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Shipchandler FT, Huntley ES, Holder TF, Ali T, Behnia F, Chauhan SP, Huntley BJF. Maternal and Neonatal Outcomes of Gunshot Wounds in Pregnancy: A Systematic Review of Case Reports. Am Surg 2024; 90:279-291. [PMID: 37864523 DOI: 10.1177/00031348231207298] [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] [Indexed: 10/23/2023]
Abstract
A systematic review was performed to compare adverse maternal and neonatal outcomes among pregnant patients with gunshot wounds (GSW) to the abdominopelvic vs other region(s) at > 20 weeks gestation. A search of Medline Ovid, Elsevier Embase, EBSCO CINAHL, and Cochrane Library in July 2022 and reference searches resulted in 1742 studies, which were screened. The 41 included studies reported outcomes for 59 pregnant patients with GSW, of which 31 (52.5%) had an isolated abdominopelvic GSW and 28 (47.5%) had an extremity, thorax, head/neck, back/spine, poly-site, or other/unknown GSW. Stillbirth occurred in 26.7% of abdominopelvic GSW and 26% of non-abdominopelvic GSW. Maternal death occurred in 3.7% of abdominopelvic GSW and 10.7% of non-abdominopelvic GSW. Neonatal death occurred in 9.1% of abdominopelvic GSW and 5.3% of non-abdominopelvic GSW. Further research is needed to standardize the approach for the evaluation and management of patients with GSW in pregnancy.
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Affiliation(s)
| | - Erin S Huntley
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Travis F Holder
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Talha Ali
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Faranak Behnia
- Obstetrix Maternal-Fetal Medicine Specialists of Houston, Katy, TX, USA
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Benjamin J F Huntley
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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Nyrhi L, Kuitunen I, Ponkilainen V, Huttunen TT, Mattila VM. Incidence of fracture hospitalization and surgery during pregnancy in Finland-1998-2017: a retrospective register-based cohort study. Arch Orthop Trauma Surg 2023; 143:5719-5725. [PMID: 37310432 PMCID: PMC10449954 DOI: 10.1007/s00402-023-04931-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/24/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The aim of this study was to assess the incidence of all major fractures and surgery during pregnancy and the outcomes of pregnancy in Finland between 1998 and 2017. MATERIALS AND METHODS A retrospective cohort study using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register. As participants we included all women aged between 15 and 49 years from January 1, 1998 to December 31, 2017 and their ≥ 22-week pregnancies. RESULTS Of a total 629,911 pregnancies, 1813 pregnant women were hospitalized with a fracture diagnosis, yielding an incidence of 247 fractures/100,000 pregnancy-years. Of these, 24% (n = 513/2098) were treated operatively. The most common fractures were fractures of the tibia, ankle, and the forearm, which made up half of all fractures. The incidence of pelvic fractures was 6.8/100,000 pregnancy-years, with an operation rate of 14%. The stillbirth rate of all fracture patients was low at 0.6% (n = 10/1813), although this was 1.5-fold the overall stillbirth rate in Finland. Lumbosacral and comminuted spinopelvic fractures resulted in preterm delivery in 25% (n = 5/20) of parturients, with a stillbirth rate of 10% (n = 2/20). CONCLUSION The incidence of fracture hospitalization during pregnancy is lower than in the general population, and fractures in this population are more often treated conservatively. A higher proportion of preterm deliveries and stillbirths occurred in women with lumbosacral and comminuted spinopelvic fractures. Maternal mortality and stillbirth rates remain low among women with fractures leading to hospitalization or surgery during pregnancy.
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Affiliation(s)
- Lauri Nyrhi
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Ilari Kuitunen
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Tuomas T Huttunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Center, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
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García Martín A, Alhambra Expósito MR, Cortés Berdonces M, Jódar Gimeno E, Huguet I, Rozas Moreno P, Varsavsky M, Ávila Rubio V, Muñoz Garach A, Muñoz Torres M. Guía de manejo de las alteraciones del metabolismo mineral y óseo en la gestación y la lactancia. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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García Martín A, Alhambra Expósito MR, Cortés Berdonces M, Jódar Gimeno E, Huguet I, Rozas Moreno P, Varsavsky M, Ávila Rubio V, Muñoz Garach A, Muñoz Torres M. Guide of management of alterations in mineral and bone metabolism during gestation and lactation. ENDOCRINOL DIAB NUTR 2022; 69:530-539. [PMID: 36028449 DOI: 10.1016/j.endien.2022.08.002] [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: 03/11/2021] [Accepted: 10/24/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To provide practical recommendations for the management of mineral and bone metabolism alterations in pregnancy and lactation. PARTICIPANTS Members of the Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology and Nutrition. METHODS Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. A systematic search was carried out in Medline of the available evidence for each pathology. Papers in English with publication date until 29 February 2020 were included. A methodologist resolved the differences that arose during the process of reviewing the literature and formulating recommendations. The recommendations were discussed and approved by all members of the Working Group. CONCLUSIONS The document establishes practical recommendations based on evidence about the management of mineral and bone metabolism disorders in pregnancy and lactation.
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Affiliation(s)
- Antonia García Martín
- Servicio de Endocrinología y Nutrición, Hospital Universitario Clínico San Cecilio, Granada, Spain; Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Granada, Spain.
| | - María Rosa Alhambra Expósito
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - María Cortés Berdonces
- Departamento de Endocrinología y Nutrición Clínica, Hospital Quirón Salud Madrid y Complejo Hospitalario Ruber Juan Bravo, Quirón Salud, Madrid, Spain; Departamento de Formación Médica, Universidad Europea de Madrid, Madrid, Spain
| | - Esteban Jódar Gimeno
- Departamento de Endocrinología y Nutrición Clínica, Hospital Quirón Salud Madrid y Complejo Hospitalario Ruber Juan Bravo, Quirón Salud, Madrid, Spain; Departamento de Formación Médica, Universidad Europea de Madrid, Madrid, Spain
| | - Isabel Huguet
- Servicio de Endocrinología y Nutrición, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Pedro Rozas Moreno
- Sección de Endocrinología y Nutrición, Hospital General Universitario, Ciudad Real, Spain
| | - Mariela Varsavsky
- Servicio de Endocrinología, Metabolismo y Medicina Nuclear, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Verónica Ávila Rubio
- Servicio de Endocrinología y Nutrición, Hospital Universitario Clínico San Cecilio, Granada, Spain; Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Granada, Spain
| | - Araceli Muñoz Garach
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Manuel Muñoz Torres
- Servicio de Endocrinología y Nutrición, Hospital Universitario Clínico San Cecilio, Granada, Spain; Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Granada, Spain; Departamento de Medicina, Universidad de Granada, Granada, Spain
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Jafari Kafiabadi M, Sabaghzadeh A, Khabiri SS, Sadighi M, Mehrvar A, Biglari F, Ebrahimpour A. Orthopedic Trauma During Pregnancy; a Narrative Review. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e39. [PMID: 35765609 PMCID: PMC9206833 DOI: 10.22037/aaem.v10i1.1573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction Blunt traumas, like road accidents and falls, are common causes of injuries to pregnant women, and the major risk factors are young age and low socioeconomic level. Due to physiological and anatomical changes specific to pregnancy, such as changes in blood pressure and hemoglobin drop, trauma management involves certain complexities. Physical trauma is estimated to cause at least 1 complication in every 12 pregnancies. This study aims to evaluate orthopedic trauma during pregnancy and appreciate the different approaches to circumvent the resultant challenges. Methods We reviewed 55 articles, published on orthopedic trauma during pregnancy between 2011 and 2021. The articles were identified by searching PubMed, google-scholar, Scopus, and Science-Direct. We utilized the search terms: fall in pregnancy, traumas in pregnancy, motor vehicle accident/crash in pregnancy, blunt trauma in pregnancy, pregnant trauma patient, penetrating injury during pregnancy, assault, interpersonal violence in pregnancy, and mortality and pregnancy. Results According to available reports, after stabilizing the pregnant patient, diagnostic procedures, including radiography, and even gadolinium-based techniques when needed, can be performed to examine extensive trauma. In contrast to elective orthopedic surgery, emergency orthopedic surgeries, including reduction of open fractures, should be performed promptly. Conclusion Based on our investigation, pregnant women with orthopedic injuries that are severe, or even seemingly less severe, experience significantly increased adverse pregnancy outcomes, which include preterm birth, placental abruption, poor infant condition at birth, infant death, and even maternal death.
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Affiliation(s)
- Meisam Jafari Kafiabadi
- Department of Orthopedics Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Orthopedics Surgery, Taleghani Hospital Research Development Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Sabaghzadeh
- Department of Orthopedics Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed Saeed Khabiri
- Department of Orthopedics Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sadighi
- Department of Orthopedics Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Mehrvar
- Department of Orthopedics Surgery, Taleghani Hospital Research Development Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farsad Biglari
- Department of Orthopedics Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding Author: Farsad Biglari; Department of Orthopedics Surgery, Shohada-e Tajrish Hospital, Shahrdari Avenue, Tajrish Square, Tehran, Iran
| | - Adel Ebrahimpour
- Department of Orthopedics Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Physiotherapy Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Transient Osteoporosis of Hip Causing Fracture Neck of Femur in Pregnancy. J Obstet Gynaecol India 2021; 72:346-348. [PMID: 35923502 PMCID: PMC9339425 DOI: 10.1007/s13224-021-01512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022] Open
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