Maternal Outcomes After Trauma in Pregnancy: A National Database Study

Abstract

Objectives Trauma is an important non-obstetric cause of mortality in pregnant females. Methods The National Trauma Databank (NTDB) was queried between 2017 and 2018. Pregnant women >20 weeks gestation, who underwent trauma, were included. They were categorized into different age groups from 12-18, 18-35, and 36-50 years of age. The primary outcome measure was 30-day mortality. Results 1,058 pregnant trauma patients were included. Mean age was 26.7 ± 6 years. Of those 94.5% had blunt and 3.8% had penetrating injuries. Median GCS and ISS were 15 (15, 15) and 2 (1, 5), respectively. Penetrating trauma patients required more operative intervention (57.5%) than blunt trauma patients (24.6%). Univariate analysis comparing age groups 12-18, 19-35, and >36 years revealed differences. ( P < .05) in ED systolic blood pressure (110.9 ± 19.7 vs 117.3 ± 20.3 vs 129.1 ± 29.3 mmHg, P = .01) and diabetes mellitus (.0 vs 2.7% vs 6.6% P = .03). There was no difference in HLOS ( P = .72), complications ( P = .279), and mortality ( P = .32). Multivariate logistic regression analysis revealed that compared to patients 12-18 years old, patients 19 to 35 ( P = .27) or those >36 ( P = 1.0) did not show a significant difference in mortality. Patients with high ISS had higher complication rates (OR 1.09; 95% CI 1.04-1.15) and prolonged HLOS (OR 1.00; 95% CI 1.07-1.15). Conclusion On average pregnant women (>20 weeks gestation) who presented to trauma centers had minor injuries and maternal age or mechanism of injury did not affect mortality. Despite a low ISS, a significant number of these patients required operative procedures.

Trauma in pregnancy: An analysis of the adverse perinatal outcomes and the injury severity score

“…[15] In the study of Siddiqi et al, in which The National Trauma Databank was scanned between 2017 and 2018, the mean age of traumatized pregnant women over the 20 th gestational week was found to be 26.7±6 years. [16] In our study, the mean age of the traumatized pregnant women was 26.92±5.82 years and the gestational age at the time of trauma was 19.85±9.9 weeks, which was consistent with the literature. Trauma was most common in the second trimester (42.67%).…”

“…Despite the low ISS, a significant proportion of these patients require operative procedures. [ 16 ] In our clinic, penetrating injury was stabbing injury and observed in only 2 (0.22%) patients who presented with trauma. Severe trauma was detected in one of these patients.…”

Maternal and Neonatal Outcomes of Gunshot Wounds in Pregnancy: A Systematic Review of Case Reports

“…These studies are fraught with many confounding variables including heterogeneity in outcomes metrics published (eg, sparse data on ISS, GCS, maternal vital signs, and other baseline characteristics such as comorbidity profiles). Unfortunately, we found that larger databases and registries either have not parsed GSW data from other forms of penetrating trauma 62-67 or have inextricably bundled gestational ages. 68-70…”

“…These studies are fraught with many confounding variables including heterogeneity in outcomes metrics published (eg, sparse data on ISS, GCS, maternal vital signs, and other baseline characteristics such as comorbidity profiles). Unfortunately, we found that larger databases and registries either have not parsed GSW data from other forms of penetrating trauma [62][63][64][65][66][67] or have inextricably bundled gestational ages. [68][69][70] In the absence of large registries whose data fit predefined inclusion and exclusion criteria, remaining available data effectively resulted in systematically reviewing individual cases.…”