A comprehensive program to improve safety for pregnant women and fetuses in motor vehicle crashes: a preliminary report

Prediction of Placental Abruption of Pregnant Women Drivers with Various Collision Velocities, Seatbelt Positions and Placental Positions-Analysis with Novel Pregnant Occupant Model

The aims of this study were as follows: the (a) creation of a pregnant occupant finite element model based on pregnant uterine data from sonography, (b) development of the evaluation method for placental abruption using this model and (c) analysis of the effects of three factors (collision speed, seatbelt position and placental position) on the severity of placental abruption in simulations of vehicle collisions. The 30-week pregnant occupant model was developed with the uterine model including the placenta, uterine-placental interface, fetus, amniotic fluid and surrounding ligaments. A method for evaluating the severity of placental abruption on this pregnant model was established, and the effects of these factors on the severity of the injury were analyzed. As a result, a higher risk of placental abruption was observed in high collision speeds, seatbelt position over the abdomen and anterior-fundal placenta. Lower collision speeds and seatbelt position on the iliac wings prevented severe placental abruption regardless of placental positions. These results suggested that safe driving and keeping seatbelt position on the iliac wings were essential to decrease the severity of this injury. From the analysis of the mechanism for placental abruption, the following hypothesis was proposed: a shear at adhesive sites between the uterus and placenta due to direct seatbelt loading to the uterus.

Maternal outcomes in association with motor vehicle crashes during pregnancy: a nationwide population-based retrospective study

BACKGROUND

Limited studies have assessed the association of motor vehicle crashes (MVCs) during pregnancy with adverse maternal outcomes using a population-based nationwide dataset that covers all MVCs.

METHODS

A total of 20 844 births from women who had been involved in MVCs during pregnancy were obtained from the National Birth Notification (BN) Database in Taiwan. We randomly selected 83 274 control births from women in the BN matched on age, gestational age and crash date. All study subjects were linked to medical claims and the Death Registry to identify the maternal outcomes after crashes. Conditional logistic regression models were used to estimate the adjusted odds ratio (aOR) and 95% CI of adverse outcomes associated with MVCs during pregnancy.

RESULTS

Pregnant women involved in MVCs had significantly higher risks of placental abruption (aOR=1.51, 95% CI 1.30 to 1.74), prolonged uterine contractions (aOR=1.31, 95% CI 1.11 to 1.53), antepartum haemorrhage (aOR=1.19, 95% CI 1.12 to 1.26) and caesarean delivery (aOR=1.05, 95% CI 1.02 to 1.09) than the controls. Such elevated risks tended to be higher in the MVCs with greater severity. Scooter riders had higher ORs of various adverse maternal outcomes than car drivers.

CONCLUSIONS

Women involved in MVCs during pregnancy were at increased risk of various adverse maternal outcomes, especially in those with severe MVCs and riding scooters at MVCs. These findings suggest that clinicians should be aware of these effects, and educational materials that include the above information should be provided as part of prenatal care.

Navigating Pregnancy for Employees in Civilian Rotary-Wing Aeromedicine

INTRODUCTION: Women of child-bearing age make up an ever-increasing element of the aeromedical workforce in Australia and the UK. However, policy relating to the management of risk for pregnant employees in this sector is often missing or inadequate, with many women facing detrimental impacts on their career progression and financial well-being. For women who choose to continue flying, there is a lack of transparent guidance about the risks of flying within a helicopter in an aeromedical role. While grounding pregnant employees removes some risks, it is at the cost of autonomy and brings other adverse effects for the employee and employer. Updated reflections on this important topic will empower the audience to make informed discussions around pregnancy in aeromedical roles.TOPIC: Applying principles from literature surrounding commercial, military, and medical aviation, the risks to pregnant employees and the fetus are reviewed. These risks are complex and dynamic depending on gestation and underlying medical problems; thus, individualization of risk management is of key importance. In low-risk pregnancies, incapacitation risk is below the usual threshold adopted for safety-sensitive aviation activities. Based on available evidence we have quantified risks where possible and provide guidance on the relevant factors to consider in creating a holistic risk-management framework. The greatest unknown surrounds the risk from vibration, noise, and winching. These are reviewed and suggestions given for discussing this risk. We also highlight the need for policy providing acceptable nonflying options to remove the pressure to continue flying in pregnancy.APPLICATION: Based on a literature review we have generated a framework for understanding and assessing risk relating to pregnant employees in the aeromedical sector. This is intended for use by aeromedical organizations, pregnant employees, and their treating medical practitioners to provide rational and sensible policy and guidance.Storey HM, Austin J, Davies-White NL, Ransley DG, Hodkinson PD. Navigating pregnancy for employees in civilian rotary-wing aeromedicine. Aerosp Med Hum Perform. 2022; 93(12):866-876.

Trauma in Pregnancy

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.

The Pregnant Trauma Patient

Trauma is the leading non-obstetric cause of maternal death. Optimal management of the pregnant trauma patient requires a multidisciplinary approach. The anaesthetist and critical care physician play a pivotal role in the entire continuum of fetomaternal care, from initial assessment, resuscitation and intraoperative management, to postoperative care that often involves critical care support and patient transfer. Primary goals are aggressive resuscitation of the mother and maintenance of uteroplacental perfusion and fetal oxygenation by the avoidance of hypoxia, hypotension, hypocapnia, acidosis and hypothermia. Recognizing and understanding the mechanisms of injury, the factors that may predict fetal outcome, and the pathophysiological changes that can result from trauma, will allow early identification and treatment of fetomaternal injury. This in turn should improve morbidity and mortality. A framework for the acute care of the pregnant trauma patient is presented.

Trauma in pregnancy: anatomical and physiological considerations

Management of a pregnant trauma victim is a relatively rare but stressful event, not least due to the need to consider two patients. Initial management by a trauma team should follow a structured approach applicable to all trauma patients, combined with knowledge of the specific problems encountered in pregnancy. This review outlines important anatomical and physiological changes that occur during pregnancy and their relevance to initial assessment and treatment. It discusses the epidemiology of trauma in pregnancy, the presentation and manage ment of specific problems and the methods of fetal assessment.

Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery

In 2011, one in three women who gave birth in the United States did so by cesarean delivery. Cesarean birth can be life-saving for the fetus, the mother, or both in certain cases. However, the rapid increase in cesarean birth rates from 1996 to 2011 without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed. The most common indications for primary cesarean delivery include, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia. Safe reduction of the rate of primary cesarean deliveries will require different approaches for each of these, as well as other, indications. For example, it may be necessary to revisit the definition of labor dystocia because recent data show that contemporary labor progresses at a rate substantially slower than what was historically taught. Additionally, improved and standardized fetal heart rate interpretation and management may have an effect. Increasing women's access to nonmedical interventions during labor, such as continuous labor and delivery support, also has been shown to reduce cesarean birth rates. External cephalic version for breech presentation and a trial of labor for women with twin gestations when the first twin is in cephalic presentation are other of several examples of interventions that can contribute to the safe lowering of the primary cesarean delivery rate.

Safe prevention of the primary cesarean delivery

In 2011, 1 in 3 women who gave birth in the United States did so by cesarean delivery. Cesarean birth can be lifesaving for the fetus, the mother, or both in certain cases. However, the rapid increase in cesarean birth rates from 1996 through 2011 without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed. The most common indications for primary cesarean delivery include, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia. Safe reduction of the rate of primary cesarean deliveries will require different approaches for each of these, as well as other, indications. For example, it may be necessary to revisit the definition of labor dystocia because recent data show that contemporary labor progresses at a rate substantially slower than what was historically taught. Additionally, improved and standardized fetal heart rate interpretation and management may have an effect. Increasing women's access to nonmedical interventions during labor, such as continuous labor and delivery support, also has been shown to reduce cesarean birth rates. External cephalic version for breech presentation and a trial of labor for women with twin gestations when the first twin is in cephalic presentation are other of several examples of interventions that can contribute to the safe lowering of the primary cesarean delivery rate.

Managing a surgical exsanguination emergency in the operating room through simulation: an interdisciplinary approach

OBJECTIVE

Operating room (OR) emergencies, such as fire, anaphylaxis, cardiac arrest, and exsanguination, are infrequent, but high-risk situations that can result in significant morbidity and mortality. An exsanguination scenario involving a pregnant trauma patient in the OR was developed for surgery residents with the objectives of improving overall team performance when activating an emergency response system, identifying a team leader, initiating an exsanguination protocol, following advanced cardiac life support guidelines, and recognizing the mother as the first patient.

STUDY DESIGN

During 6 months, 171 OR staff members of the Hospital of the University of Pennsylvania participated in a prospective study in which randomly selected groups of surgery residents, anesthesia residents, and perioperative nurses were trained in a simulated exsanguination and cardiac arrest emergency. Upon arrival to the simulation center, groups of trainees were assigned to a simulated OR equipped with a SimMan 3G (Laerdal, Norway) and a session moderator. The scenario started with a pregnant patient in hemorrhagic shock, bleeding from a carotid injury, ultimately leading to cardiac arrest. Each group did an initial "cold" simulation without any prior training or knowledge of the scenario, followed by a didactic training session, and ending with a "warm" simulation.

SETTING

Penn Medicine Clinical Simulation Center at 1800 Lombard Street, Philadelphia, Pennsylvania.

RESULTS

Among 156 participants, 50% reported understanding their role in an OR exsanguination emergency pretraining, compared with 98% who understood it posttraining (p < 0.001). For activation of the exsanguination protocol, 50% understood how to do it pretraining, compared with 98% posttraining (p = 0.004). The time needed to complete 8 clinically significant tasks was documented pre- and posttraining, with a statistically significant improvement in all tasks.

CONCLUSIONS

The results of this simulated exsanguination emergency demonstrate that team training using a high-fidelity mannequin is an effective way to train OR personnel, on how to manage exsanguinating traumatic patients in a high-risk surgical emergency.

Maternal mortality due to trauma

Maternal mortality is an important indicator of adequacy of health care in our society. Improvements in the obstetric care system as well as advances in technology have contributed to reduction in maternal mortality rates. Trauma complicates up to 7% of all pregnancies and has emerged as the leading cause of maternal mortality, becoming a significant concern for the public health system. Maternal mortality secondary to trauma can often be prevented by coordinated medical care, but it is essential that caregivers recognize the unique situation of providing simultaneous care to 2 patients who have a complex physiologic relationship. Optimal management of the pregnant trauma victim requires a multidisciplinary team, where the obstetrician plays a central role. This review focuses on the incidence of maternal mortality due to trauma, the mechanisms involved in traumatic injury, the important anatomic and physiologic changes that may predispose to mortality due to trauma, and finally, preventive strategies that may decrease the incidence of traumatic maternal death.

The effect of air bags on pregnancy outcomes in Washington State: 2002-2005

OBJECTIVE

To estimate whether air-bag deployment is associated with an increased risk of adverse pregnancy outcomes.

METHODS

We performed a retrospective cohort study to assess the effect of air-bag availability and air-bag deployment on the risk of adverse pregnancy outcomes among pregnant, front-seat occupants in motor vehicle crashes in Washington State. Pregnant women involved in motor vehicle crashes were identified by linking birth and fetal death certificate data with Washington State Patrol crash data, which reported air-bag availability and deployment. We calculated relative risks (RRs) of adverse maternal and perinatal outcomes and 95% confidence intervals (CIs) using Poisson regression, adjusted for maternal age, seatbelt use, and vehicle model year.

RESULTS

We found no increased risk of adverse maternal or perinatal pregnancy outcomes among occupants of air-bag-equipped vehicles in all collisions (n=2,207) compared with those in vehicles without air bags (n=1,141). Among crashes in which air-bag deployment would be likely, we found a nonsignificant 70% increased risk of preterm labor (RR 1.7, 95% CI 0.9-3.2) and a nonsignificant threefold increased risk (RR 3.1, 95% CI 0.4-22.1) of fetal death among occupants in vehicles with air-bag deployment compared with occupants in vehicles without air bags, although fetal death results were limited by small numbers (2/198 [1.0%] in pregnant women whose air bags deployed; 2/622 [0.3%] in pregnant women whose air bags did not deploy).

CONCLUSION

Our findings provide clinicians with evidence to advise women that air bags do not seem to elevate risk of most potential adverse outcomes during pregnancy.

LEVEL OF EVIDENCE

II.

Trauma in pregnancy

Acute traumatic injury during pregnancy is a significant contributor to maternal and fetal morbidity and mortality in the United States. Motor vehicle accidents are the leading cause of injury-related maternal death, followed by violence and assault. Lack of seat belts or other restraints increases the risks of both maternal and fetal morbidity and mortality. The American College of Obstetricians and Gynecologists recommends proper seat belt use by all pregnant women and screening for domestic abuse. Maternal injury and death from physical abuse is prevalent, and in some communities, homicide is a major cause of pregnancy-associated maternal death. Blunt trauma most often occurs as a result of motor vehicle accidents, whereas penetrating trauma results from gunshots or stabbings. Blunt trauma to the abdomen increases the risk for placental abruption, and direct fetal injury is more likely with penetrating trauma. Management strategies in acute maternal trauma must focus on a thorough assessment of the mother. A coordinated team effort that includes the obstetrician is essential to ensure optimal maternal and fetal outcomes. Imaging studies should not be delayed because of concerns of fetal radiation exposure, because the risk is minimal with usual imaging procedures, especially in mid-to-late pregnancy. The obstetrician should serve in a consultative role if nonobstetric surgical care is required and must also be prepared to intervene on behalf of the mother and the fetus if trauma care is compromised by the pregnancy. Perimortem cesarean delivery should be considered early in the resuscitation of a pregnant trauma victim, especially when fetal viability is a concern. Once the mother is stabilized in the emergency setting, she should be transported for appropriate maternal and fetal observation until both mother and fetus are clear of danger. It is essential that the clinician and staff maintain thorough and accurate documentation and recording of the chronology of events, the maternal and fetal assessment, and the management and outcome of the pregnancy.

Fetal monitoring in the prehospital setting

BACKGROUND

Prehospital emergency care providers have very little information regarding fetal perfusion adequacy in the field.

OBJECTIVE

This study was conducted to evaluate the feasibility of the use of fetal monitoring in the prehospital setting.

METHODS

A mobile cardiotocometer was used for all consecutive pregnant women managed by our physician-staffed Emergency Medical Services unit. The visualization of interpretable tracings (both fetal heart rate and tocography) at the different stages of prehospital management was evaluated. Any change in a patient's management was also recorded.

RESULTS

There were 145 patients enrolled during 119 inter-hospital transfers and 26 primary prehospital interventions. Interpretable tracings were obtained for 81% of the patients during the initial examination. This rate decreased to 66% during handling and transfer procedures. For 17 patients (12%), the monitoring led to a change in the patient's management.

CONCLUSION

This study shows that cardiotocography can be easily performed in the prehospital setting, and is usually feasible. Moreover, the study demonstrates a positive impact of fetal heart rate monitoring on prehospital management.

Fetal outcome in motor-vehicle crashes: effects of crash characteristics and maternal restraint

OBJECTIVE

This project was undertaken to improve understanding of factors associated with adverse fetal outcomes of pregnant occupants involved in motor-vehicle crashes.

STUDY DESIGN

In-depth investigations of crashes involving 57 pregnant occupants were performed. Maternal and fetal injuries, restraint information, measures of external and internal vehicle damage, and details about the crash circumstances were collected. Crash severity was calculated using vehicle crush measurements. Chi-square analysis and logistic regression models were used to determine factors with a significant association with fetal outcome.

RESULTS

Fetal outcome is most strongly associated with crash severity (P < .001) and maternal injury (P = .002). Proper maternal belt-restraint use (with or without airbag deployment) is associated with acceptable fetal outcome (odds ratio = 4.5, P = .033). Approximately half of fetal losses in motor-vehicle crashes could be prevented if all pregnant women properly wore seat belts.

CONCLUSION

Higher crash severity, more severe maternal injury, and lack of proper seat belt use are associated with a higher risk of adverse fetal outcome. These results strongly support recommendations that pregnant women use properly positioned seatbelts.

[Traumatic uterine rupture: a rare complication of motor vehicle accidents during pregnancy. A case report]

The rupture of gravid uterus is a rare complication concerning less than one percent of the pregnant women involved in a motor vehicle accident. The authors report the case of a 39-year woman, gravida 4, referred for an uterine rupture with intrauterine fetal death at 24 weeks gestation, following a car crash. The surgical laparotomic exploration in emergency showed a wide fundal uterine tear with placental abruption. The placenta and the fetus were found in the abdominal cavity. A conservative surgical treatment could be realized. Principles of management, which must be quick and co-ordinated, are reminded.

[Pregnant woman and road safety: a numerical approach. Application to a restrained third trimester pregnant woman in frontal impact]

OBJECTIVES

The goal of our work is the development of a numerical model of pregnant woman in driving position. We present an application to the study of injury mechanisms during a frontal car crash for a seat belt restrained pregnant woman in driving position.

MATERIALS AND METHODS

We integrated a digital representation of a pregnant uterus, foetus and placenta in a previous existing numerical model of non pregnant Human body in driving position, the Humos model. The realization of a numerical simulation of a frontal car crash enabled us to analyze the part played by the safety belt in the organic traumatisms.

RESULTS

Three phases were highlighted. The first phase consists of a translation forwards of the pregnant uterus during the impact. The second phase is a rotation forwards in the sagittal plan of the pregnant uterus with for axis of rotation the posterior wall of the pubis. The third phase is a vertical adjustment coupled to a translation of the uterus towards the back. This translation leads the uterus to impact the spine.

CONCLUSION

The development of a pregnant numerical model in the field of accidentology allows the analysis of organic traumatisms. That makes it possible to study the role played by the existing safety systems. This model might make it possible to develop safety systems specific to the pregnant woman.

Common problems and emergencies in the obstetric patient

Physicians not used to caring for pregnant patients may feel uncomfortable dealing with the many routine problems that can occur during a pregnancy. Other than true obstetric emergencies, which are usually cared for by obstetricians and family physicians, and the common problems of pregnancy can often be cared for by any primary care physician. Given the litigious nature of our society, especially in the realm of obstetrics, it does behoove the physician caring for pregnant women to be aware of the standards of care. When in doubt, it would be prudent to consult with a physician that routinely provides care to pregnant women.

Modeling the pregnant woman in driving position

Despite motor vehicle crashes being the leading cause of traumatic fetal morbidity, only a few researches have tried to study the automobile crashes on pregnant women. The possible negative effect of the restraint systems and the injuries mechanisms involved in car crashes with pregnant women are therefore still poorly understood. In this context, the aim of this study is to develop a numerical model of the whole human body with a gravid uterus, in order to investigate car crash scenarios and to evaluate alternative security systems to improve protection of both the woman and the fetus. A 3D reconstruction based on a set of MRI images led us to a good spatial representation of the pregnant woman in driving position. The anatomical precision will make progress possible in the field of traumatology of the pregnant woman.

Trauma during pregnancy

Trauma is the leading nonobstetrical cause of maternal death. The effect of trauma on the pregnant woman and unborn fetus can be devastating. The major causes of maternal injury are blunt trauma, penetrating trauma, burns, falls, and assaults. There are specific changes associated with pregnancy that are important for the clinician to consider when providing care to these patients. Initial management of traumatic injuries during pregnancy is essential for maternal and fetal well-being. This review outlines common causes of maternal trauma, the initial assessment of the pregnant trauma patient, and ongoing care for the pregnant trauma patient and unborn fetus.

Seatbelt use during pregnancy: a comparison of women in two prenatal care settings

OBJECTIVES

This study examines knowledge of proper automobile restraint use during pregnancy and attitudes toward restraint use. This manuscript, the second in a series, compares knowledge and attitudes in two populations of pregnant women, those receiving prenatal care at several county clinics and those receiving care in a private practice.

METHODS

A survey requesting demographic information and frequency and knowledge of proper automobile restraint use was administered during prenatal visits.

RESULTS

County clinic patients (n = 450, 70% black) were younger and less educated than private practice patients (n = 203, 75% non-Hispanic white). Fewer county patients (49%) always wore seatbelts prior to the pregnancy than private practice patients (88%). Correct use was reported by fewer county clinic patients (67%) than private practice patients (83%). Few (25-28%) in either setting reported receiving information on seatbelt use.

CONCLUSIONS

Despite existing knowledge with respect to the consequences of seatbelt non-use in pregnant women, the proportion of women receiving information about correct seatbelt use during pregnancy appears to be low, regardless of care source.

Trauma in pregnancy

OBJECTIVE

The objective of this article was to review the existing standards of practice regarding trauma which occurs during pregnancy.

DESIGN

The design of this study was to review the available data from the surgical and obstetrical literature regarding trauma during pregnancy. The design was also to incorporate the contemporary recommendations from the trauma resuscitation courses relating to trauma during pregnancy.

RESULTS

Trauma occurs in 5% of pregnancies. A fetus is not considered to be viable until week 25. Motor vehicle accidents account for more than 50% of all trauma during pregnancy, with 82% of fetal deaths occurring during these automobile accidents. With life threatening trauma a 50% fetal loss rate exists. As anatomy, physiology, and even laboratory findings change during pregnancy, the clinician must consider both patients, the mother and fetus. Following blunt trauma abruption of the placenta is the more common cause of fetus loss. Anterior abdominal penetrating trauma almost never fails to injury the uterus and fetus in the last half of pregnancy. Preventive strategies exist in the areas of social violence, automobile restraints and use of alcohol and drugs by the mother. Perimortem caesarian section is rarely successful.

CONCLUSIONS

Trauma during pregnancy is uncommon, but with increasing trauma severity leads to increased fetal loss. Preventive strategies exist and when admitted monitoring standards should be followed.

Risk of urinary tract infection and asymptomatic bacteriuria among diabetic and nondiabetic postmenopausal women

No prospective data exist on the risk of microbiologically confirmed urinary tract infection (UTI) and asymptomatic bacteriuria (AB) in relation to diabetes mellitus and its characteristics. The authors prospectively (1998-2002) followed 218 diabetic and 799 nondiabetic Washington State women aged 55-75 years for UTI and AB. The baseline examination and two annual follow-up examinations included urine culture, measurement of hemoglobin A1c and postvoid residual bladder volume, and a survey of diabetes and other characteristics. Surveillance for UTI included self-reports confirmed by microbiologic culture and medical record review. UTI incidence per 100 person-years was 12.2 for diabetic women and 6.7 for nondiabetic women (relative risk (RR) = 1.8, 95% confidence interval (CI): 1.2, 2.7). AB incidence per 100 person-years was 6.7 for diabetic women and 3.0 for nondiabetic women (RR = 2.3, 95% CI: 1.3, 3.9). In Cox models adjusted for multiple covariates, the increased UTI risk occurred mainly in women taking insulin (RR = 3.7, 95% CI: 1.8, 7.3) and women with a longer diabetes duration (> or =10 years; RR = 2.6, 95% CI: 1.3, 5.1) compared with nondiabetic women. No clear linear trend between hemoglobin A1c and UTI or AB risk was seen. Postmenopausal women with diabetes have higher risks of UTI and AB in relation to diabetes duration and severity but not to recent glucose control.

Extensive brain injury in a premature infant following a relatively minor maternal motor vehicle accident with airbag deployment

Traumatic injury following a motor vehicle accident during pregnancy has an enormous potential for fetal injury and demise. With the advent of seat belts, shoulder restraints and airbags, and improved maternal survival, the most common cause of fetal loss is placental injury. However, the safety of airbag deployment during pregnancy and in particular during the latter stages, and the potential for fetal trauma remains unclear. We report a case of extensive neurological injury of a premature infant with minimal maternal trauma associated with deployment of an airbag following a minor motor vehicle accident.

Injury rates among restrained drivers in motor vehicle collisions: the role of body habitus

BACKGROUND

Previous studies have examined the independent effects of occupant height, obesity, and body mass index in motor vehicle collisions and identified related injury patterns. The hypothesis of this study was that as the driver's body habitus diverges from the 50% percentile male Hybrid III Crash Dummy (H3CD), the frequency of injury changes.

METHODS

The 1995 to 1999 National Automotive Sampling System Crashworthiness Data System was used. Study entry was limited to restrained drivers who were then subdivided into height and weight categories. Incidence rates were calculated for injuries to selected body regions as defined by the Abbreviated Injury Scale for overall, frontal, and driver's side collisions.

RESULTS

When grouped according to height and weight as descriptors of body habitus, injury rates for restrained drivers were increased as well as decreased in several subgroups. This association was seen in overall, frontal, and driver's side collisions.

CONCLUSION

The H3CD plays a major role in vehicular cabin interior design and crash testing. For drivers with a body habitus different from that of the H3CD, the vehicle cabin/body fit changes and the safety features may perform differently, which could account for these observations.

Periventricular cystic lesions in a preterm infant after a car accident during pregnancy

We report on a preterm infant born at 30+5/7 gestational weeks who developed severe cystic cerebral lesions after exposure to a car accident one day before delivery. The literature on car accidents during pregnancy is reviewed with specific focus on neonatal neurological outcome.