Trauma in pregnant women: analysis of maternal and fetal mortality

Twenty-seven traumatised pregnant women were analysed retrospectively over a period of 9 years. Mean age was 23.7 years (16-42 years). Gestational age ranged from 10 to 40 weeks (mean, 21.5 weeks), with most victims (46.1%) being in the second trimester. The predominant mechanism (65.3%) was blunt abdominal injury due to an automobile accident (the patient being run over or collision). At admission, 8 (30.7%) patients had haemodynamic alterations. 6 patients (23.0%) presented vaginal bleeding and 4 of these were haemodynamically normal. We analysed maternal mortality, fetal mortality and their causes. We also compared the median RTS and TRISS values for the groups with maternal-fetal survival and the group with maternal-fetal death. Fetal death occurred in all pregnant women admitted with vaginal bleeding. Maternal mortality due to haemorrhagic shock was 11.5%. Fetal mortality was 30.7%, with 37.5% of these deaths being caused by maternal death. The major cause of fetal mortality was a detached placenta (50.0%). The trauma indices, RTS and TRISS, were significantly lower (p = 0.0025 and p < 0.0001) in the group of maternal-fetal death but they were not of prognostic value in terms of fetal mortality.

[Weight of the newborn in relation to maternal weight gains in 513 normal pregnancies: analysis of different stages of the maternal weight at the onset of pregnancy]

The average weight of the newborns (3,293 g; SD = 460) was studied in 513 normal pregnancies (free of clinical and obstetrical intercorrencies) and it was correlated to: a) maternal average weight gain (12,355 g; SD - 4,067) and b) maternal average weight at the onset of pregnancy, both with positive linear relation. It was noted too that the relation between maternal weight gain and weight of newborns gradually decreased as the comparison involved higher initial weight of the mothers. Actually, in the group of average initial weight above 79 kg no relation was found between maternal weight gain and the weight of the newborn. Results were compared to those in the literature and it was concluded that the influence of maternal weight gain upon that of the newborn varies with the maternal initial weight: 1) in the group of lower and normal initial average maternal weight there is an important influence on the average weight of the newborn; 2) in the group of initially overweight mothers (above 70 kg) the average weight of the newborn was high, but independent of maternal weight gain. Thus, caloric restriction in the latter group should be revised.