n = 78) endorsed experiencing IPV. The bivariate relations among five childhood maltreatment types (i.e., sexual, physical, and emotional abuse, physical and emotional neglect) and IPV with and without a weapon were assessed. All childhood maltreatment subtype scores-except childhood physical neglect-were significantly higher among participants who reported a history of IPV with or without a weapon compared to participants who denied a history of IPV with or without a weapon. Logistic regression models revealed childhood sexual abuse emerged as the only significant predictor of experiencing IPV with a weapon (B = 0.10, p = .003) and IPV without a weapon (B = 0.11, p = .001). For every point increase in childhood sexual abuse subtype score, the odds of experiencing IPV with and without a weapon increased by 10% (OR = 1.10, 95%CI [1.04, 1.18]) and 12% (OR = 1.12, [1.05, 1.20]), respectively. Findings suggest that screening for childhood sexual abuse may provide a critical opportunity for maternity care providers to identify individuals at increased risk for IPV victimization with and without a weapon.
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Affiliation(s)
| | | | - Meghna Ravi
- Emory University School of Medicine, Atlanta, GA, USA
| | - Sriya Karra
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | | | - Vasiliki Michopoulos
- Emory University School of Medicine, Atlanta, GA, USA
- Emory National Primate Research Center, Atlanta, GA, USA
| | - Emma C Lathan
- Emory University School of Medicine, Atlanta, GA, USA
- Auburn University, Auburn, AL, USA
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Awad KG, Nahmias J, Aryan N, 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, Grigorian A. Outcomes of severely injured pregnant trauma patients: a multicenter analysis. Updates Surg 2024:10.1007/s13304-024-01817-3. [PMID: 38554224 DOI: 10.1007/s13304-024-01817-3] [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: 12/18/2023] [Accepted: 03/04/2024] [Indexed: 04/01/2024]
Abstract
Nearly 10% of pregnant women suffer traumatic injury. Clinical outcomes for pregnant trauma patients (PTPs) with severe injuries have not been well studied. We sought to describe outcomes for PTPs presenting with severe injuries, hypothesizing that PTPs with severe injuries will have higher rates of complications and mortality compared to less injured PTPs. A post-hoc analysis of a multi-institutional retrospective study at 12 Level-I/II trauma centers was performed. Patients were stratified into severely injured (injury severity score [ISS] > 15) and not severely injured (ISS < 15) and compared with bivariate analyses. From 950 patients, 32 (3.4%) had severe injuries. Compared to non-severely injured PTPs, severely injured PTPs were of similar maternal age but had younger gestational age (21 vs 26 weeks, p = 0.009). Penetrating trauma was more common in the severely injured cohort (15.6% vs 1.4%, p < 0.001). The severely injured cohort more often underwent an operation (68.8% vs 3.8%, p < 0.001), including a hysterectomy (6.3% vs 0.3%, p < 0.001). The severely injured group had higher rates of complications (34.4% vs 0.9%, p < 0.001), mortality (15.6% vs 0.1%, p < 0.001), a higher rate of fetal delivery (37.5% vs. 6.0%, p < 0.001) and resuscitative hysterotomy (9.4% vs. 0%, p < 0.001). Only approximately 3% of PTPs were severely injured. However, severely injured PTPs had a nearly 40% rate of fetal delivery as well as increased complications and mortality. This included a resuscitative hysterotomy rate of nearly 10%. Significant vigilance must remain when caring for this population.
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Affiliation(s)
- Kyrillos G Awad
- Department of Surgery, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Negaar Aryan
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Alexa N Lucas
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, 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
| | - Sigrid Burruss
- Division of Trauma and Critical Care, Harbor-UCLA Hospital, Torrance, CA, USA
| | - Alden Dahan
- Department of Trauma, Acute Care Surgery, Surgical Critical Care, Loma Linda Medical Center, Loma Linda, 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, La Jolla, CA, USA
| | - Dunya Bayat
- Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Matthew Castelo
- Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, 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
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Moreno Valley, CA, USA
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Moreno Valley, CA, USA
| | - Rahul Tuli
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Moreno Valley, CA, USA
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, San Diego School of Medicine, University of California, San Diego, CA, USA
| | - Brent Emigh
- The Warren Alpert Medical School of Brown University, Providence, RI, 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
| | - 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
| | - Erika Tay-Lasso
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Danielle C Zezoff
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Areg Grigorian
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA.
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MacDermott R, Berger FH, Phillips A, Robins JA, O’Keeffe ME, Mughli RA, MacLean DB, Liu G, Heipel H, Nathens AB, Qamar SR. Initial Imaging of Pregnant Patients in the Trauma Bay-Discussion and Review of Presentations at a Level-1 Trauma Centre. Diagnostics (Basel) 2024; 14:276. [PMID: 38337792 PMCID: PMC10855036 DOI: 10.3390/diagnostics14030276] [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: 12/12/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Trauma is the leading non-obstetric cause of maternal and fetal mortality and affects an estimated 5-7% of all pregnancies. Pregnant women, thankfully, are a small subset of patients presenting in the trauma bay, but they do have distinctive physiologic and anatomic changes. These increase the risk of certain traumatic injuries, and the gravid uterus can both be the primary site of injury and mask other injuries. The primary focus of the initial management of the pregnant trauma patient should be that of maternal stabilization and treatment since it directly affects the fetal outcome. Diagnostic imaging plays a pivotal role in initial traumatic injury assessment and should not deviate from normal routine in the pregnant patient. Radiographs and focused assessment with sonography in the trauma bay will direct the use of contrast-enhanced computed tomography (CT), which remains the cornerstone to evaluate the potential presence of further management-altering injuries. A thorough understanding of its risks and benefits is paramount, especially in the pregnant patient. However, like any other trauma patient, if evaluation for injury with CT is indicated, it should not be denied to a pregnant trauma patient due to fear of radiation exposure.
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Affiliation(s)
- Roisin MacDermott
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (R.M.); (F.H.B.); (J.A.R.); (M.E.O.); (R.A.M.)
| | - Ferco H. Berger
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (R.M.); (F.H.B.); (J.A.R.); (M.E.O.); (R.A.M.)
| | - Andrea Phillips
- Tory Trauma Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Jason A. Robins
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (R.M.); (F.H.B.); (J.A.R.); (M.E.O.); (R.A.M.)
| | - Michael E. O’Keeffe
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (R.M.); (F.H.B.); (J.A.R.); (M.E.O.); (R.A.M.)
| | - Rawan Abu Mughli
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (R.M.); (F.H.B.); (J.A.R.); (M.E.O.); (R.A.M.)
| | - David B. MacLean
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Grace Liu
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Heather Heipel
- Department of Medicine (Emergency Medicine), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Avery B. Nathens
- Tory Trauma Program, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Sadia Raheez Qamar
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (R.M.); (F.H.B.); (J.A.R.); (M.E.O.); (R.A.M.)
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8
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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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9
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Smith EJ, Bailey BA, Cascio A. Sexual Coercion, Intimate Partner Violence, and Homicide: A Scoping Literature Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:341-353. [PMID: 36722380 DOI: 10.1177/15248380221150474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The specific relationship between sexual coercion, intimate partner violence (IPV) during pregnancy, and intimate partner homicide (IPH) is poorly understood. Through a scoping literature review, we identified 101 studies on sexual coercion, IPV during pregnancy, and IPH and created a conceptual model suggesting unintended pregnancies may serve as both a risk factor for and a product of IPV that may escalate to IPH. We illustrate a healthcare systems intervention implication of this model in the context of the Colorado Family Planning Initiative (CFPI). Descriptive statistics suggest an inverse association between contraception access and IPH, which declined by 62% during the first 4 years of the CFPI. Interventions aimed at improving reproductive agency, including improving contraception access and reducing unintended pregnancy, may be a useful opportunity for clinician and health systems to contribute to reducing both lethal and nonlethal IPV.
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Affiliation(s)
- Emily Joan Smith
- Central Michigan University College of Medicine, Mount Pleasant, USA
| | - Beth A Bailey
- Central Michigan University College of Medicine, Mount Pleasant, USA
| | - Ariel Cascio
- Central Michigan University College of Medicine, Mount Pleasant, USA
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Chang YH, Chien YW, Chang CH, Chen PL, Lu TH, Li CY. Pregnancy is associated with more severe injuries from motor vehicle crashes. J Formos Med Assoc 2023:S0929-6646(23)00489-8. [PMID: 38129265 DOI: 10.1016/j.jfma.2023.12.009] [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: 08/31/2023] [Revised: 11/21/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Whether pregnancy is associated with severe injuries from motor vehicle crashes (MVCs) remains unclear. This study aimed to investigate the potential relationship between pregnancy and severity of injuries from MVCs. METHODS We identified a total of 23,559 pregnant women victims who encountered MVCs during pregnancy as well as 94,236 age- and calendar year-at MVC matched non-pregnant women victims that are also involved in MVCs. Injury severity was assessed using the Maximum Abbreviated Injury Scale (MAIS) based on the diagnosis of medical claims after MVCs. Multinomial logistic regression models were used to estimate the odds ratio and corresponding 95 % CI of injury severity levels associated with pregnancy. RESULTS Pregnant women had a significantly higher risk of both severe (adjusted odds ratio, aOR = 1.79, 95 % CI = 1.54-2.08) and mild injuries (aOR = 8.63, 95 % CI = 8.21-9.07) following MVCs as compared to non-pregnant women victims. Particularly, pregnant women who were riding scooters had an increased risk of severe injury (aOR = 4.25, 95 % CI = 3.58-5.04). In addition, pregnant women who experienced MVC but without any injury were more likely to visit a clinic than non-pregnant MVC victims. CONCLUSION Pregnant women victims, particularly those who were riding scooters involved in MVCs suffered from a higher risk of severe injury as compared to their non-pregnant counterparts. Our findings suggest that women should consider avoiding riding a scooter and must use restrictive devices during pregnancy, which would help reduce the severity of injuries sustained following an MVC.
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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, United States
| | - 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
| | - 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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11
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Maganha CA, Ribeiro MAF, Mattar R, Godinho M, Souza RT, Ferreira EC, Solha STG, Grossi FS, Godinho LMDO. Trauma and pregnancy. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:622-632. [PMID: 38057286 PMCID: PMC10700145 DOI: 10.1055/s-0043-1777339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Affiliation(s)
| | - Marcelo Augusto Fontenelle Ribeiro
- University and Gulf Medical University, Division Chair of Trauma, Burns, Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City, Mayo Clinic Abu Dhabi, United Arab Emirates
| | - Rosiane Mattar
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Mauricio Godinho
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | | | | | - Larissa Mariz de Oliveira Godinho
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, da Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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12
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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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Abu-Zidan FM, Eid HO, Alao DO, Elbiss H. The changing epidemiology of trauma in child-bearing age women. World J Emerg Surg 2023; 18:25. [PMID: 36991466 DOI: 10.1186/s13017-023-00495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND In the last two decades, there have been major improvements in the trauma system in the United Arab Emirates (UAE). We aimed to study the changes in the incidence, type, severity, and outcome of trauma of hospitalized child-bearing age women in Al-Ain City, UAE, during that time. METHODS Data from two separate trauma registries of Al-Ain Hospital, which were prospectively collected from March 2003 to March 2006 and January 2014 to December 2017, were analyzed retrospectively. All women aged 15-49 years were studied. The two periods were compared. RESULTS Trauma incidence of hospitalized child-bearing age women was reduced by 47% during the second period. There were no significant differences in the mechanism of injury between the two periods. Road traffic collision was the main cause of injury (44% and 42%, respectively) followed by fall down (26.1% and 30.8%, respectively). The location of injury was significantly different (p = 0.018), with a strong trend of more home injuries in the second period (52.8% compared with 44%, p = 0.06). There was a strong statistical trend of mild traumatic brain injury (GCS 13-15) in the second period (p = 0.067, Fisher's Exact test). Those who had normal GCS of 15 were significantly higher in the second period compared with those in the first period (95.3% compared with 86.4%, p < 0.001, Fisher's Exact test) despite having more anatomical injury severity of the head (AIS 2 (1-5) compared with 1 (1-5), p = 0.025). The NISS was significantly higher in the second period (median (range) NISS 5 (1-45) compared with 4 (1-75), p = 0.02). Despite that, mortality was the same (1.6% compared with 1.7%, p = 0.99) while the length of hospital stay was significantly less (mean (SD) 5.6 (6.3) days compared with 10.6 (13.6) days, p < 0.0001). CONCLUSIONS The incidence of trauma in hospitalized child-bearing-age women was reduced by 47% over the last 15 years. Road traffic collisions and falls are the leading cause of injury in our setting. Home injuries increased over time. The mortality remained stable despite the increased severity of injured patients. More injury prevention efforts should target home injuries.
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Affiliation(s)
- Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
| | - Hani O Eid
- Rescue and Air Ambulance, Abu Dhabi Police Aviation, Abu Dhabi, United Arab Emirates
| | - David O Alao
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- Emergency Department,, Tawam Hospital, Al-Ain, United Arab Emirates
| | - Hassan Elbiss
- The Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
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15
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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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16
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Odedra D, Mellnick VM, Patlas MN. Imaging of Trauma in Pregnancy. Radiol Clin North Am 2023; 61:129-139. [DOI: 10.1016/j.rcl.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Intimate Partner Violence and Pregnancy: Nationwide Analysis of Injury Patterns and Risk Factors. J Am Coll Surg 2023; 236:198-207. [PMID: 36519917 DOI: 10.1097/xcs.0000000000000421] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) is a significant cause of injury, and in pregnant patients (PIPV) poses a risk to both mother and fetus. Characteristics and outcomes for PIPV patients have not been well described. We hypothesize that PIPV patients have higher admission rates and mortality than non-IPV pregnant trauma (PT) patients and nonpregnant female IPV patients of childbearing age. We also hypothesize differences exist between PIPV and PT patient injury patterns, allowing for targeted IPV screening. STUDY DESIGN The Nationwide Emergency Department Sample database was queried from 2010 to 2014 to identify IPV in adult women patients by injury code E967.3. Patients were compared in 2 ways, PIPV vs PT and PIPV vs nonpregnant female IPV patients. Demographics, injury mechanisms, and National Trauma Data Standard injury diagnoses were surveyed. Primary outcomes were hospital admissions and mortality. Logistic regression was used to estimate risk factors of the outcomes of hospitalization and IPV victimization in pregnant injured patients. RESULTS There were 556 PIPV patients, 73,970 PT patients, and 56,543 nonpregnant female IPV patients. When comparing PIPV to PT, more PIPV patients had Medicaid coverage or were self-pay. Suffocation, head injuries, face/neck/scalp contusions, multiple contusions, and abrasions/friction burns were more prevalent in PIPV patients. Mortality and hospital admissions were scarce among all cohorts. Predictors of IPV victimization among injured pregnant patients include multiple injuries, head injuries, face/neck/scalp contusions, abrasions/friction burns, contusions of multiple sites, and those with Medicaid or self-pay coverage. CONCLUSIONS Among injured pregnant patients, those with multiple injuries, head injuries, contusions of the face/neck/scalp, abrasions/friction burns, and multiple contusions should undergo IPV screening. Admissions and mortality are low; therefore, prevention measures should be implemented in the emergency department to reduce repeat victimization.
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Epidemiology and outcomes of pregnant trauma patients in Japan: a nationwide descriptive study. Eur J Trauma Emerg Surg 2022; 49:1287-1293. [DOI: 10.1007/s00068-022-02165-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022]
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Risk of Mortality in Association with Pregnancy in Women Following Motor Vehicle Crashes: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020911. [PMID: 35055738 PMCID: PMC8775890 DOI: 10.3390/ijerph19020911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 02/04/2023]
Abstract
The aim of the study was to provide a systematic review and meta-analysis of studies examining the association between mortality risk and motor vehicle crashes (MVCs) in pregnant women compared with nonpregnant women. We used relevant MeSH terms to identify epidemiological studies of mortality risk in relation to MVCs from PubMed, Embase, and MEDLINE databases. The Newcastle–Ottawa Scale (NOS) was used for quality assessment. For comparison of mortality from MVCs between pregnant and nonpregnant women, the pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effects model. The eight studies selected met all inclusion criteria. These studies included 14,120 injured victims who were pregnant at the time of the incident and 207,935 victims who were not pregnant. Compared with nonpregnant women, pregnant women had a moderate but insignificant decrease in mortality risk (pooled OR = 0.68, 95% CI = 0.38–1.22, I2 = 88.71%). Subgroup analysis revealed that the pooled OR significantly increased at 1.64 (95% CI = 1.16–2.33, I2 < 0.01%) for two studies with a similar difference in the mean injury severity score (ISS) between pregnant and nonpregnant women. Future studies should further explore the risk factors associated with MVCs in pregnant women to reduce maternal mortality.
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Wallace M, Gillispie-Bell V, Cruz K, Davis K, Vilda D. Homicide During Pregnancy and the Postpartum Period in the United States, 2018-2019. Obstet Gynecol 2021; 138:762-769. [PMID: 34619735 PMCID: PMC9134264 DOI: 10.1097/aog.0000000000004567] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the national pregnancy-associated homicide mortality ratio, characterize pregnancy-associated homicide victims, and compare the risk of homicide in the perinatal period (pregnancy and up to 1 year postpartum) with risk among nonpregnant, nonpostpartum females aged 10-44 years. METHODS Data from the National Center for Health Statistics 2018 and 2019 mortality files were used to identify all female decedents aged 10-44 in the United States. These data were used to estimate 2-year pregnancy-associated homicide mortality ratios (deaths/100,000 live births) for comparison with homicide mortality among nonpregnant, nonpostpartum females (deaths/100,000 population) and to mortality ratios for direct maternal causes of death. We compared characteristics and estimated homicide mortality rate ratios and 95% CIs between pregnant or postpartum and nonpregnant, nonpostpartum victims for the total population and with stratification by race and ethnicity and age. RESULTS There were 3.62 homicides per 100,000 live births among females who were pregnant or within 1 year postpartum, 16% higher than homicide prevalence among nonpregnant and nonpostpartum females of reproductive age (3.12 deaths/100,000 population, P<.05). Homicide during pregnancy or within 42 days of the end of pregnancy exceeded all the leading causes of maternal mortality by more than twofold. Pregnancy was associated with a significantly elevated homicide risk in the Black population and among girls and younger women (age 10-24 years) across racial and ethnic subgroups. CONCLUSION Homicide is a leading cause of death during pregnancy and the postpartum period in the United States. Pregnancy and the postpartum period are times of elevated risk for homicide among all females of reproductive age.
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Affiliation(s)
- Maeve Wallace
- Mary Amelia Center for Women's Health Equity Research, Department of Social, Behavioral, and Population Science, Tulane University School of Public Health and Tropical Medicine, the Department of Obstetrics and Gynecology, Ochsner Baptist Medical Center, and the National Birth Equity Collaborative, New Orleans, Louisiana
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Rodríguez-Soto NC, Buxó CJ, Morou-Bermudez E, Pérez-Edgar K, Ocasio-Quiñones IT, Surillo-González MB, Martinez KG. The impact of prenatal maternal stress due to potentially traumatic events on child temperament: A systematic review. Dev Psychobiol 2021; 63:e22195. [PMID: 34674245 PMCID: PMC8549868 DOI: 10.1002/dev.22195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 07/21/2021] [Accepted: 08/18/2021] [Indexed: 12/11/2022]
Abstract
The objective of the current study was to complete a systematic review of the relationship between prenatal maternal stress due to potentially traumatic events (PTEs) and child temperament. Eligible studies through June 2020 were identified utilizing a search strategy in PubMed and PsycInfo. Included studies examined associations between prenatal maternal stress due to PTE and child temperament. Two independent coders extracted study characteristics and three coders assessed study quality. Of the 1969 identified studies, 20 met full inclusion criteria. Studies were classified on two dimensions: (1) disaster-related stress and (2) intimate partner violence during pregnancy. For disaster-related prenatal maternal stress, 75% (nine out of 12) of published reports found associations with increased child negative affectivity, 50% (five out of 10) also noted associations with lower effortful control/regulation, and 38% (three out of eight) found associations with lower positive affectivity. When considering prenatal intimate partner violence stress, 80% (four out of five) of published reports found associations with higher child negative affectivity, 67% (four out of six) found associations with lower effortful control/regulation, and 33% (one out of three) found associations with lower positive affectivity. Prenatal maternal stress due to PTEs may impact the offspring's temperament, especially negative affectivity. Mitigating the effects of maternal stress in pregnancy is needed in order to prevent adverse outcomes on the infant's socioemotional development.
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Affiliation(s)
- Nayra C. Rodríguez-Soto
- University of Puerto Rico, Medical Sciences Campus, San Juan, PR
- Carlos Albizu University, San Juan, PR
| | - Carmen J. Buxó
- University of Puerto Rico, Medical Sciences Campus, San Juan, PR
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22
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Comparison of Motor Vehicle Collision Injuries between Pregnant and Non-Pregnant Women: A Nationwide Collision Data-Based Study. Healthcare (Basel) 2021; 9:healthcare9111414. [PMID: 34828464 PMCID: PMC8625431 DOI: 10.3390/healthcare9111414] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
We compared the independent predictive factors for moderate and severe injuries, along with characteristics and outcomes of motor vehicle collisions, between pregnant and non-pregnant women. Using 2001–2015 records from the National Automotive Sampling System/Crashworthiness Data System, we selected 736 pregnant women and 21,874 non-pregnant women having any anatomical injuries. Pregnant women showed less severe collisions, fewer fatalities, and less severe injuries in most body regions than non-pregnant women. In pregnant women, the rate of sustaining abbreviated injury scale (AIS) scores 2+ injuries was higher for the abdomen only. For non-pregnant women, rear seat position, airbag deployment, multiple collisions, rollover, force from the left, and higher collision velocity had a positive influence on the likelihood of AIS 2+ injuries, and seatbelt use and force from the rear had a negative influence. There is a need for further development of passive safety technologies for restraint and active safety features to slow down vehicles and mitigate collisions. The influencing factors identified may be improved by safety education. Therefore, simple and effective interventions by health professionals are required that are tailored to pregnant women.
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Kong F, Wang A, Su J, He J, Xie D, Xiong L, Sheng X, Liu Z. Accidental death during pregnancy and puerperium from 2009 to 2019 in Hunan, China: a cross-sectional study. BMJ Open 2021; 11:e047660. [PMID: 34593489 PMCID: PMC8487173 DOI: 10.1136/bmjopen-2020-047660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Few studies have analysed accidental maternal deaths. This study analysed the basic situation and classification of maternal accidental deaths and compared the differences between urban and rural areas. DESIGN A cross-sectional study on accidental deaths during pregnancy and puerperium from 2009 to 2019 in Hunan Province. SETTING Hunan Province, with a population of 74 million, has an area of 210 000 km2 and 123 counties/districts. PARTICIPANTS A collection of 239 cases of accidental death during pregnancy and puerperium in Hunan Province from 2009 to 2019, including 181 cases of rural pregnancy and puerperium and 58 cases of urban pregnancy and puerperium. MAIN OUTCOME MEASURE Classification of accidental mortality of pregnant women. RESULTS A total of 239 accidental deaths occurred in Hunan Province, with an accidental mortality rate of 2.8 per 100 000 live births. The accidental mortality rate in rural areas (3.2 per 100 000 live births) was higher than in urban areas (2.0 per 100 000 live births). The proportion of accidental deaths among pregnancy-related deaths showed an upward trend. The main types of accidental deaths were suicide (1.0 per 100 000 live births), traffic accidents (0.8 per 100 000 live births), accidental poisoning/overdose and assault/homicide (0.2 per 100 000 live births), and other accidents (0.6 per 100 000 live births). Maternal accidental deaths were mainly concentrated in low-income families, in rural areas and in those with low level of education. 74.5% of accidental deaths occurred before childbirth. 49.2% of pregnant women gave birth by caesarean section. CONCLUSION In response to the different causes of accidental maternal death, public health programmes and policy interventions should pay special attention to maternal suicide and traffic injuries.
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Affiliation(s)
- Fanjuan Kong
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Aihua Wang
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Jinping Su
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Jian He
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Donghua Xie
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Lili Xiong
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Xiaoqi Sheng
- Psychology Department, Hunan Province, Changsha, Hunan, China
| | - Zhiyu Liu
- Information Management Section, Hunan Province, Changsha, Hunan, China
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Wallace ME, Vilda D, Theall KP, Stoecker C. Firearm Relinquishment Laws Associated With Substantial Reduction In Homicide Of Pregnant And Postpartum Women. Health Aff (Millwood) 2021; 40:1654-1662. [PMID: 34550804 DOI: 10.1377/hlthaff.2021.01129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Homicide is a leading cause of death among women who are pregnant and up to one year postpartum in the United States. Most incidents are perpetrated by an intimate partner with a firearm. Some states have implemented laws that prohibit firearm possession by perpetrators of domestic violence and, in some instances, include explicit statutory language mandating relinquishment of firearms once a person has become prohibited from possessing them. We examined the impact of these policies on state-level rates of homicide among pregnant and postpartum women during the period 2011-19. We found that state laws prohibiting possession of firearms and requiring relinquishment of firearms by people convicted of domestic violence-related misdemeanors were associated with substantial reductions in homicide of pregnant and postpartum women. State policy makers should consider further strengthening domestic violence-related firearm regulations and their enforcement to prevent homicide of pregnant and postpartum women.
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Affiliation(s)
- Maeve E Wallace
- Maeve E. Wallace is an assistant professor in the Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, in New Orleans, Louisiana
| | - Dovile Vilda
- Dovile Vilda is a research assistant professor in the Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine
| | - Katherine P Theall
- Katherine P. Theall is a professor in the Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine
| | - Charles Stoecker
- Charles Stoecker is an associate professor in the Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
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Neuro-anesthesiology in pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2021. [PMID: 32736750 DOI: 10.1016/b978-0-444-64239-4.00010-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Management of the pregnant patient requiring neurosurgery poses multiple challenges, juxtaposing pregnancy-specific considerations with that accompanying the safe provision of intracranial or spine surgery. There are no specific evidence-based recommendations, and case-by-case interdisciplinary discussions will guide informed decision-making about the timing of delivery vis-à-vis neurosurgery, the performance of cesarean delivery immediately before neurosurgery, consequences of neurosurgery on subsequent delivery, or even the optimal anesthetic modality for neurosurgery and/or cesarean delivery. In general, identifying whether increased intracranial pressure poses a risk for herniation is crucial before allowing neuraxial procedures. Modified rapid sequence induction with advanced airway approaches (videolaryngoscopic or fiberoptic) allows improved airway manipulation with reduced risks associated with endotracheal intubation of the obstetric airway. Currently, very few anesthetic drugs are avoided in the neurosurgical pregnant patient; however, ensuring access to critical care units for prolonged monitoring and assistance of the respiratory-compromised patient is necessary to ensure safe outcomes.
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Abstract
One of the most common causes of obstetric morbidity and mortality is trauma in pregnancy. Several maternal physiological changes during pregnancy have a significant impact on the mechanism, presentation, and management of trauma in this population. It is crucial for health providers dealing with trauma to know and understand these differences between pregnant and nonpregnant patients. The obstetric trauma patient requires a multidisciplinary approach, including obstetrics, maternal fetal medicine, anesthesiology, surgery, and intensive care teams. The aim of this article is to review the most updated information on trauma during pregnancy.
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Sato N, Cameron P, Thomson BN, Read D, McLellan S, Woodward A, Beck B. Epidemiology of pregnant patients with major trauma in Victoria. Emerg Med Australas 2021; 34:24-28. [PMID: 34164928 DOI: 10.1111/1742-6723.13816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/15/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Trauma is one of the most common contributors to maternal and foetal morbidity and mortality. The aim of the present study was to describe the characteristics and outcomes of major trauma in pregnant patients using a population-based registry. METHODS Registry-based study using data from the Victorian State Trauma Registry (VSTR), a population-based database of all hospitalised major trauma (death due to injury, Injury Severity Score [ISS] ≥12, admission to an intensive care unit [ICU] for more than 24 h and requiring mechanical ventilation for at least part of their ICU stay or urgent surgery) in Victoria, Australia, from 1 July 2007 to 30 June 2019. Pregnant patients with major trauma were identified on the VSTR. We summarised patient data using descriptive statistics. RESULTS Over the 12-year study period, there were 63 pregnant major trauma patients. Fifty-two (82.5%) patients sustained injuries resulting from road transport collisions. The maternal survival rate was 98.4% and the foetal survival rate was 88.9%. Thoracic injury was the most common injury (25/63), followed by abdominal injury (23/63). Eighty-six percent of the third trimester patients (19/22) were transported directly to a major trauma service with capacity for definitive care of the pregnancy. CONCLUSION The present study demonstrated road transport injury was the most common mechanism of injury and both maternal survival rates and foetal survival rates were high. This information is essential for trauma care system planning and public health initiatives to improve the clinical management and outcomes of pregnant women with major trauma.
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Affiliation(s)
- Nobuhiro Sato
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Benjamin Nj Thomson
- Trauma Services, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Read
- Department of General Surgical Specialties, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Susan McLellan
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Anthony Woodward
- Birth Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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Hansen A, Quesinberry D, Akpunonu P, Martin J, Slavova S. Validation of ICD-10-CM codes for injuries complicating pregnancy, childbirth and the puerperium: a medical record review. Inj Prev 2021; 27:i9-i12. [PMID: 33674327 PMCID: PMC7948181 DOI: 10.1136/injuryprev-2019-043512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 09/09/2020] [Accepted: 09/26/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The purpose of this study was to estimate the positive predictive value (PPV) of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for injury, poisoning, physical or sexual assault complicating pregnancy, childbirth and the puerperium (PCP) to capture injury encounters within both hospital and emergency department claims data. METHODS A medical record review was conducted on a sample (n=157) of inpatient and emergency department claims from one Kentucky healthcare system from 2015 to 2017, with any diagnosis in the ICD-10-CM range O9A.2-O9A.4. Study clinicians reviewed medical records for the sampled cases and used an abstraction form to collect information on documented presence of injury and PCP complications. The study estimated the PPVs and the 95% CIs of O9A.2-O9A.4 codes for (1) capturing injuries and (2) capturing injuries complicating PCP. RESULTS The estimated PPV for the codes O9A.2-O9A.4 to identify injury in the full sample was 79.6% (95% CI 73.3% to 85.9%) and the PPV for capturing injuries complicating PCP was 72.0% (95% CI 65.0% to 79.0%). The estimated PPV for an inpatient principal diagnosis O9A.2-O9A.4 to capture injuries was 90.7% (95% CI 82.0% to 99.4%) and the PPV for capturing injuries complicating PCP was 88.4% (95% CI 78.4% to 98.4%). The estimated PPV for any mention of O9A.2-O9A.4 in emergency department data to capture injuries was 95.2% (95% CI 90.6% to 99.9%) and the PPV for capturing injuries complicating PCP was 81.0% (95% CI 72.4% to 89.5%). DISCUSSION The O9A.2-O9A.4 codes captured high percentage true injury cases among pregnant and puerperal women.
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Affiliation(s)
- Anna Hansen
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA.,Sociology, University of Kentucky, Lexington, Kentucky, USA.,College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA.,Health Management & Policy, University of Kentucky, Lexington, Kentucky, USA
| | - Peter Akpunonu
- Department of Emergency Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Julia Martin
- Department of Emergency Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Svetla Slavova
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA .,Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
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Irving T, Menon R, Ciantar E. Trauma during pregnancy. BJA Educ 2021; 21:10-19. [PMID: 33456969 PMCID: PMC7808026 DOI: 10.1016/j.bjae.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- T. Irving
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - R. Menon
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E. Ciantar
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Abstract
BACKGROUND Trauma is the leading cause for nonpregnancy-linked maternal mortality in pregnant women, even though the exact incidence for accidents in pregnancy is unknown. Trauma management concepts applied for nonpregnant adult patients are just as valid for injured and severely injured pregnant women but in addition trauma management has to consider the unique physiological and pathophysiological conditions for a favorable maternal and fetal outcome. OBJECTIVE Overview of current data about the epidemiology, injury mechanisms, maternal and fetal outcome and recommendations on the management of injured pregnant women based on a systematic literature search. RESULTS Currently, there is no evidence indicating an association between maternal injury severity, the physiological condition and the fetal outcome. Practice guidelines for trauma management in pregnancy recommend prioritization of maternal treatment and resuscitation for optimal initial treatment of the fetus. The current recommendations for trauma room management in pregnancy, surgical treatment, including damage control surgery, are based on weak evidence. CONCLUSION The examination, stabilization and treatment of injured pregnant women has priority for fetal survival and outcome. The management of severe trauma in pregnancy requires a multidisciplinary expertise and team approach consisting of surgeons, anesthetists, radiologists, obstetricians and neonatologists, so that for a severely injured gravida, the decision for admission to designated trauma centers is already preclinically made. The principles of management and treatment of severely injured pregnant women should adhere to the treatment principles of nonpregnant trauma victims.
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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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Education for appropriate seatbelt use required for early-phase pregnant women drivers. Sci Rep 2020; 10:17609. [PMID: 33077889 PMCID: PMC7572508 DOI: 10.1038/s41598-020-74730-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 10/06/2020] [Indexed: 11/08/2022] Open
Abstract
Considerable numbers of pregnant women do not understand the correct way to use seatbelts; thus, they are inappropriately restrained when wearing seatbelts. To improve appropriate seatbelt wearing by pregnant women vehicle passengers, we examined their use by pregnant women drivers and the independent factors influencing appropriate use. We undertook a cross-sectional survey of 1,000 pregnant women in Shiga Prefecture, Japan. Among 774 returned questionnaires, we analysed those of 680 pregnant women who always wore a seatbelt. The mean participant age was 31.4 ± 5.0 years and mean gestational age 26.2 ± 8.2 weeks; 97.7% of subjects always wore a seatbelt; 86.9% wore a seatbelt correctly and 13.1% incorrectly. Multivariate analysis indicated that receiving information about correct seatbelt use (odds ratio, 2.25; P < 0.005) and gestational age (odds ratio, 1.06; P < 0.001) were significant independent factors for correct seatbelt use. Providing information about correct seatbelt use during the early term is required for pregnant women to protect both the mother and fetus.
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Amezcua-Prieto C, Ross J, Rogozińska E, Mighiu P, Martínez-Ruiz V, Brohi K, Bueno-Cavanillas A, Khan KS, Thangaratinam S. Maternal trauma due to motor vehicle crashes and pregnancy outcomes: a systematic review and meta-analysis. BMJ Open 2020; 10:e035562. [PMID: 33020077 PMCID: PMC7537450 DOI: 10.1136/bmjopen-2019-035562] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 07/09/2020] [Accepted: 08/04/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To systematically review and quantify the effect of motor vehicle crashes (MVCs) in pregnancy on maternal and offspring outcomes. DESIGN Systematic review and meta-analysis of observational data searched from inception until 1 July 2018. Searching was from June to August 2018 in Medline, Embase, Web of Science, Scopus, Latin-American and Caribbean System on Health Sciences Information, Scientific Electronic Library Online, TRANSPORT, International Road Research Documentation, European Conference of Ministers of Transportation Databases, Cochrane Database of Systematic Reviews and Cochrane Central Register. PARTICIPANTS Studies were selected if they focused on the effects of exposure MVC during pregnancy versus non-exposure, with follow-up to verify outcomes in various settings, including secondary care, collision and emergency, and inpatient care. DATA SYNTHESIS For incidence data, we calculated a pooled estimate per 1000 women. For comparison of outcomes between women involved and those not involved in MVC, we calculated ORs with 95% CIs. Where possible, we statistically pooled the data using the random-effects model. The quality of studies used in the comparative analysis was assessed with Newcastle-Ottawa Scale. RESULTS We included 19 studies (3 222 066 women) of which the majority was carried out in high-income countries (18/19). In population-level studies of women involved in MVC, maternal death occurred in 3.6 per 1000 (95% CI 0.25-10.42; 3 studies, 12 000 women; Tau=1.77), and fetal death or stillbirth in 6.6 per 1000 (95% CI 3.81-10.12; 8 studies, 47 992 women; I2=92.6%). Pooled incidence of complications per 1000 women involved in MVC was labour induction (276.43), preterm delivery (191.90) and caesarean section (166.65). Compared with women not involved in MVC, those involved had increased odds of placental abruption (OR 1.43, 95% CI 1.27-1.63; 3 studies, 1 500 825 women) and maternal death (OR 202.27; 95% CI 110.60-369.95; 1 study, 1 094 559 women). CONCLUSION Pregnant women involved in MVC were at higher risk of maternal death and complications than those not involved. PROSPERO REGISTRATION NUMBER CRD42018100788.
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Affiliation(s)
- Carmen Amezcua-Prieto
- Preventive Medicine and Public Health, University of Granada Faculty of Medicine, Granada, Andalucía, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
| | - Jennifer Ross
- Centre for Trauma Sciences, Queen Mary University of London, London, UK
| | - Ewelina Rogozińska
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, London, UK
- Meta-analysis Group, MRC Clinical Trials Unit, University College London, London, UK
| | - Patritia Mighiu
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, London, UK
| | - Virginia Martínez-Ruiz
- Preventive Medicine and Public Health, University of Granada Faculty of Medicine, Granada, Andalucía, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
| | - Karim Brohi
- Centre for Trauma Sciences, Queen Mary University of London, London, UK
| | - Aurora Bueno-Cavanillas
- Preventive Medicine and Public Health, University of Granada Faculty of Medicine, Granada, Andalucía, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
| | - Khalid Saeed Khan
- Preventive Medicine and Public Health, University of Granada Faculty of Medicine, Granada, Andalucía, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Granada, Spain
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, London, UK
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, London, UK
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Maxwell BG, Greenlaw A, Smith WJ, Barbosa RR, Ropp KM, Lundeberg MR. Pregnant trauma patients may be at increased risk of mortality compared to nonpregnant women of reproductive age: trends and outcomes over 10 years at a level I trauma center. ACTA ACUST UNITED AC 2020; 16:1745506520933021. [PMID: 32578516 PMCID: PMC7315661 DOI: 10.1177/1745506520933021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Pregnancy has been identified as a risk factor for poor outcomes after traumatic injury, but prior outcome analyses are conflicting and dated. We sought to examine outcomes in a contemporary cohort. Methods: Retrospective cohort analysis at a level I trauma center’s institutional registry from 2009 to 2018, with comparison to population-level demographic trends in women of reproductive age and pregnancy prevalence. Unadjusted cohorts of pregnant versus nonpregnant trauma patients were compared. Pregnant patients then were matched on age, mechanism of injury, year, and injury severity score with nonpregnant controls for adjusted analysis with a primary outcome of maternal mortality. Results: Despite declining birth and pregnancy rates in the population, pregnant women comprised a stable 5.3% of female trauma patients of reproductive age without decline over the study period (p = 0.53). Compared with nonpregnant women, pregnant trauma patients had a lower injury severity score (1 [1–5] vs 5 [1–10] p < 0.0001) and a shorter length of stay (1 [1–2] vs 1 [1–4] p = 0.04), were less likely to have CT imaging (48.8% vs 67.4%, p < 0.0001) and more likely to be admitted (89.3% vs 79.2%, p = 0.003). Positive toxicology screens were less prevalent in pregnant women, but only for ethanol (5.4% vs 31.4%, p < 0.0001); there was no difference in rates of cannabis, opiates, or cocaine. After matching to adjust for age, year, mechanism of injury, and injury severity score, mortality occurred significantly more frequently in the pregnant cohort (2.1% vs 0.2%, OR = 13.5 [1.39–130.9], p = 0.02). Conclusion: Pregnant trauma patients have not declined in our population despite population-level declines in pregnancy. After adjusting for lower injury severity, pregnant women were at substantially greater risk of mortality. This supports ongoing concern for pregnant trauma patients as a vulnerable population. Further efforts should optimize systems of care to maximize the chances of rescue for both mother and fetus.
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Affiliation(s)
- Bryan G Maxwell
- Department of Anesthesiology, Legacy Emanuel Medical Center, Portland, OR, USA
| | - Andrea Greenlaw
- Department of Trauma Services, Legacy Emanuel Medical Center, Portland, OR, USA
| | - Wendy J Smith
- Department of Obstetrics, Legacy Emanuel Medical Center, Portland, OR, USA
| | - Ronald R Barbosa
- Department of Surgery; Legacy Emanuel Medical Center, Portland, OR, USA
| | - Kate M Ropp
- Department of Anesthesiology, Legacy Emanuel Medical Center, Portland, OR, USA
| | - Megan R Lundeberg
- Department of Surgery; Legacy Emanuel Medical Center, Portland, OR, USA
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Brolinson M, Tondo-Steele K, Chan M, Gable B. Multidisciplinary in situ simulation to improve emergency obstetric care. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:190-191. [DOI: 10.1136/bmjstel-2019-000488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2019] [Indexed: 11/04/2022]
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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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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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Abstract
Maternal mortality plagues much of the world. There were 303,000 maternal deaths in 2015 representing an overall global maternal mortality ratio of 216 maternal deaths per 100,000 live births. In the United States, the maternal mortality ratio had been decreasing until 1987, remained stable until 1999, and then began to increase. Racial disparities exist in the rates of maternal mortality in the United States with maternal death affecting a higher proportion of black women compared with white women. To reduce maternal mortality, national organizations in the United States have called for standardized review of cases of maternal morbidity and mortality.
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Soni K, Aggarwal R, Trikha A. Initial management of a pregnant woman with trauma. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.4103/joacc.joacc_4_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kilpatrick SJ. Trauma in pregnancy: an underappreciated cause of maternal death. Am J Obstet Gynecol 2017; 217:499-500. [PMID: 29110810 DOI: 10.1016/j.ajog.2017.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
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