Trauma in Obstetrical Patients

Abstract

Introduction: Pregnant trauma patients are an underdescribed cohort in the medical literature. Noting injury patterns and contributors to mortality may lead to improved care. Methods: Female patients between 14 and 49 years of age were identified among entries in the 2017 National Trauma Data Bank. Data points were compared using Chi-square test, Fisher's exact test, Student's t-test, Mann–Whitney rank-sum, or multiple logistic regression as appropriate. P < 0.05 was used to determine the findings of significance. Results: There were 569 pregnant trauma patients identified, which was 0.54% of the 105,507 women identified. Overall, mortality was low among all women and not different between groups (1.2% for pregnant women vs. 2.2% for nonpregnant, P = 0.12). Pregnant women with head injuries had a higher mortality rate than pregnant women without (4.2% vs. 0.47%, P < 0.01). Head injuries (Abbreviated Injury Severity Score [AIS] head >1) were associated with an increased risk for mortality (odds ratio: 3.33, 95% confidence interval: 3.0–3.7, P < 0.01). Conclusion: There was no increase in mortality for trauma patients who are pregnant when controlling for covariates. Factors such as head injuries, the need for blood, and comorbid diseases appear to have a more significant contribution to mortality. We also report the prevalence of head, cervical spine, and extremity injuries in pregnant trauma patients. Multidisciplinary simulation, jointly crafted protocols, and expanding training in regional anesthesia may be the next steps to improving care for pregnant trauma patients.

Management of Maxillofacial Trauma in Pregnant Women

“…Additional care in the maintenance of the patent airway, anesthesia considerations, and imaging restraints is necessary for pregnant patients. 7,8 The management of facial fractures in pregnant patients involves a balance between the need for surgery to repair the fracture and the risks associated with anesthesia and surgery on the developing fetus. However, reports of operative management of maxillofacial fracture in gravid women are limited.…”

“…Maxillofacial fractures in pregnancy also directly affect the well-being of the fetus by impinging on normal material functions such as breathing, mastication, and nutrition. Additional care in the maintenance of the patent airway, anesthesia considerations, and imaging restraints is necessary for pregnant patients 7,8 . The management of facial fractures in pregnant patients involves a balance between the need for surgery to repair the fracture and the risks associated with anesthesia and surgery on the developing fetus.…”

Predictors of fetal delivery in pregnant trauma patients: A multicenter study

“…Proponents of observation cite the increased risk of placental abruption, which results in preterm labor in up to 20% of PTPs, along with an increased risk of premature rupture of membranes (PROM). 8,13,14 Despite the importance of evaluating maternal and fetal outcomes, there is a paucity of data on in-hospital outcomes, [15][16][17][18] especially related to fetal delivery (FD) in PTPs. Moreover, most of the reports are from single institutions or utilize databases with limited sample size and granularity and thus, lack generalizability to inform optimal practice.…”

“…Despite the importance of evaluating maternal and fetal outcomes, there is a paucity of data on in-hospital outcomes, 15–18 especially related to fetal delivery (FD) in PTPs. Moreover, most of the reports are from single institutions or utilize databases with limited sample size and granularity and thus, lack generalizability to inform optimal practice 15,17,18 .…”

“…Despite the importance of evaluating maternal and fetal outcomes, there is a paucity of data on in-hospital outcomes, 15–18 especially related to fetal delivery (FD) in PTPs. Moreover, most of the reports are from single institutions or utilize databases with limited sample size and granularity and thus, lack generalizability to inform optimal practice 15,17,18 . Therefore, this study aims to use multicenter data to identify predictors of FD in PTPs with potentially viable pregnancies, which may inform future guidelines regarding the recommended observation of PTPs.…”