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April MD, Long B. Trauma in pregnancy: A narrative review of the current literature. Am J Emerg Med 2024; 81:53-61. [PMID: 38663304 DOI: 10.1016/j.ajem.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION Trauma accounts for nearly half of all deaths of pregnant women. Pregnant women have distinct physiologic and anatomic characteristics which complicate their management following major trauma. OBJECTIVE This paper comprises a narrative review of the most recent literature informing the management of pregnant trauma patients. DISCUSSION The incidence of trauma during pregnancy is 6-8%. The focus of clinical assessment must be on the mother, starting with the primary survey. During airway management, clinicians should consider early intubation if necessary and utilize gastric tubes to minimize the risk of aspiration. Pregnant women experience progesterone-mediated hyperventilation, and normal PaCO2 levels may portend imminent respiratory failure. Clinicians should utilize left lateral tilt in hypotensive pregnant women to displace the uterus off the inferior vena cava. Ultrasonography is an attractive imaging modality for pregnant women which is specific for ruling in intraabdominal hemorrhage but not sufficiently sensitive to exclude this diagnosis. Clinicians should not hesitate to order computed tomography imaging in unstable patients if there is diagnostic ambiguity. Cardiotocographic monitoring simultaneously assesses uterine contractions and fetal heart rate and should last at least 4 h for pregnant women following even minor abdominal trauma if their fetus has achieved viable gestational age (approximately 24 weeks). In the event of cardiac arrest, peri-mortem cesarean section may improve outcomes for the mother and fetus alike. Unique specific complications include uterine rupture and placental abruption, which require emergent resuscitation and obstetrics consultation for definitive management. Emergency clinicians should maintain a low threshold for transfer to a tertiary care center given correlations between even isolated and relatively minor traumatic injuries with adverse fetal and maternal outcomes. CONCLUSIONS Trauma is a common cause of morbidity and mortality in pregnant women. Emergency clinicians must understand the evaluation and management of pregnant trauma patients.
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Affiliation(s)
- Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 14th Field Hospital, Fort Stewart, GA, USA.
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Huang RS, Spence AR, Abenhaim HA. Non-Obstetric Maternal Mortality Trends by Race in the United States. Matern Child Health J 2024; 28:895-904. [PMID: 38147278 DOI: 10.1007/s10995-023-03862-7] [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: 12/11/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES Public health interventions to reduce maternal mortality have largely focused on obstetric causes of death. However, previous studies have noted that non-obstetrics factors, such as motor vehicle accidents, substance overdoses, homicides, and suicides, may account for a large proportion of maternal deaths. The study objective was to examine trends in maternal deaths from non-obstetric causes across races in the United States (US). METHODS A population-based cross-sectional study was conducted on 80,710,348 live births using data from the "Birth Data" and "Mortality Multiple Cause" files compiled by the Centers for Disease Control and Prevention from 2000 to 2019. The annual incidence of maternal deaths attributed to non-obstetric causes (/100,000 live-births) during pregnancy and up to 42 days postpartum were calculated across racial groups. Then the effects of race on the risk of non-obstetric maternal mortality and temporal changes over the study period were examined using logistic regression models. RESULTS From 2000 to 2019, a total 7,334 women died during pregnancy, childbirth, and within 42 days postpartum from non-obstetric causes, representing 34.5% (7,334/21,241) of all maternal mortality. Of non-obstetric deaths, 31.3% were caused by transport accidents and 27.3% by accidental poisoning. American Indian women were found to have the highest risk of non-obstetric maternal mortality (OR 2.20,95% CI 1.90-2.56), and 46.1% (176/382) of all deaths among pregnant American Indian women were caused by non-obstetric complications. Risk of non-obstetric maternal mortality increased overall during the 20-year study period, with a greater increase among Black (1.15, 1.13-1.17) and American Indian women (1.17, 1.13-1.21). CONCLUSION Non-obstetric causes of death have become increasingly prevalent in the US, especially in American Indian women. Novel interventions to address these non-obstetric factors should especially target American Indian women to improve maternal outcomes.
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Affiliation(s)
- Ryan S Huang
- Division of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Andrea R Spence
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, 5790 Cote-Des Neiges, Pav. H 325, Montreal, QC, H3S 1Y9, Canada.
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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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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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Abdullahi AS, Yasin YJ, Shah SM, Ahmed LA, Grivna M. Seat belt use among pregnant women in the United Arab Emirates: the Mutaba'ah Study. Inj Prev 2024; 30:108-113. [PMID: 37940378 DOI: 10.1136/ip-2023-045047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/04/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Motor vehicle collisions are a major cause of death and injury among pregnant women and their fetuses. Seat belt use compliance during pregnancy varies in different populations. We aimed to study seat belt use among pregnant women and factors affecting seat belt use during pregnancy in Al Ain City, the United Arab Emirates. METHODS This cross-sectional analysis used the baseline data collected from pregnant women participating in the Mutaba'ah Study from May 2017 to November 2022. Data were collected using self-administered questionnaires. Variables included sociodemographic, gestation periods and seat belt-related information. All pregnant women who responded to the questions related to seat belt use were included (N=2354). RESULTS Seat belt use before and during pregnancy was estimated at 69.7% (95% CI 67.9% to 71.6%) and 65.5% (95% CI 63.6% to 67.4%), respectively. The reasons for not using seat belts during pregnancy included being uncomfortable to wear, habitual non-use and considering them unsafe for pregnancy. Age, higher levels of education of the pregnant woman or her spouse, being employed, having a sufficient household income, lower gestational age, and using a seat belt before pregnancy were positively associated with using a seat belt during pregnancy in the bivariate analyses. Pregnant women in their third trimester had independently significant lower odds of using a seat belt compared with those in the first trimester (OR 0.42, 95% CI 0.24 to 0.76). CONCLUSIONS The findings indicate decreased compliance with seat belt use during pregnancy and as gestation progressed. The decrease was related to several reasons, including feeling uncomfortable wearing seat belts, habitual non-use and unsafe for pregnancy, necessitating appropriate measures to increase awareness. Raising public awareness about the advantages of wearing seat belts during pregnancy and the involvement of healthcare professionals in educating pregnant women are warranted.
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Affiliation(s)
- Aminu S Abdullahi
- Institute of Public Health, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi, UAE
| | - Yasin J Yasin
- Institute of Public Health, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi, UAE
- Department of Environmental Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Syed M Shah
- Institute of Public Health, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi, UAE
| | - Luai A Ahmed
- Institute of Public Health, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi, UAE
| | - Michal Grivna
- Institute of Public Health, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Abu Dhabi, UAE
- Department of Public Health and Preventive Medicine, Second Faculty of Medicine, Charles University, Prague, Czechia
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6
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Lucas AN, Tay-Lasso E, Zezoff DC, 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, Kirby KA, Nahmias J. Significant variation in computed tomography imaging of pregnant trauma patients: a retrospective multicenter study. Emerg Radiol 2024; 31:53-61. [PMID: 38150084 PMCID: PMC10830714 DOI: 10.1007/s10140-023-02195-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/08/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Following motor vehicle collisions (MVCs), patients often undergo extensive computed tomography (CT) imaging. However, pregnant trauma patients (PTPs) represent a unique population where the risk of fetal radiation may supersede the benefits of liberal CT imaging. This study sought to evaluate imaging practices for PTPs, hypothesizing variability in CT imaging among trauma centers. If demonstrated, this might suggest the need to develop specific guidelines to standardize practice. METHODS A multicenter retrospective study (2016-2021) was performed at 12 Level-I/II trauma centers. Adult (≥18 years old) PTPs involved in MVCs were included, with no patients excluded. The primary outcome was the frequency of CT. Chi-square tests were used to compare categorical variables, and ANOVA was used to compare the means of normally distributed continuous variables. RESULTS A total of 729 PTPs sustained MVCs (73% at high speed of ≥ 25 miles per hour). Most patients were mildly injured but a small variation of injury severity score (range 1.1-4.6, p < 0.001) among centers was observed. There was a variation of imaging rates for CT head (range 11.8-62.5%, p < 0.001), cervical spine (11.8-75%, p < 0.001), chest (4.4-50.2%, p < 0.001), and abdomen/pelvis (0-57.3%, p < 0.001). In high-speed MVCs, there was variation for CT head (12.5-64.3%, p < 0.001), cervical spine (16.7-75%, p < 0.001), chest (5.9-83.3%, p < 0.001), and abdomen/pelvis (0-60%, p < 0.001). There was no difference in mortality (0-2.9%, p =0.19). CONCLUSION Significant variability of CT imaging in PTPs after MVCs was demonstrated across 12 trauma centers, supporting the need for standardization of CT imaging for PTPs to reduce unnecessary radiation exposure while ensuring optimal injury identification is achieved.
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Affiliation(s)
- Alexa N Lucas
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Erika Tay-Lasso
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 3800 W. Chapman Ave., Suite 6200, Orange, CA, 92868, USA
| | - Danielle C Zezoff
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, 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
- Department of Trauma, Acute Care Surgery, Surgical Critical Care, Loma Linda Medical Center, Loma Linda, CA, USA
| | - Alden Dahan
- Riverside School of Medicine, University of California, Riverside, CA, USA
| | - Arianne Johnson
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - William Ganske
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Walter L Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA
| | - Dunya Bayat
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA
| | - Matthew Castelo
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA
| | | | - Dennis J Zheng
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Areti Tillou
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System Medical Center, Riverside, CA, USA
| | - Rahul Tuli
- Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System Medical Center, Riverside, CA, USA
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Brent Emigh
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - 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
| | - Katharine A Kirby
- Center for Statistical Consulting, Department of Statistics, University of California Irvine, Irvine, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 3800 W. Chapman Ave., Suite 6200, Orange, CA, 92868, 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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8
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Aryan N, Grigorian A, Lucas AN, Tay-Lasso E, Zezoff DC, Fierro N, Dhillon NK, Ley EJ, Smith J, Dahan A, Johnson A, Ganske W, Biffl WL, Bayat D, Castelo M, Wintz D, Schaffer KB, Zheng DJ, Tillou A, Coimbra R, Santorelli JE, Schellenberg M, Inaba K, Emigh B, Duncan TK, Diaz G, Burruss S, Tuli R, Nahmias J. Outcomes for advanced aged (35 and older) versus younger aged pregnant trauma patients: A multicenter study. Am J Surg 2023; 226:798-802. [PMID: 37355376 DOI: 10.1016/j.amjsurg.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Effects of advanced maternal age (AMA) pregnancies (defined as ≥35 years) on pregnant trauma patients (PTPs) are unknown. This study compared AMA versus younger PTPs, hypothesizing AMA PTPs have increased risk of fetal delivery (FD). METHODS A retrospective (2016-2021) multicenter study included all PTPs. Multivariable logistic regression was used to evaluate risk of FD after trauma. RESULTS A total of 950 PTPs were included. Both cohorts had similar gestational age and injury severity scores. The AMA group had increased injuries to the pancreas, bladder, and stomach (p < 0.05). There was no difference in rate or associated risk of FD between cohorts (5.3% vs. 11.4%; OR 0.59, CI 0.19-1.88, p > 0.05). CONCLUSION Compared to their younger counterparts, some intra-abdominal injuries (pancreas, bladder, and stomach) were more common among AMA PTPs. However, there was no difference in rate or associated risk of FD in AMA PTPs, thus they do not require increased observation.
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Affiliation(s)
- Negaar Aryan
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Alexa N Lucas
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Erika Tay-Lasso
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Danielle C Zezoff
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Nicole Fierro
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Navpreet K Dhillon
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Eric J Ley
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Jennifer Smith
- Division of Trauma and Critical Care, Harbor-UCLA Hospital, Torrance, CA, USA.
| | - Alden Dahan
- University of California, Riverside School of Medicine, Riverside, CA, USA.
| | - Arianne Johnson
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
| | - William Ganske
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
| | - Walter L Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
| | - Dunya Bayat
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
| | - Matthew Castelo
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA.
| | | | - Dennis J Zheng
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Areti Tillou
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, CA, USA.
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA, USA.
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
| | - Kenji Inaba
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
| | - Brent Emigh
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA; Warren Alpert Medical School at Brown University, Department of Surgery, Division of Trauma, USA.
| | - Thomas K Duncan
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA.
| | - Graal Diaz
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA.
| | - Sigrid Burruss
- Department of Trauma, Acute Care Surgery, Surgical Critical Care, Loma Linda Medical Center, Loma Linda, CA, USA.
| | - Rahul Tuli
- Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, University of California Riverside School of Medicine, CA, USA.
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
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Chambers M, Nguyen Pham A, Milone G, Licon E, Bakhta Y, Chan K. A case of traumatic uterine avulsion in pregnancy. Trauma Case Rep 2023; 47:100920. [PMID: 37705926 PMCID: PMC10495616 DOI: 10.1016/j.tcr.2023.100920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/15/2023] Open
Abstract
Complete uterine avulsion is an extremely rare complication of trauma sustained during pregnancy. We present the case of a 21-year-old nullipara at 16 weeks' gestation who was involved in a high-speed motor vehicle collision with subsequent fetal demise. Initially she was hemodynamically stable and demonstrated small amounts of intraabdominal free fluid, therefore multidisciplinary conservative measures were undertaken. However, as her condition worsened, she was taken for exploratory laparotomy, revealing complete gravid uterine avulsion at the level of the cervicoisthmic junction. Due to hemodynamic instability and concerns for retroperitoneal bleeding, a supracervical hysterectomy was performed. Although a rare occurrence, our case demonstrates the need for a high level of suspicion for uterine avulsion in certain cases of trauma in pregnancy. This highlights the false reassurance provided by stable vitals in a pregnant patient that may mask ongoing bleeding and development of hemorrhagic shock, the importance of interpreting different imaging modalities together when the cause of instability is unclear, and the utility of a multidisciplinary approach. While our patient underwent hysterectomy due to hemodynamic instability, it is unknown whether earlier investigation with laparoscopy to confirm uterine integrity may have circumvented this and allowed for fertility-sparing management. As such, our case encourages the utilization of early diagnostic laparoscopy if there is concern for uterine avulsion for the consideration of alternative surgical interventions for management.
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Affiliation(s)
- M.E. Chambers
- University of California, Irvine, Department of Obstetrics & Gynecology, 3800 West Chapman Ave, Suite 3400, Orange, CA 92868, United States of America
| | - A.B. Nguyen Pham
- University of California, Irvine, Department of Obstetrics & Gynecology, 3800 West Chapman Ave, Suite 3400, Orange, CA 92868, United States of America
| | - G.F. Milone
- University of California, Irvine, Department of Obstetrics & Gynecology, 3800 West Chapman Ave, Suite 3400, Orange, CA 92868, United States of America
| | - E. Licon
- University of California, Irvine, Department of Obstetrics & Gynecology, 3800 West Chapman Ave, Suite 3400, Orange, CA 92868, United States of America
| | - Y.A. Bakhta
- University of California, Irvine, Department of Obstetrics & Gynecology, 3800 West Chapman Ave, Suite 3400, Orange, CA 92868, United States of America
| | - K.K. Chan
- University of California, Irvine, Department of Obstetrics & Gynecology, 3800 West Chapman Ave, Suite 3400, Orange, CA 92868, United States of America
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10
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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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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.
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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.
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12
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Abback PS, Benchetrit A, Delhaye N, Daire JL, James A, Neuschwander A, Boutonnet M, Cook F, Vinour H, Hanouz JL, Cotte J, Pastene B, Jouffroy V, Gauss T, Group T. Multiple trauma in pregnant women: injury assessment, fetal radiation exposure and mortality. A multicentre observational study. Scand J Trauma Resusc Emerg Med 2023; 31:22. [PMID: 37131266 PMCID: PMC10152762 DOI: 10.1186/s13049-023-01084-y] [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: 01/10/2023] [Accepted: 04/01/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Fetal radiation exposure in pregnant women with trauma is a concern. The purpose of this study was to evaluate fetal radiation exposure with regard to the type of injury assessment performed. METHODS It is a multicentre observational study. The cohort study included all pregnant women suspected of severe traumatic injury in the participating centres of a national trauma research network. The primary outcome was the cumulative radiation dose (mGy) received by the fetus with respect to the type of injury assessment initiated by the physician in charge of the pregnant patient. Secondary outcomes were maternal and fetal morbi-mortality, the incidence of haemorrhagic shock and the physicians' imaging assessment with consideration of their medical specialty. RESULTS Fifty-four pregnant women were admitted for potential major trauma between September 2011 and December 2019 in the 21 participating centres. The median gestational age was 22 weeks [12-30]. 78% of women (n = 42) underwent WBCT. The remaining patients underwent radiographs, ultrasound or selective CT scans based on clinical examination. The median fetal radiation doses were 38 mGy [23-63] and 0 mGy [0-1]. Maternal mortality (6%) was lower than fetal mortality (17%). Two women (out of 3 maternal deaths) and 7 fetuses (out of 9 fetal deaths) died within the first 24 h following trauma. CONCLUSIONS Immediate WBCT for initial injury assessment in pregnant women with trauma was associated with a fetal radiation dose below the 100 mGy threshold. Among the selected population with either a stable status with a moderate and nonthreatening injury pattern or isolated penetrating trauma, a selective strategy seemed safe in experienced centres.
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Affiliation(s)
- Paer-Selim Abback
- Department of Anesthesiology and Intensive Care, AP-HP.Nord, Beaujon Hospital, DMU PARABOL, 100 boulevard du General Leclerc, Clichy, 92110, France.
| | - Alison Benchetrit
- Department of Anesthesiology, Burn and Critical Care, Saint-Louis-Lariboisiere University Hospital, APHP, Paris, France
| | - Nathalie Delhaye
- Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Jean-Luc Daire
- Radiology department, AP-HP.Nord, Beaujon Hospital, Clichy, France
| | - Arthur James
- DMU DREAM, Department of Anesthesiology and critical care, Sorbonne University, AP-HP, Pitié-Salpêtrière Hospital, GRC 29, Paris, France
| | - Arthur Neuschwander
- Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Mathieu Boutonnet
- Department of Anesthesiology and Intensive Care, Percy Military Teaching Hospital, Clamart, France
| | - Fabrice Cook
- Service d'Anesthésie et des Réanimations chirurgicales, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (APHP), Créteil, France
| | - Hélène Vinour
- Department of Anesthesiology and Critical Care, Toulouse University Hospital, University, Toulouse, France
| | - Jean-Luc Hanouz
- Department of Anesthesiology and Intensive Care, University Hospital of Caen, Caen, France
| | - Jean Cotte
- Intensive Care Unit, HIA Sainte Anne, Military Teaching Hospital, Toulon, France
| | - Bruno Pastene
- Department of Anesthesiology and Critical Care, Nord Hospital, Assistance Publique Hôpitaux Universitaires de Marseille, Aix Marseille Université, Marseille, France
| | - Viridiana Jouffroy
- Department of Anesthesiology and Intensive Care, AP-HP, Kremlin-Bicêtre Hospital, Kremlin-Bicêtre, France
| | - Tobias Gauss
- Department of Anesthesiology and Intensive Care, AP-HP.Nord, Beaujon Hospital, DMU PARABOL, 100 boulevard du General Leclerc, Clichy, 92110, France
| | - Traumabase Group
- Department of Anesthesiology and Intensive Care, AP-HP.Nord, Beaujon Hospital, DMU PARABOL, 100 boulevard du General Leclerc, Clichy, 92110, France
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13
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Lopez CE, Salloum J, Varon AJ, Toledo P, Dudaryk R. The Management of Pregnant Trauma Patients: A Narrative Review. Anesth Analg 2023; 136:830-840. [PMID: 37058718 DOI: 10.1213/ane.0000000000006363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Trauma is the leading nonobstetric cause of maternal death and affects 1 in 12 pregnancies in the United States. Adhering to the fundamentals of the advanced trauma life support (ATLS) framework is the most important component of care in this patient population. Understanding the significant physiologic changes of pregnancy, especially with regard to the respiratory, cardiovascular, and hematologic systems, will aid in airway, breathing, and circulation components of resuscitation. In addition to trauma resuscitation, pregnant patients should undergo left uterine displacement, insertion of 2 large bore intravenous lines placed above the level of the diaphragm, careful airway management factoring in physiologic changes of pregnancy, and resuscitation with a balanced ratio of blood products. Early notification of obstetric providers, initiation of secondary assessment for obstetric complications, and fetal assessment should be undertaken as soon as possible but without interference to maternal trauma assessment and management. In general, viable fetuses are monitored by continuous fetal heart rate for at least 4 hours or more if abnormalities are detected. Moreover, fetal distress may be an early sign of maternal deterioration. When indicated, imaging studies should not be limited out of fear for fetal radiation exposure. Resuscitative hysterotomy should be considered in patients approaching 22 to 24 weeks of gestation, who arrive in cardiac arrest or present with profound hemodynamic instability due to hypovolemic shock.
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Affiliation(s)
- Carmen E Lopez
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joe Salloum
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Albert J Varon
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, Florida
| | - Paloma Toledo
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, Florida
| | - Roman Dudaryk
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, Florida
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14
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Ali A, Simpson JT, Tatum D, Sedhom JA, Broome J, McGrew PR, Duchesne J, Taghavi S. Traumatic Injury in Pregnancy: A Propensity Score-Matched Analysis. J Surg Res 2023; 283:1018-1025. [PMID: 36914991 DOI: 10.1016/j.jss.2022.10.087] [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: 07/14/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Trauma represents the leading cause of nonobstetrical maternal death. How in-hospital outcomes of acutely injured pregnant patients (PP) compares to that of similarly aged nonpregnant control groups (CGs) has not been described. We hypothesized that PPs suffering acute traumatic injuries would have worse outcomes compared to a matched CG. MATERIALS AND METHODS The American College of Surgeons Trauma Quality Improvement Program (TQIP) was used to identify traumatically injured females between 2017 and 2019. Propensity score matching on age, race, injury severity score , and type of trauma (blunt, penetrating, or other) was used to compare PPs and the CG. Primary outcomes were mortality, disposition, length of stay (LOS), and complications. RESULTS A total of 1078 traumatically injured pregnant females were identified. Propensity score matching resulted in 990 patients in the PP and CG cohorts. After matching, PPs were more likely to be assault victims (11% versus 6%, P < 0.001), had longer length of stay (LOS) (5 versus 3 d, P < 0.001), and were more likely to require mechanical ventilation (26% versus 16%, P < 0.001) or intensive care unit (ICU) admission (44% versus 32%, P < 0.001). PPs were more likely to proceed directly to the operating room (OR)(34% versus 15%, P < 0.001) and less likely to be discharged home from the emergency department (ED) (1% versus 12%, P < 0.001). Complications and mortality rates were similar among PPs. CONCLUSIONS After acute trauma, PPs did not have increased mortality or complications when compared to matched controls, although they were more likely to be victims of assault, directly proceed to the OR, require mechanical ventilation or ICU admission, and have longer LOSs.
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Affiliation(s)
- Ayman Ali
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - John T Simpson
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - Danielle Tatum
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - Jessica A Sedhom
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - Jacob Broome
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - Patrick R McGrew
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - Juan Duchesne
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - Sharven Taghavi
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana.
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15
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Carr H, Jones R. Trauma in the Obstetric Patient. Crit Care Nurs Clin North Am 2023; 35:213-222. [PMID: 37127377 DOI: 10.1016/j.cnc.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
The authors provide a concise, comprehensive overview of the unique anatomic and physiologic features of pregnancy as well as modification and considerations important for the management of the pregnant trauma patient.
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16
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Chen R, Zhou W, Wang Z, Cheng Z. A Rare Secondary Dysmenorrhea Resulted from Separation of Corpus Uteri from Cervix: A Case Report and Literature Review. J Minim Invasive Gynecol 2023; 30:240-244. [PMID: 36402379 DOI: 10.1016/j.jmig.2022.11.005] [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: 08/18/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022]
Abstract
Secondary dysmenorrhea is a pain associated with disease such as endometriosis, pelvic inflammatory disease, leiomyomas, and interstitial cystitis. Treatment of secondary dysmenorrhea always focuses on the causative pelvic pathology or medical condition. Here, we found a rare case with secondary dysmenorrhea that resulted from traumatic separation of the uterine corpus from the cervix. In this case, the patient experienced a childhood blunt trauma of the pelvic crush and was successfully diagnosed by magnetic resonance imaging and 3-dimensional ultrasonography. Moreover, laparoscopic anastomosis could be a minimally invasive way to resolve this problem.
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Affiliation(s)
- Rong Chen
- Department of Gynecology and Obstetrics, Shanghai Tenth People's Hospital (Drs. Chen, Zhou, Wang, and Cheng); Tongji University School of Medicine (Drs. Chen, Zhou, Wang, and Cheng); Institute of Gynecologic Minimal Invasive Medicine, Tongji University (Drs. Chen, Zhou, and Cheng), Shanghai, P.R. China
| | - Wenni Zhou
- Department of Gynecology and Obstetrics, Shanghai Tenth People's Hospital (Drs. Chen, Zhou, Wang, and Cheng); Tongji University School of Medicine (Drs. Chen, Zhou, Wang, and Cheng); Institute of Gynecologic Minimal Invasive Medicine, Tongji University (Drs. Chen, Zhou, and Cheng), Shanghai, P.R. China
| | - Zhongjie Wang
- Department of Gynecology and Obstetrics, Shanghai Tenth People's Hospital (Drs. Chen, Zhou, Wang, and Cheng); Tongji University School of Medicine (Drs. Chen, Zhou, Wang, and Cheng)
| | - Zhongping Cheng
- Department of Gynecology and Obstetrics, Shanghai Tenth People's Hospital (Drs. Chen, Zhou, Wang, and Cheng); Tongji University School of Medicine (Drs. Chen, Zhou, Wang, and Cheng); Institute of Gynecologic Minimal Invasive Medicine, Tongji University (Drs. Chen, Zhou, and Cheng), Shanghai, P.R. China.
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17
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Gopireddy DR, Kee-Sampson JW, Vulasala SSR, Stein R, Kumar S, Virarkar M. Imaging of penetrating vascular trauma of the body and extremities secondary to ballistic and stab wounds. J Clin Imaging Sci 2023; 13:1. [PMID: 36751564 PMCID: PMC9899476 DOI: 10.25259/jcis_99_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023] Open
Abstract
In the United States, gunshot wounds (GSWs) have become a critical public health concern with substantial annual morbidity, disability, and mortality. Vascular injuries associated with GSW may pose a clinical challenge to the physicians in the emergency department. Patients demonstrating hard signs require immediate intervention, whereas patients with soft signs can undergo further diagnostic testing for better injury delineation. Although digital subtraction angiography is the gold standard modality to assess vascular injuries, non-invasive techniques such as Doppler ultrasound, computed tomography angiography, and magnetic resonance angiography have evolved as appropriate alternatives. This article discusses penetrating bodily vascular injuries, specifically ballistic and stab wounds, and the corresponding radiological presentations.
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Affiliation(s)
- Dheeraj Reddy Gopireddy
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Joanna W. Kee-Sampson
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Sai Swarupa Reddy Vulasala
- Department of Internal Medicine, East Carolina University Health Medical Center, Greenville, North Carolina, United States.,Corresponding author: Sai Swarupa Reddy Vulasala, Department of Internal Medicine, East Carolina University Health Medical Center, Greenville, United States.
| | - Rachel Stein
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Sindhu Kumar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Mayur Virarkar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
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18
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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.
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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
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De Vito M, Capannolo G, Alameddine S, Fiorito R, Lena A, Patrizi L, D' Antonio F, Rizzo G. Trauma in pregnancy clinical practice guidelines: systematic review. J Matern Fetal Neonatal Med 2022; 35:9948-9955. [PMID: 35703623 DOI: 10.1080/14767058.2022.2078190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To objectively evaluate the methodological quality and clinical heterogeneity robustness of the published clinical practice guidelines (CPGs) on the management of trauma in pregnancy. MATERIALS AND METHODS Pubmed, Google Scholar, UpToDate, and Scopus Database were searched. The risk of bias and quality assessment of the included CPGs were performed using "The Appraisal Of Guidelines for Research and Evaluation (AGREE II)" tool. The following points relating to the management of trauma during pregnancy were addressed: quality of evidence assessment, classification of recommendations, main causes of trauma in pregnancy, importance of correct use of seat belts, ultrasound scans and/or pregnancy test in every female of reproductive age, description of physiological changes in pregnancy, classification in primary and secondary survey, primary survey based on ABCD Approach, fetus viable based on the weeks, radiographic studies for maternal evaluation, duration of fetal monitoring, use of anti-D immunoglobulin in rhesus-D-negative pregnant trauma patients, description of dose of RhD-Ig, the way to define gestational age if it was undetermined, descriptions of obstetrical complications, use of tetanus vaccination, and timing to perimortem cesarean section (CS). RESULTS Six CPGs were included. Quality of evidence assessment was described in 16.7% of CPGs (1/6), while it was not reported in 83.3% (5/6). Classification of recommendations was reported in 50% (3/3) of the CPGs. Motor vehicle crash was reported as the main cause of trauma in pregnancy in all the CPGs included in the present review, despite that the importance of a correct use of seat belts was described only in the 50% (3/6). Definition of fetal viability was also different among the included CPGs; in 50% (3/6) defined a fetus viable when it from 23 weeks, 33.3% (2/6) from 24 weeks, and 16.7% (1/6) from 20 weeks of gestation. Regarding the type of fetal monitoring, 33.3% (2/6) CPGs recommended CTG assessment at least every 4 h, 16.7% (1/6) at least every 6 h, 33.3% for 24 h if there are not reassuring signs and 16.7% (1/6) did not specify the duration of monitoring. Recommendations about the use of anti-D-immunoglobulin in rhesus-D-negative pregnant were also heterogeneous: 50% (3/6) of the CPGs suggested administration in all rhesus-D-negative pregnant women, 16.7% (1/6) only according to gestational age at trauma or in case of significant abdominal trauma, and 16.7% (1/6) only in case of positive Kleihauer test while 16.7% (1/6) did not specify it. Administration of tetanus vaccination was suggested in in 33.3% (2/6) of CPGs. Finally, there were different descriptions of timing to perimortem CS: 33.3% (2/6) of CPGs claims to do CS no later than 4 min, 50% (3/6) no later than 5 min, and 16.7% (1/6) does not describe timing for CS. The AGREE II standardized domain scores for the first overall assessment (OA1) had a mean of 69%. Only three CPGs scored more than 60% and revealed a consensus agreement between the reviewers on recommending the use of these CPGs. CONCLUSION There is clinical heterogeneity in some of the most relevant aspects of the management of pregnant women with trauma. The findings from this systematic review highlight the need for up to date and shared guidelines promoted by the main body societies in order make management of pregnant women with trauma homogenous.
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Affiliation(s)
- Marika De Vito
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Giulia Capannolo
- Department of Obstetrics and Gynecology Chieti, Università di Chieti, Chieti, Italy
| | - Sara Alameddine
- Department of Obstetrics and Gynecology Chieti, Università di Chieti, Chieti, Italy
| | - Roberto Fiorito
- Department of Surgery Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Alessandro Lena
- Department of Obstetrics and Gynecology Ospedale San Paolo Civitavecchia, Roma, Italy
| | - Lodovico Patrizi
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Francesco D' Antonio
- Department of Obstetrics and Gynecology Chieti, Università di Chieti, Chieti, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
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Stokes SC, Rubalcava NS, Theodorou CM, Bhatia MB, Gray BW, Saadai P, Russo RM, McLennan A, Bichianu DC, Austin MT, Marwan AI, Alkhoury F. Recognition and management of traumatic fetal injuries. Injury 2022; 53:1329-1344. [PMID: 35144809 DOI: 10.1016/j.injury.2022.01.037] [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] [Received: 11/28/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 02/02/2023]
Abstract
Trauma during pregnancy is the leading non-obstetric cause of morbidity and mortality, and accounts for five per 1000 fetal deaths. Direct fetal injury due to trauma during pregnancy is rare, and limited information is available about how to optimize fetal outcomes after injury. Early recognition and appropriate management of direct fetal trauma may improve outcomes for the fetus. There are currently no available guidelines to direct management of the injured fetus. We provide a detailed literature review of the management and outcomes of direct fetal injury following blunt and penetrating injury during pregnancy, and describe a suggested initial approach to the injured pregnant patient with a focus on evaluation for fetal injury. We identified 45 reported cases of blunt trauma resulting in direct fetal injury, with 21 surviving past the neonatal period, and 33 of penetrating trauma resulting in direct fetal injury, with 24 surviving past the neonatal period. Prenatal imaging identified fetal injury in 19 cases of blunt trauma and was used to identify bullet location relative to the fetus in 6 cases. These reports were used to develop management algorithms for the injured fetus.
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Affiliation(s)
- Sarah C Stokes
- Division of Pediatric General, Thoracic and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA.
| | - Nathan S Rubalcava
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI 48109, USA
| | - Christina M Theodorou
- Division of Pediatric General, Thoracic and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA
| | - Manisha B Bhatia
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Brian W Gray
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Payam Saadai
- Division of Pediatric General, Thoracic and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA
| | - Rachel M Russo
- Division of Trauma/Critical Care, Department of Surgery, University of California, Davis Medical Center, Sacramento, CA 95817, USA
| | - Amelia McLennan
- Department of Obstetrics and Gynecology, University of California Davis Medical Center, Sacramento, 95817, USA
| | - Dana C Bichianu
- Neonatology, Department of Child Health, University of Missouri, School of Medicine, Women's and Children's Hospital, Columbia, MO 65201, USA
| | - Mary T Austin
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston TX 77030, United States
| | - Ahmed I Marwan
- Division of Pediatric Surgery, University of Columbia School of Medicine, Columbia, MO, USA; Department of Pediatric Surgery, Nicklaus Children's Hospital, Miami, FL 33155, USA
| | - Fuad Alkhoury
- Division of Pediatric Surgery, University of Columbia School of Medicine, Columbia, MO, USA
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21
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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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22
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BIOMECHANICAL ASPECTS OF POSTURAL CONTROL OF THE HUMAN BODY. WORLD OF MEDICINE AND BIOLOGY 2022. [DOI: 10.26724/2079-8334-2022-4-82-181-186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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23
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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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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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Kumar S, Gupta A, Sagar S, Bagaria D, Kumar A, Choudhary N, Kumar V, Ghoshal S, Alam J, Agarwal H, Gammangatti S, Kumar A, Soni KD, Agarwal R, Gunjaganvi M, Joshi M, Saurabh G, Banerjee N, Kumar A, Rattan A, Bakhshi GD, Jain S, Shah S, Sharma P, Kalangutkar A, Chatterjee S, Sharma N, Noronha W, Mohan LN, Singh V, Gupta R, Misra S, Jain A, Dharap S, Mohan R, Priyadarshini P, Tandon M, Mishra B, Jain V, Singhal M, Meena YK, Sharma B, Garg PK, Dhagat P, Kumar S, Kumar S, Misra MC. Management of Blunt Solid Organ Injuries: the Indian Society for Trauma and Acute Care (ISTAC) Consensus Guidelines. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02820-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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26
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Wheeler ML, Oyen ML. Bioengineering Approaches for Placental Research. Ann Biomed Eng 2021; 49:1805-1818. [PMID: 33420547 DOI: 10.1007/s10439-020-02714-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022]
Abstract
Research into the human placenta's complex functioning is complicated by a lack of suitable physiological in vivo models. Two complementary approaches have emerged recently to address these gaps in understanding, computational in silico techniques, including multi-scale modeling of placental blood flow and oxygen transport, and cellular in vitro approaches, including organoids, tissue engineering, and organ-on-a-chip models. Following a brief introduction to the placenta's structure and function and its influence on the substantial clinical problem of preterm birth, these different bioengineering approaches are reviewed. The cellular techniques allow for investigation of early first-trimester implantation and placental development, including critical biological processes such as trophoblast invasion and trophoblast fusion, that are otherwise very difficult to study. Similarly, computational models of the placenta and the pregnant pelvis at later-term gestation allow for investigations relevant to complications that occur when the placenta has fully developed. To fully understand clinical conditions associated with the placenta, including those with roots in early processes but that only manifest clinically at full-term, a holistic approach to the study of this fascinating, temporary but critical organ is required.
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Affiliation(s)
- Mackenzie L Wheeler
- Department of Engineering, East Carolina University, Greenville, NC, 27834, USA
| | - Michelle L Oyen
- Department of Engineering, East Carolina University, Greenville, NC, 27834, USA.
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27
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Armbruster M, Koliogiannis V. [The (severely) injured pregnant patient from the perspective of radiology]. Unfallchirurg 2020; 123:928-935. [PMID: 33064161 DOI: 10.1007/s00113-020-00885-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Trauma is one of the leading causes of mortality in pregnant women and significantly increases the likelihood of an unwanted termination of pregnancy. Particularly in severe trauma with an increased risk of significant maternal injuries, computed tomography (CT) remains the imaging modality of choice as it is comprehensively available, quick to carry out and has a high diagnostic accuracy in the detection and classification of life-threatening trauma-associated pathologies compared to other imaging techniques. Considering the radiation-associated risks, it is unlikely that a single, monophasic CT in the emergency trauma room will exceed the threshold of deterministic radiation damage; therefore, fetal malformations or fetal loss are not to be expected; however, there is a low stochastic risk for the delayed occurrence of radiation-induced cancer both for the child and the mother that can be considered small in comparison to missed or delayed diagnoses after severe trauma. Intravenous, nonionic iodinated contrast agents are not contraindicated during pregnancy and should be administered whenever their use would also be considered appropriate in a nonpregnant patient; however, unnecessary scans and, if possible, multiple contrast agent phases should be avoided in order to reduce radiation. Magnetic resonance imaging (MRI) has a major role in the subacute setting and constitutes an excellent problem solver for specific questions, such as the evaluation of discoligamentous injuries of the spine. Its use is deemed acceptable at any stage of pregnancy when the required information is considered important for the management of further treatment. Due to potential teratogenic effects of MRI contrast media containing gadolinium on the fetus, including an increased likelihood of fetal loss, they should only be administered with great caution and under strictly defined indications.
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Affiliation(s)
- M Armbruster
- Klinik und Poliklinik für Radiologie, LMU Klinikum München, Marchionistr. 15, 81377, München, Deutschland.
| | - V Koliogiannis
- Klinik und Poliklinik für Radiologie, LMU Klinikum München, Marchionistr. 15, 81377, München, Deutschland
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Combined Acetabulum Fracture and Hip Dislocation in an 18-Year-Old Female at 35-Week Gestation: A Case Report and Review of the Literature. Case Rep Orthop 2020; 2020:8888015. [PMID: 32774967 PMCID: PMC7396045 DOI: 10.1155/2020/8888015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 12/02/2022] Open
Abstract
Caring for an injured, pregnant patient can be a management challenge. We report the case of an 18-year-old female who sustained a left acetabulum fracture with a concurrent hip dislocation at 35 weeks' gestation following a motor vehicle accident. Through an interdisciplinary, team-based approach, the patient was guided through obstetric delivery and orthopedic surgical fracture fixation without complication. By being familiar with the unique challenges in management posed by pregnant patients, orthopedic surgeons can be better equipped to minimize morbidity and mortality in this patient population while maximizing clinical outcomes.
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