1
|
Santos JW, Grigorian A, Lucas AN, Fierro N, Dhillon NK, Ley EJ, Smith J, Burruss S, Dahan A, Johnson A, Ganske W, Biffl WL, Bayat D, Castelo M, Wintz D, Schaffer KB, Zheng DJ, Tillou A, Coimbra R, Tuli R, Santorelli JE, Emigh B, Schellenberg M, Inaba K, Duncan TK, Diaz G, Tay-Lasso E, Zezoff DC, Nahmias J. Predictors of fetal delivery in pregnant trauma patients: A multicenter study. J Trauma Acute Care Surg 2024; 96:109-115. [PMID: 37580875 DOI: 10.1097/ta.0000000000003964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
BACKGROUND Pregnant trauma patients (PTPs) undergo observation and fetal monitoring following trauma due to possible fetal delivery (FD) or adverse outcome. There is a paucity of data on PTP outcomes, especially related to risk factors for FD. We aimed to identify predictors of posttraumatic FD in potentially viable pregnancies. METHODS All PTPs (≥18 years) with ≥24-weeks gestational age were included in this multicenter retrospective study at 12 Level-I and II trauma centers between 2016 and 2021. Pregnant trauma patients who underwent FD ((+) FD) were compared to those who did not deliver ((-) FD) during the index hospitalization. Univariate analyses and multivariable logistic regression were performed to identify predictors of FD. RESULTS Of 591 PTPs, 63 (10.7%) underwent FD, with 4 (6.3%) maternal deaths. The (+) FD group was similar in maternal age (27 vs. 28 years, p = 0.310) but had older gestational age (37 vs. 30 weeks, p < 0.001) and higher mean injury severity score (7.0 vs. 1.5, p < 0.001) compared with the (-) FD group. The (+) FD group had higher rates of vaginal bleeding (6.3% vs. 1.1%, p = 0.002), uterine contractions (46% vs. 23.5%, p < 0.001), and abnormal fetal heart tracing (54.7% vs. 14.6%, p < 0.001). On multivariate analysis, independent predictors for (+) FD included abdominal injury (odds ratio [OR], 4.07; confidence interval [CI], 1.11-15.02; p = 0.035), gestational age (OR, 1.68 per week ≥24 weeks; CI, 1.44-1.95; p < 0.001), abnormal FHT (OR, 12.72; CI, 5.19-31.17; p < 0.001), and premature rupture of membranes (OR, 35.97; CI, 7.28-177.74; p < 0.001). CONCLUSION The FD rate was approximately 10% for PTPs with viable fetal gestational age. Independent risk factors for (+) FD included maternal and fetal factors, many of which are available on initial trauma bay evaluation. These risk factors may help predict FD in the trauma setting and shape future guidelines regarding the recommended observation of PTPs. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
Collapse
Affiliation(s)
- Jeffrey W Santos
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, (J.W.S., A.G., A.N.L., E.T.-L., D.C.Z., J.N.), University of California, Irvine, Orange; Department of Surgery (N.F., N.K.D., E.J.L.), Cedars-Sinai Medical Center, Los Angeles; Division of Trauma and Critical Care (J.S.), Harbor-UCLA Hospital, Torrance; Department of Trauma, Acute Care Surgery, Surgical Critical Care (S.B.), Loma Linda Medical Center, Loma Linda; Riverside School of Medicine (A.D.), University of California, Riverside; Cottage Health Research Institute (A.J., W.G.), Santa Barbara Cottage Hospital, Santa Barbara; Trauma and Acute Care Surgery, Scripps Memorial Hospital (W.L.B., D.B., M.C.), La Jolla; Department of Surgery (D.W., K.B.S.), Sharp Memorial Hospital, San Diego; Department of Surgery (D.J.Z., A.T.), UCLA David Geffen School of Medicine, Los Angeles; Department of Surgery, Comparative Effectiveness and Clinical Outcomes Research Center-CECORC (R.C., R.T.), Riverside University Health System Medical Center, Moreno Valley; Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery (J.E.S.), University of California San Diego School of Medicine, San Diego; Division of Acute Care Surgery (B.E., M.S., K.I.), LAC+USC Medical Center, University of Southern California, Los Angeles; and Department of Trauma (T.K.D., G.D.), Ventura County Medical Center, Ventura, California
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
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
| |
Collapse
|
3
|
Arias J, Kurgansky G, Wei OC, Chan-Akeley R, Toma M. Fluid-structure interaction analysis of amniotic fluid with fetus and placenta inside uterus exposed to military blasts. Injury 2023; 54:110843. [PMID: 37270348 DOI: 10.1016/j.injury.2023.110843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/02/2023] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Pregnancy-related trauma is one of the leading causes of morbidity and mortality in pregnant women and fetuses. The fetal response to injury is largely dependent on the timing of fetal presentation and the underlying pathophysiology of the trauma. The optimal management of pregnant patients who have suffered an obstetric emergency depends on clinical assessment and understanding of the placental implantation process, which can be difficult to perform during an emergency. Understanding the mechanisms of traumatic injuries to the fetus is crucial for developing next-generation protective devices. METHODS This study aimed to investigate the effect of amniotic fluid on mine blast on the uterus, fetus, and placenta via computational analysis. Finite element models were developed to analyze the effects of explosion forces on the uterus, fetus, and placenta, based on cadaveric data obtained from the literature. This study uses computational fluid-structure interaction simulations to study the effect of external loading on the fetus submerged in amniotic fluid inside of the uterus. RESULTS Computational fluid-structure interaction simulations are used to study the effect of external loading on the fetus/placenta submerged in amniotic fluid inside the uterus. Cushioning function of the amniotic fluid on the fetus and placenta is demonstrated. The mechanism of traumatic injuries to the fetus/placenta is shown. DISCUSSION The intention of this research is to understand the cushioning function of the amniotic fluid on the fetus. Further, it is important to make use of this knowledge in order to ensure the safety of pregnant women and their fetuses.
Collapse
Affiliation(s)
- Jonathan Arias
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, 11568, New York, USA.
| | - Gregory Kurgansky
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, 11568, New York, USA.
| | - Ong Chi Wei
- Institute of High Performance Computing, 1 Fusionopolis Way #16-16 Connexis, Singapore, 138632, Singapore.
| | - Rosalyn Chan-Akeley
- Lang Research Center, NewYork-Presbyterian Queens, Flushing, 11355, New York, USA.
| | - Milan Toma
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, 11568, New York, USA.
| |
Collapse
|
4
|
Liggett MR, Amro A, Son M, Schwulst S. Management of the Pregnant Trauma Patient: A Systematic Literature Review. J Surg Res 2023; 285:187-196. [PMID: 36689816 DOI: 10.1016/j.jss.2022.11.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Trauma during pregnancy is the leading cause of non-obstetric maternal death and complicates up to 5%-7% of pregnancies. This systematic review without meta-analysis explores the current literature regarding the assessment and management of pregnant trauma patients to provide evidence-based recommendations to guide the general surgeon regarding the prognostic value of laboratory testing including Kleihauer-Betke testing, duration of maternal and fetal monitoring, the use of tranexamic acid, the safety of radiographic studies, and the utility of perimortem cesarean section to improve maternal and fetal mortality. MATERIALS AND METHODS A systematic search of MEDLINE (Ovid), the Cochrane Library (Wiley), and Embase (Elsevier) was performed. The reference lists of included studies were reviewed for relevant citations. RESULTS Of the 45 studies included in this review, there was reasonable evidence to suggest that the minimally injured pregnant trauma patient should be observed for a minimum of 4 h, CT scans to rule out traumatic injury are necessary and safe, perimortem cesarean sections should be performed as soon as maternal cardiac arrest occurs. CONCLUSIONS We recommend delivery by perimortem cesarean section as soon as possible after maternal cardiac arrest, to provide TXA to the hemorrhaging pregnant trauma patient, to obtain trauma CT scans as indicated, and to observe the injured pregnant patient for a minimum of at least 4 h. Additional high-quality studies focusing on the prognostic potential of KB tests and other laboratory studies are needed.
Collapse
Affiliation(s)
- Marjorie R Liggett
- Department of General Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Ali Amro
- Department of General Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Moeun Son
- Yale University School of Medicine, Obstetrics, Gynecology & Reproductive Sciences, New Haven, Connecticut
| | - Steven Schwulst
- Department of General Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
5
|
Kirk CH, Ciraulo GE, Ciraulo RS, Falank CR, Ciraulo DL. Obstetrical Trauma: Reducing the Burden of Trauma Transfer to Tertiary Care Centers. Am Surg 2023:31348231157847. [PMID: 36797010 DOI: 10.1177/00031348231157847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND In rural state trauma systems, management of the obstetrical trauma patient often defaults to transfer to level I trauma centers. We evaluate the necessity of transferring obstetrical trauma patients without severe maternal injury. MATERIALS AND METHODS A retrospective 5-year review of obstetrical trauma patients admitted to a rural state-level I trauma center was conducted. Injury severity measures such as abdominal AIS, ISS, and GCS were correlated with outcomes. Furthermore, the impact of maternal and gestational age on uterine compromise, uterine irritability, and the need for cesarean section intervention are presented. RESULTS Twenty-one percent of patients were transferred from outside facilities with a median age of 29 years, average ISS of 3.9 ± 5.6, GCS of 13.8 ± 3.6, and abdominal AIS of 1.6 ± .8. Outcomes included maternal fatality of 2%, fetal demise of 4%, 6% experienced premature rupture of membranes, 9% experienced fetal placental compromise, 15% had uterine contractions, 15% of cesarean deliveries, and fetal decelerations occurred in 4%. Predictors of fetal compromise are strongly associated with high maternal ISS and low GCS. DISCUSSION The frequency of traumatic injury in this unique population of patients is fortunately limited. The best predictor for fetal demise and uterine irritability is maternal injury severity, measured by ISS and GCS. Therefore, without severe maternal trauma, obstetrical trauma patients with minor injuries can safely be managed at non-tertiary care facilities with obstetrical capabilities.
Collapse
Affiliation(s)
- Charlotte H Kirk
- 115985University of New England College of Osteopathic Medicine, Biddeford, ME, USA
| | | | | | | | - David L Ciraulo
- Department of Surgery, 92602Maine Medical Center, Portland, ME, USA
| |
Collapse
|
6
|
Ahmed A, Rosella LC, Oskoui M, Watson T, Yang S. In Utero Exposure to Maternal Injury and the Associated Risk of Cerebral Palsy. JAMA Pediatr 2023; 177:53-61. [PMID: 36441546 PMCID: PMC9706397 DOI: 10.1001/jamapediatrics.2022.4535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
Importance Although maternal unintentional injury during pregnancy has shown negative impacts on the mother and fetus, the evidence on its long-term associations with children's neurodevelopment is limited. Objective To examine the association between maternal unintentional injury and cerebral palsy (CP) in offspring. Design, Setting, and Participants This was a population-based, longitudinal, cohort study of all in-hospital live births born between April 1, 2002, and March 31, 2017, in a publicly funded health care system setting of Ontario, Canada. Infants born more than 20 weeks' gestation were included and followed up until March 31, 2018. Excluded from the analysis were stillbirths, infants with missing or invalid records, and births with missing or invalid birth characteristics. Data were analyzed from March 1 to June 30, 2021. Exposures Maternal unintentional injury during pregnancy ascertained based on inpatient or emergency department diagnoses. Main Outcomes and Measures CP diagnosis between birth and the end of follow-up in 2018 with the CP case definition of a single inpatient or 2 or more outpatient diagnoses at least 2 weeks apart between birth and age 16 years. Results Of 2 110 177 children included in this study (mean [SD] gestational age, 38.8 [1.9] weeks; 1 082 520 male [51.3%]), 81 281 (3.9%) were exposed in utero to maternal unintentional injury. During a median (IQR) follow-up time of 8 (4-12) years, 5317 children (0.3%) were diagnosed with CP (292 CP cases [5.5%] were exposed to maternal unintentional injury). The mean incidence rates of CP were 4.36 and 2.93 per 10 000 child-years in the exposed and the unexposed group, respectively. Children exposed to maternal unintentional injury had a modest increase in the risk of CP, compared with those unexposed (hazard ratio [HR], 1.33; 95% CI, 1.18-1.50) after adjusting for maternal sociodemographic and clinical characteristics. Severe injuries that resulted in hospitalization and delivery within 1 week from the injury conferred higher risks of CP (adjusted HR, 2.18; 95% CI, 1.29-3.68 and adjusted HR, 3.40; 95% CI, 1.93-6.00, respectively). Results were robust in multiple bias analyses. Conclusions and Relevance In this Canadian population-based birth cohort study, in utero exposure to maternal unintentional injury was associated with an increased risk of CP, with a higher risk with more severe injuries. These findings fill an important gap in knowledge on the potential role of maternal injury on children's neurodevelopment outcomes. Public health professionals and stakeholders should be aware of these potential long-term consequences on offspring when designing programs and providing recommendations about safety during pregnancy. Early monitoring and developmental assessment of children exposed to maternal injury might be warranted.
Collapse
Affiliation(s)
- Asma Ahmed
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Laura C. Rosella
- Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Temerty Faculty of Medicine, Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Oskoui
- McGill University Health Center Research Institute, Child Health and Human Development Program, Centre for Outcomes Research and Evaluation, Montreal, Quebec, Canada
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Department of Neurology & Neurosurgery, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Tristan Watson
- Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Al Fauzi A, Apriawan T, Ranuh IGMAR, Christi AY, Bajamal AH, Turchan A, Agus Subagio E, Suroto NS, Santoso B, Dachlan EG, Utomo B, Kasper EM. Traumatic brain injury in pregnancy: A systematic review of epidemiology, management, and outcome. J Clin Neurosci 2023; 107:106-117. [PMID: 36527810 DOI: 10.1016/j.jocn.2022.12.007] [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: 10/11/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) during pregnancy is an extremely rare condition in our neurosurgical emergency practices. Studies on the epidemiology and management of TBI in pregnancy are limited to case reports or serial case reports. There is no specific guidelines of management of TBI in pregnancy yet. METHODS The authors performed a structured search of all published articles on TBI in pregnancy from 1990 to 2020. We restricted search for papers in English and Bahasa. RESULTS The literature search yielded 22 articles with total 43 patients. We distinguished C-section based on its timing according to the neurosurgical treatment into primary (simultaneous or prior to neurosurgery) and secondary group (delayed C-section). The mean GOS value in primary C-section is better compared to secondary C-section in severe TBI group (3.57 ± 1.47 vs 3.0 ± 1.27, respectively) consistently in the moderate TBI group (4.33 ± 1.11 vs 3.62 ± 1.47, respectively). The fetal death rate in primary C-section is lower compared to secondary C-section in severe TBI group (14.2 % vs 33.3 %, respectively), contrary, in moderate TBI group (16.7 % vs 12.5 %, respectively). CONCLUSIONS Care of pregnant patients with TBI often requires multidisciplinary approach to optimize treatment strategy on a case-by-case basis in light of prior experience across different center. We propose management guideline for head injury in pregnancy.
Collapse
Affiliation(s)
- Asra Al Fauzi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
| | - Tedy Apriawan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - I G M Aswin R Ranuh
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ayu Yoniko Christi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Agus Turchan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Eko Agus Subagio
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Nur Setiawan Suroto
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Budi Santoso
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Erry Gumilar Dachlan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Budi Utomo
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ekkehard M Kasper
- Department of Neurosurgery, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
8
|
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]
|
9
|
Wasiak K, Czajkowski K, Frasuńska J. Spinal cord injury during early pregnancy: Problems in the course of rehabilitation and infant care, a case report. J Spinal Cord Med 2021:1-5. [PMID: 34726586 DOI: 10.1080/10790268.2021.1965336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CONTEXT Spinal cord injury (SCI) sustained during pregnancy may be dangerous to the mother and her child. The risk is associated both with necessary diagnostic work-up and with the therapeutic process (radiographic investigations, surgical procedures, anesthesia, spinal shock, SCI complications, delivery). However, infant care is an enormous challenge for a woman with motor disability. The authors present a case report concerning the problems of treatment, rehabilitation and infant care in an SCI woman. To our knowledge, it is the first paper to describe SCI at such an early stage of gestation (2.5 weeks of gestational age/WGA). FINDINGS A 20-year old paraplegic woman after SCI was pregnant. The period of diagnostics (MRI, X-ray), surgery and rehabilitation was associated with minor complications for the mother and no complications for the child. At discharge from the rehabilitation center the patient presented Th11 paraplegia (AIS-C), 24.5 WGA, and she could walk using a walker with a knee-ankle-foot-orthosis on the right and an ankle-foot-orthosis on the left lower limb. She delivered at 38 WGA via cesarean section (girl, birth weight 2960 g, length 50 cm, APGAR = 9 and 10). Bathing the baby and walking with it were the main problems of the post-delivery period. CONCLUSIONS Factors potentially threatening the mother and child's health in SCI during pregnancy do not always contribute to the complications of the clinical status and health of the child. Comprehensive approach to the treatment, rehabilitation and care of pregnant women with SCI facilitates the course of pregnancy, delivery and child care.
Collapse
Affiliation(s)
- Krzysztof Wasiak
- Department of Rehabilitation, Mazovian Rehabilitation Center STOCER, Konstancin-Jeziorna, Poland
| | - Krzysztof Czajkowski
- Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Justyna Frasuńska
- Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland.,Department of Rehabilitation, Eleonora Reicher National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| |
Collapse
|
10
|
Arsh A, Darain H. Obstetric Outcomes of Women Who Sustained Traumatic Spinal Injury during Pregnancy: A Systematic Review. Asian Spine J 2021; 16:290-300. [PMID: 33940772 PMCID: PMC9066247 DOI: 10.31616/asj.2020.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 01/18/2021] [Indexed: 11/23/2022] Open
Abstract
Literature regarding pregnant women who sustained traumatic spinal injury during pregnancy is limited. Existing papers are mainly case reports, and this indicates a need for more high-quality research evidence in this area. Therefore, this study was designed to systematically review available literature that reported demographic information, clinical characteristics, and obstetric outcomes of women who sustained spinal injury during pregnancy. Studies published from the earliest record to January 2019, which reported traumatic spinal injury during pregnancy, were included. Studies that have reported pregnancy in patients with pre-existing spinal injury, review articles, commentaries, letter to editors, conference papers, and studies published in languages other than English were excluded. Sixteen studies reporting on 26 women were included. Their mean age was 26.7±5.5 years. Motor vehicle accidents were the main cause of spinal injury (n=15, 58%). Of the cases, four women sustained spinal injury during the 1st trimester of pregnancy, of which one had a spontaneous abortion, one delivered a baby with arthrogryposis multiplex congenital disorder, and the third one delivered a premature baby who died shortly after the delivery. Fifteen women sustained injury during their 2nd trimester, of which 14 delivered normal babies, while six sustained spinal injury during the 3rd trimester. Of these women, five delivered normal babies at term. Outcomes of pregnancy appear significantly affected if a spinal injury occurs during the 1st trimester of pregnancy; however, injuries sustained during the 2nd and 3rd trimesters can have good obstetric outcomes.
Collapse
Affiliation(s)
- Aatik Arsh
- KMU Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Pakistan
| | - Haider Darain
- KMU Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Pakistan
| |
Collapse
|
11
|
Bryant MK, Roy S, Purcell LN, Porras KL, Spencer A, Udekwu P. Trauma in Pregnancy: The Relationship of Trauma Activation Level and Obstetric Outcomes. Am Surg 2020. [DOI: 10.1177/000313481908500742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Trauma in pregnancy is a leading cause of poor fetal and obstetric outcomes. Trauma team activation (TTA) criteria include injury with ≥ 20 weeks gestational age (GA). A retrospective analysis was performed on pregnant patients evaluated at a Level 1 trauma center. Patients were characterized by TTA: full, partial, or non-TTA, and TTA criteria independent of pregnancy. Index trauma and delayed delivery hospitalization outcomes were examined. Bivariate analysis, t test, and logistic regression were used when appropriate. From 2010 to 2015, 216 full, 50 partial, and 50 non-TTAs presented. Independent of pregnancy, 79 per cent of patients did not meet the TTA criteria. Fourteen (4%) had a pregnancy-related complication during index hospitalization (eight fetal and two maternal deaths). Nine of ten deaths occurred in patients meeting TTA independent of pregnancy. Delivery complications were greater in the index (52%, 13/25) versus subsequent (5%, 17/155) hospitalizations and were predicted by the respiratory rate ( P = 0.016) and injury severity score ( P < 0.001). Poor delayed delivery outcomes were associated with earlier GA ( P < 0.002) and longer index hospitalization ( P < 0.024). Odds of complication are higher in patients meeting the physiologic and anatomic criteria criteria for TTA versus GA criteria alone, signifying overtriage. Trauma activation protocols should be adapted based on the physiologic and anatomic criteria criteria in pregnant patients.
Collapse
Affiliation(s)
- Mary K. Bryant
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| | - Sara Roy
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| | - Laura N. Purcell
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| | - Kristina L. Porras
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| | - Alex Spencer
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| | - Pascal Udekwu
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| |
Collapse
|
12
|
Mulder MB, Quiroz HJ, Yang WJ, Lasko DS, Perez EA, Proctor KG, Sola JE, Thorson CM. The unborn fetus: The unrecognized victim of trauma during pregnancy. J Pediatr Surg 2020; 55:938-943. [PMID: 32061362 DOI: 10.1016/j.jpedsurg.2020.01.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Trauma is the leading cause of non-obstetric death in pregnancy. While maternal management is defined, few studies have examined the effects on the fetus. METHODS Following IRB approval, all pregnant females (2010-2017) at a level-1 trauma center were retrospectively reviewed. Maternal and fetal demographics, interventions, and clinical outcomes were analyzed. RESULTS There were 188 pregnancies in 5654 females. Maternal demographics were 26 ± 7 years old, gestational age at trauma 21 ± 12 weeks, 81% blunt mechanism, and maternal mortality 6%. Forty-one (22%) fetuses were immediately affected by the trauma including 20 (11%) born alive, 12 (7%) fetal demise, and 9 (5%) stillbirths. Of those that initially survived (n = 20), 5 (25%) expired during neonatal hospitalization. Two mothers returned immediately after trauma discharge with stillbirths for an overall infant mortality of 14% (n = 26). There were 84 patients with complete data to delivery including the 41 born at trauma and 43 born on a subsequent hospitalization. Those born at the time of trauma had significantly more delivery/neonatal complications and worse outcomes. Overall trauma burden to the fetus (preterm delivery, stillbirth, delivery/neonatal complication, or long-term disability) was 66% (56/84). CONCLUSIONS Trauma during pregnancy has significant immediate mortality and delayed effects on the unborn fetus. This study has uncovered a previously hidden burden and mortality of trauma during pregnancy. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Michelle B Mulder
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Hallie J Quiroz
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Wendy J Yang
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Davis S Lasko
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Eduardo A Perez
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Kenneth G Proctor
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Juan E Sola
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Chad M Thorson
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136.
| |
Collapse
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
Traumatic injuries to the pregnant patient: a critical literature review. Eur J Trauma Emerg Surg 2017; 45:383-392. [DOI: 10.1007/s00068-017-0839-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/12/2017] [Indexed: 11/26/2022]
|
15
|
Consequences of traumatic spinal cord injury during pregnancy in Pakistan. Spinal Cord Ser Cases 2017; 3:17041. [PMID: 28725486 DOI: 10.1038/scsandc.2017.41] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Traumatic spinal cord injury (SCI) is one of the major causes for poor outcomes of pregnancy. Injury during pregnancy is uncommon; therefore, outcome data are scarce. This case series presents outcomes of pregnancy in five women who sustained SCI during their pregnancies. CASE PRESENTATION Five women who sustained SCIs during pregnancy (age range: 24-38 years) were identified and included in this case series. The causes of SCI in this population were fall from heights (cases 1 and 2), road traffic accidents (cases 3 and 4) and firearm injury (case 5). Two of the females were managed conservatively (cases 1 and 5) and the rest underwent surgical procedures for fixing their spine. Out of these patients, four patients delivered normal healthy babies, while the baby of one patient died within 1 hour after delivery. DISCUSSION Limited data about the outcomes of pregnancy in women who sustained SCIs during pregnancy are available in the literature. The outcomes of pregnancy in women who sustained SCIs during the first trimester are not satisfactory, and special attention may be needed to improve the expected outcomes. Data from our study show similar findings to developed countries.
Collapse
|
16
|
Battaloglu E, Porter K. Management of pregnancy and obstetric complications in prehospital trauma care: faculty of prehospital care consensus guidelines. Emerg Med J 2017; 34:318-325. [PMID: 28264877 DOI: 10.1136/emermed-2016-205978] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 10/14/2016] [Accepted: 10/30/2016] [Indexed: 11/04/2022]
Abstract
This consensus statement seeks to provide clear guidance for the management of pregnant trauma patients in the prehospital setting. Pregnant patients sustaining trauma injuries have certain clinical management priorities beyond that of the non-pregnant trauma patients and that if overlooked may be detrimental to maternal and fetal outcomes.
Collapse
Affiliation(s)
- E Battaloglu
- Academic Department of Clinical Traumatology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - K Porter
- Academic Department of Clinical Traumatology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
17
|
Jain V, Chari R, Maslovitz S, Farine D. Lignes directrices pour la prise en charge d'une patiente enceinte ayant subi un traumatisme. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S665-S687. [PMID: 28063573 DOI: 10.1016/j.jogc.2016.09.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
18
|
Redelmeier DA, Naqib F, Thiruchelvam D, R Barrett JF. Motor vehicle crashes during pregnancy and cerebral palsy during infancy: a longitudinal cohort analysis. BMJ Open 2016; 6:e011972. [PMID: 27650764 PMCID: PMC5051428 DOI: 10.1136/bmjopen-2016-011972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To assess the incidence of cerebral palsy among children born to mothers who had their pregnancy complicated by a motor vehicle crash. DESIGN Retrospective longitudinal cohort analysis of children born from 1 April 2002 to 31 March 2012 in Ontario, Canada. PARTICIPANTS Cases defined as pregnancies complicated by a motor vehicle crash and controls as remaining pregnancies with no crash. MAIN OUTCOME Subsequent diagnosis of cerebral palsy by age 3 years. RESULTS A total of 1 325 660 newborns were analysed, of whom 7933 were involved in a motor vehicle crash during pregnancy. A total of 2328 were subsequently diagnosed with cerebral palsy, equal to an absolute risk of 1.8 per 1000 newborns. For the entire cohort, motor vehicle crashes correlated with a 29% increased risk of subsequent cerebral palsy that was not statistically significant (95% CI -16 to +110, p=0.274). The increased risk was only significant for those with preterm birth who showed an 89% increased risk of subsequent cerebral palsy associated with a motor vehicle crash (95% CI +7 to +266, p=0.037). No significant increase was apparent for those with a term delivery (95% CI -62 to +79, p=0.510). A propensity score-matched analysis of preterm births (n=4384) yielded a 138% increased relative risk of cerebral palsy associated with a motor vehicle crash (95% CI +27 to +349, p=0.007), equal to an absolute increase of about 10.9 additional cases per 1000 newborns (18.2 vs 7.3, p=0.010). CONCLUSIONS Motor vehicle crashes during pregnancy may be associated with an increased risk of cerebral palsy among the subgroup of cases with preterm birth. The increase highlights a specific role for traffic safety advice in prenatal care.
Collapse
Affiliation(s)
- Donald A Redelmeier
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation
- Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Faisal Naqib
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Toronto, Ontario, Canada
| | - Deva Thiruchelvam
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Toronto, Ontario, Canada
| | - Jon F R Barrett
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
19
|
Complications obstétricales des traumatismes de la femme enceinte : épidémiologie dans une maternité d’un CHU en France. ANNALES FRANCAISES DE MEDECINE D URGENCE 2016. [DOI: 10.1007/s13341-016-0661-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Battaloglu E, McDonnell D, Chu J, Lecky F, Porter K. Epidemiology and outcomes of pregnancy and obstetric complications in trauma in the United Kingdom. Injury 2016; 47:184-7. [PMID: 26404664 DOI: 10.1016/j.injury.2015.08.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/09/2015] [Accepted: 08/15/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To understand the epidemiology of pregnancy and obstetric complications encountered in the management of pregnant trauma patients. METHODS AND DESIGN Retrospective analysis of national trauma registry for recording of pregnancy status or obstetric complication in cases of trauma. Sub-division of patient cohort by severity of trauma and stage of pregnancy. Comparison of data sets between pregnant trauma patients and age-matched non-pregnant female trauma patients to determine patterns of injury and impact upon clinical outcomes. SETTINGS National registry data for the United Kingdom. OUTCOME For the five year period between 2009 and 2014, a total of 15,140 female patients, aged between 15 years old and 50 years old were identified within the trauma registry. A record of pregnancy was identified in 173 patients (1.14%) from within this cohort. Mechanisms of injury within the cohort of pregnant trauma patients saw increased rate of vehicular collision and interpersonal violence, especially penetrating trauma. Higher abbreviated injury scores were recorded for the abdominal region in pregnancy than in the non-pregnant cohort. Maternal mortality rates were seen to be higher, when compared with the non-pregnant trauma patient. Foetal survival rate from this series was 56% following trauma. Foetal death in pregnant trauma patients most frequently occurred in the 2nd trimester. No cases of isolated foetal survival were recorded following maternal trauma. CONCLUSIONS Trauma to pregnant patients is rare in the United Kingdom, encountered in 1% of female trauma patients of child bearing age. Observations in altered mechanisms of injury and clinical outcomes were recorded. This provides useful information regarding the clinical management of pregnant trauma patients and offers potential areas to investigate to optimise their care, as well as to focus injury prevention measures. LEVEL OF EVIDENCE IV--Case series.
Collapse
Affiliation(s)
- Emir Battaloglu
- Trauma & Orthopaedics Specialist Registrar, University Hospitals Birmingham, Birmingham, United Kingdom.
| | - Declan McDonnell
- Core Surgical Trainee Year One, University Hospital Southampton, Southampton, United Kingdom
| | - Justin Chu
- Obstetrics & Gynaecology Specialist Registrar and Clinical Research Fellow, Birmingham Women's Hospital, Birmingham, United Kingdom
| | - Fiona Lecky
- Trauma Audit Research Network, Salford, United Kingdom
| | - Keith Porter
- Clinical Traumatology and Trauma & Orthopaedics Consultant Surgeon, University Hospitals Birmingham, Birmingham, United Kingdom
| |
Collapse
|
21
|
Jain V, Chari R, Maslovitz S, Farine D, Bujold E, Gagnon R, Basso M, Bos H, Brown R, Cooper S, Gouin K, McLeod NL, Menticoglou S, Mundle W, Pylypjuk C, Roggensack A, Sanderson F. Guidelines for the Management of a Pregnant Trauma Patient. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:553-74. [PMID: 26334607 DOI: 10.1016/s1701-2163(15)30232-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Physical trauma affects 1 in 12 pregnant women and has a major impact on maternal mortality and morbidity and on pregnancy outcome. A multidisciplinary approach is warranted to optimize outcome for both the mother and her fetus. The aim of this document is to provide the obstetric care provider with an evidence-based systematic approach to the pregnant trauma patient. OUTCOMES Significant health and economic outcomes considered in comparing alternative practices. EVIDENCE Published literature was retrieved through searches of Medline, CINAHL, and The Cochrane Library from October 2007 to September 2013 using appropriate controlled vocabulary (e.g., pregnancy, Cesarean section, hypotension, domestic violence, shock) and key words (e.g., trauma, perimortem Cesarean, Kleihauer-Betke, supine hypotension, electrical shock). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English between January 1968 and September 2013. Searches were updated on a regular basis and incorporated in the guideline to February 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS This guideline is expected to facilitate optimal and uniform care for pregnancies complicated by trauma. Summary Statement Specific traumatic injuries At this time, there is insufficient evidence to support the practice of disabling air bags for pregnant women. (III) Recommendations Primary survey 1. Every female of reproductive age with significant injuries should be considered pregnant until proven otherwise by a definitive pregnancy test or ultrasound scan. (III-C) 2. A nasogastric tube should be inserted in a semiconscious or unconscious injured pregnant woman to prevent aspiration of acidic gastric content. (III-C) 3. Oxygen supplementation should be given to maintain maternal oxygen saturation > 95% to ensure adequate fetal oxygenation. (II-1B) 4. If needed, a thoracostomy tube should be inserted in an injured pregnant woman 1 or 2 intercostal spaces higher than usual. (III-C) 5. Two large bore (14 to 16 gauge) intravenous lines should be placed in a seriously injured pregnant woman. (III-C) 6. Because of their adverse effect on uteroplacental perfusion, vasopressors in pregnant women should be used only for intractable hypotension that is unresponsive to fluid resuscitation. (II-3B) 7. After mid-pregnancy, the gravid uterus should be moved off the inferior vena cava to increase venous return and cardiac output in the acutely injured pregnant woman. This may be achieved by manual displacement of the uterus or left lateral tilt. Care should be taken to secure the spinal cord when using left lateral tilt. (II-1B) 8. To avoid rhesus D (Rh) alloimmunization in Rh-negative mothers, O-negative blood should be transfused when needed until cross-matched blood becomes available. (I-A) 9. The abdominal portion of military anti-shock trousers should not be inflated on a pregnant woman because this may reduce placental perfusion. (II-3B) Transfer to health care facility 10. Transfer or transport to a maternity facility (triage of a labour and delivery unit) is advocated when injuries are neither life- nor limb-threatening and the fetus is viable (≥ 23 weeks), and to the emergency room when the fetus is under 23 weeks' gestational age or considered to be non-viable. When the injury is major, the patient should be transferred or transported to the trauma unit or emergency room, regardless of gestational age. (III-B) 11. When the severity of injury is undetermined or when the gestational age is uncertain, the patient should be evaluated in the trauma unit or emergency room to rule out major injuries. (III-C) Evaluation of a pregnant trauma patient in the emergency room 12. In cases of major trauma, the assessment, stabilization, and care of the pregnant women is the first priority; then, if the fetus is viable (≥ 23 weeks), fetal heart rate auscultation and fetal monitoring can be initiated and an obstetrical consultation obtained as soon as feasible. (II-3B) 13. In pregnant women with a viable fetus (≥ 23 weeks) and suspected uterine contractions, placental abruption, or traumatic uterine rupture, urgent obstetrical consultation is recommended. (II-3B) 14. In cases of vaginal bleeding at or after 23 weeks, speculum or digital vaginal examination should be deferred until placenta previa is excluded by a prior or current ultrasound scan. (III-C) Adjunctive tests for maternal assessment 15. Radiographic studies indicated for maternal evaluation including abdominal computed tomography should not be deferred or delayed due to concerns regarding fetal exposure to radiation. (II-2B) 16. Use of gadolinium-based contrast agents can be considered when maternal benefit outweighs potential fetal risks. (III-C) 17. In addition to the routine blood tests, a pregnant trauma patient should have a coagulation panel including fibrinogen. (III-C) 18. Focused abdominal sonography for trauma should be considered for detection of intraperitoneal bleeding in pregnant trauma patients. (II-3B) 19. Abdominal computed tomography may be considered as an alternative to diagnostic peritoneal lavage or open lavage when intra-abdominal bleeding is suspected. (III-C) Fetal assessment 20. All pregnant trauma patients with a viable pregnancy (≥ 23 weeks) should undergo electronic fetal monitoring for at least 4 hours. (II-3B) 21. Pregnant trauma patients (≥ 23 weeks) with adverse factors including uterine tenderness, significant abdominal pain, vaginal bleeding, sustained contractions (> 1/10 min), rupture of the membranes, atypical or abnormal fetal heart rate pattern, high risk mechanism of injury, or serum fibrinogen < 200 mg/dL should be admitted for observation for 24 hours. (III-B) 22. Anti-D immunoglobulin should be given to all rhesus D-negative pregnant trauma patients. (III-B) 23. In Rh-negative pregnant trauma patients, quantification of maternal-fetal hemorrhage by tests such as Kleihauer-Betke should be done to determine the need for additional doses of anti-D immunoglobulin. (III-B) 24. An urgent obstetrical ultrasound scan should be undertaken when the gestational age is undetermined and need for delivery is anticipated. (III-C) 25. All pregnant trauma patients with a viable pregnancy who are admitted for fetal monitoring for greater than 4 hours should have an obstetrical ultrasound prior to discharge from hospital. (III-C) 26. Fetal well-being should be carefully documented in cases involving violence, especially for legal purposes. (III-C) Obstetrical complications of trauma 27. Management of suspected placental abruption should not be delayed pending confirmation by ultrasonography as ultrasound is not a sensitive tool for its diagnosis. (II-3D) Specific traumatic injuries 28. Tetanus vaccination is safe in pregnancy and should be given when indicated. (II-3B) 29. Every woman who sustains trauma should be questioned specifically about domestic or intimate partner violence. (II-3B) 30. During prenatal visits, the caregiver should emphasize the importance of wearing seatbelts properly at all times. (II-2B) Perimortem Caesarean section 31. A Caesarean section should be performed for viable pregnancies (≥ 23 weeks) no later than 4 minutes (when possible) following maternal cardiac arrest to aid with maternal resuscitation and fetal salvage. (III-B).
Collapse
|
22
|
Harland KK, Saftlas AF, Yankowitz J, Peek-Asa C. Risk factors for maternal injuries in a population-based sample of pregnant women. J Womens Health (Larchmt) 2015; 23:1033-8. [PMID: 25251144 DOI: 10.1089/jwh.2013.4560] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of injuries during pregnancy is largely underestimated, as previous research has focused on more severe injuries resulting in emergency department visits and hospitalizations. The objective of our study was to estimate the frequency, risk factors, and causes of injuries in a population-based sample of pregnant women. METHODS This article is an analysis of postpartum interviews among the control series from a case-control study (n=1,488). Maternal, pregnancy, and environmental characteristics associated with injury during pregnancy in control subjects were examined to identify population-based risk factors for injury. We collected data on self-reported injury during pregnancy, including the month of pregnancy, whether medical attention was sought, the mechanism of injury, and the number and location of bodily injuries. Logistic regression was used to calculate unadjusted and adjusted odds ratios (aORs) of injury. RESULTS Over 5% of women reported an injury during pregnancy, with falls being the most common mechanism of injury. Women at highest adjusted risk for injury had unintended pregnancies (aOR: 2.28 [1.40-3.70]) and no partner during pregnancy (aOR: 2.45 [1.16-5.17]) relative to women without injuries. CONCLUSIONS Pregnant women with risk factors for many pregnancy-related complications are also at increased risk of injury during pregnancy. Further studies of pregnancy-related injuries are needed to consider environmental and maternal characteristics on risk of injury.
Collapse
Affiliation(s)
- Karisa K Harland
- 1 Injury Prevention Research Center, University of Iowa , Iowa City, Iowa
| | | | | | | |
Collapse
|
23
|
Abstract
Trauma in pregnancy is the leading non-obstetrical cause of maternal death and remains the most common cause of foetal demise. Many diagnostic and management challenges are present when dealing with the injured pregnant patient. Anatomical and physiological variations of pregnancy need to be understood in order to adapt medical management and overcome the numerous challenges which exist for such patients. The relative unfamiliarity of anatomical and physiological changes experienced in pregnancy means great care must be taken when managing such patients, especially in high energy trauma injuries. Review of the available evidence provides an epidemiological understanding for provision of trauma services. Obstetrics in trauma is a relative rare condition in the United Kingdom, however evidence based in the UK regarding the epidemiology is limited. This article also outlines the principle factors for the assessment and treatment of the injured obstetric patients, as well as discussing areas of ongoing uncertainty.
Collapse
Affiliation(s)
| | | | - Justin Chu
- Birmingham Women’s Hospital, Birmingham, UK
| | | |
Collapse
|
24
|
Sela HY, Einav S. Injury in motor vehicle accidents during pregnancy: a pregnant issue. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.10.68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
25
|
Engel S, Ferrara G. Obstetric outcomes in women who sustained a spinal cord injury during pregnancy. Spinal Cord 2012; 51:170-1. [PMID: 23247014 DOI: 10.1038/sc.2012.125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Case report. SETTING Prince of Wales Spinal Cord Injuries Unit, Sydney, Australia. METHODS Interrogation of our unit database identified only two women who became spinal cord injured while pregnant; their medical records were reviewed and an unstructured follow-up telephone interview conducted 6 years after discharge. Case 1: CC sustained a fracture dislocation with paraplegia at the sixth thoracic level (T6) in a motorbike accident while she was pregnant, 12-week gestational age (GA). Profound shock and hypoxia complicated the injury and recurrent urinary tract infections complicated the rest of her pregnancy. A baby with arthrogryposis multiplex congenita was delivered at full term. Severe cerebral palsy (CP) and deafness were present at follow-up 6 years later. Case 2: A 33-year-old multigravida, 27 weeks GA, developed sudden, spontaneous onset of paraplegia (T3 ASIA B) due to an extradural haematoma, which was evacuated on the day of admission. Systolic blood pressure was maintained above 90 mm Hg during and after surgery. A normal, healthy boy was delivered by caesarean section at 40 weeks GA and remained so at 6 years. CONCLUSION Traumatic spinal cord injury (SCI) with its attendant multiple potential insults to the developing foetus results in a high risk of foetal loss and malformation particularly in the first trimester. However, if the injury occurs later in pregnancy and if blood pressure and oxygenation are maintained, the risk of foetal loss and abnormality may be substantially reduced.
Collapse
Affiliation(s)
- S Engel
- Department of Spinal Medicine Prince of Wales Hospital, Sydney, New South Wales, Australia.
| | | |
Collapse
|
26
|
Mesdaghinia E, Sooky Z, Mesdaghinia A. Causes of trauma in pregnant women referred to shabih-khani maternity hospital in kashan. ARCHIVES OF TRAUMA RESEARCH 2012; 1:23-6. [PMID: 24719837 PMCID: PMC3955936 DOI: 10.5812/atr.5291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 10/12/2011] [Accepted: 02/10/2012] [Indexed: 11/16/2022]
Abstract
Background Trauma occurs in 7% of pregnancies and is a major cause of morbidity and mortality in the mother and fetus. Objectives The present study was conducted in Kashan in 2009–2010 to evaluate the causes of trauma in pregnancy. Patients and Methods This descriptive study analyzed data from 32 pregnant women with trauma who were referred to the maternity hospital from 2009 to 2010. Data included age, gestational age, mother’s occupation, cause of trauma, maternal-fetal complications, gravidity, and parity. The diagnosis of maternal and fetal complications was based on clinical examinations by a gynecologist and results of blood tests, urine analysis tests, and sonography. Data were analyzed as frequency distributions. Results the causes of trauma included falling (9 cases (28.1%)), abdominal trauma (8 cases ( 25%)), spousal feud (3 cases (9.4%)), motorcycle accident (2 cases (6.25%)), car accident (2 cases (6.25%)), falling from a motorcycle (2 cases (6.25%)), falling or fainting resulting in head trauma (1 case (3.1%)), pain from crossing over a bump in the car (1 cases (3.1%)), and unspecified causes (4 cases (12.55%)). The causes of traumas occurred between 5 and 40 weeks of gestation. In 17.2% of the cases, trauma occurred prior to 20 weeks of gestation. However, there was no significant relationship between the cause of trauma and maternal age or gestational age. Vaginal bleeding and retroplacental clots were reported in 2 (6.25%) cases and 1 (3.1%) case, respectively. Conclusions Nearly half of the women presenting with trauma had experienced spousal feud or domestic violence; therefore, it is necessary to recognize spousal abuse and provide adequate support to traumatized pregnant women.
Collapse
Affiliation(s)
- Elaheh Mesdaghinia
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Zahra Sooky
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Zahra Sooky, Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran, Tel: +98-9121461374, Fax: +98- 3615556633, E-mail:
| | - Azam Mesdaghinia
- Department of Pharmacology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran
| |
Collapse
|
27
|
Causes of Trauma in Pregnant Women Referred to Shabih-Khani Maternity Hospital in Kashan. ARCHIVES OF TRAUMA RESEARCH 2012. [DOI: 10.5812/atr.5382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
28
|
Melamed N, Aviram A, Silver M, Peled Y, Wiznitzer A, Glezerman M, Yogev Y. Pregnancy course and outcome following blunt trauma. J Matern Fetal Neonatal Med 2012; 25:1612-7. [PMID: 22191714 DOI: 10.3109/14767058.2011.648243] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nir Melamed
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
| | | | | | | | | | | | | |
Collapse
|
29
|
|
30
|
Jorgensen AM, Mendoza GJ, Henderson JL. Emergency Preparedness and Disaster Response Core Competency Set for Perinatal and Neonatal Nurses. J Obstet Gynecol Neonatal Nurs 2010; 39:450-65, quiz 465-7. [DOI: 10.1111/j.1552-6909.2010.01157.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
31
|
Abstract
Trauma complicates approximately 6-7% of all pregnancies and is associated with significant maternal and fetal morbidity and mortality. While the majority of trauma is minor, it is minor trauma that contributes to the majority of fetal mortality. Since virtually every organ system is affected anatomically and physiologically by pregnancy, it is important for healthcare providers who care for trauma victims to be aware of these changes. While assessment and resuscitation considers the existence of two patients, stabilization of the mother takes priority. Diagnostic and radiologic procedures should be used as indicated, with fetal exposure to radiation limited as much as possible. Management of the pregnant trauma victim requires a multidisciplinary approach in order to optimize outcome for mother and fetus. This review discusses the epidemiology, assessment and treatment of pregnant trauma patients and reviews areas where prevention efforts may be focused.
Collapse
Affiliation(s)
- Christina C Hill
- Department of Obstetrics & Gynecology, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859-5000, USA.
| |
Collapse
|
32
|
Weiss HB, Sauber-Schatz EK, Cook LJ. The epidemiology of pregnancy-associated emergency department injury visits and their impact on birth outcomes. ACCIDENT; ANALYSIS AND PREVENTION 2008; 40:1088-1095. [PMID: 18460377 DOI: 10.1016/j.aap.2007.11.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 10/19/2007] [Accepted: 11/30/2007] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Describe the demographics, injury types, mechanisms, and intents of emergency department (ED) injury visits by pregnant women and to quantify their risk of adverse birth outcomes. METHODS Through a retrospective cohort study design, Utah ED, birth, and fetal death records were probabilistically linked to identify women seen in an ED with an injury during pregnancy among births and fetal deaths from 1999 to 2002. Logistic regression was used to assess the effect of having an injury-related ED visit on various adverse pregnancy outcomes. RESULTS 7350 (3.9%) women experienced an injury-related ED visit during pregnancy. Motor vehicle occupant injuries were the leading mechanism of ED injury visits (22.4%). Controlling for known risks, pregnant women with an injury-related ED visit were more likely than non-injured pregnant women to experience preterm labor (OR=1.22, 95% CI=1.12-1.34), placental abruption (OR=1.33, 95% CI=1.08-1.65), and cesarean delivery (OR=1.27, 95% CI=1.19-1.36). Infants born to women who were injured during pregnancy were more likely to be born preterm (OR=1.23, 95% CI=1.12-1.34) and have low birth weight (OR=1.22, 95% CI=1.1-1.35). CONCLUSIONS Most injured pregnant women are treated and released from the ED; however, significant increased risks remain for several maternal complications and birth outcomes.
Collapse
Affiliation(s)
- Harold B Weiss
- University of Pittsburgh, Department of Neurological Surgery, Center for Injury Research and Control, PARKV 203, 3520 Forbes Avenue, Pittsburgh, PA 15261, USA.
| | | | | |
Collapse
|
33
|
Hill CC, Pickinpaugh J. Trauma and Surgical Emergencies in the Obstetric Patient. Surg Clin North Am 2008; 88:421-40, viii. [DOI: 10.1016/j.suc.2007.12.006] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
34
|
Abstract
The care of the pregnant trauma patient provides unique challenges and holds profound implications for both fetal and maternal outcomes. The management of these patients is influenced by unique anatomic and physiologic changes, increased concern for deleterious radiation and medication exposures, and the need for multidisciplinary care. This article reviews the critical features necessary in the assessment, diagnosis, treatment, and disposition of pregnant trauma patients with a focus on recent developments reported in the literature as pertinent to emergency management.
Collapse
Affiliation(s)
- Seric S Cusick
- Department of Emergency Medicine, UC Davis School of Medicine, PSSB, 4150 V Street, #2100, Sacramento, CA 95817, USA
| | | |
Collapse
|
35
|
Abstract
Traumatic injuries although uncommon (affect 6% to 7% of all pregnancies) are associated with poor maternal, fetal, neonatal, and infant outcomes. The magnitude of the problem is most likely largely underestimated secondary to lack of standardized reporting. Newer data are available that stratify maternal risk by type of injury sustained, and may assist in evaluation of the pregnant trauma victim. Long-term adverse events after maternal discharge for a traumatic injury are emerging, and suggest closer monitoring of the patient for preterm labor, growth restriction, and placental abruption during the affected pregnancy.
Collapse
Affiliation(s)
- Dina El Kady
- North Shore University Hospital, New York University, Manhasset, New York 11030, USA.
| |
Collapse
|