Trauma in Pregnancy: The Relationship of Trauma Activation Level and Obstetric Outcomes

Abstract

Trauma in pregnancy is a leading cause of poor fetal and obstetric outcomes. Trauma team activation (TTA) criteria include injury with ≥ 20 weeks gestational age (GA). A retrospective analysis was performed on pregnant patients evaluated at a Level 1 trauma center. Patients were characterized by TTA: full, partial, or non-TTA, and TTA criteria independent of pregnancy. Index trauma and delayed delivery hospitalization outcomes were examined. Bivariate analysis, t test, and logistic regression were used when appropriate. From 2010 to 2015, 216 full, 50 partial, and 50 non-TTAs presented. Independent of pregnancy, 79 per cent of patients did not meet the TTA criteria. Fourteen (4%) had a pregnancy-related complication during index hospitalization (eight fetal and two maternal deaths). Nine of ten deaths occurred in patients meeting TTA independent of pregnancy. Delivery complications were greater in the index (52%, 13/25) versus subsequent (5%, 17/155) hospitalizations and were predicted by the respiratory rate ( P = 0.016) and injury severity score ( P < 0.001). Poor delayed delivery outcomes were associated with earlier GA ( P < 0.002) and longer index hospitalization ( P < 0.024). Odds of complication are higher in patients meeting the physiologic and anatomic criteria criteria for TTA versus GA criteria alone, signifying overtriage. Trauma activation protocols should be adapted based on the physiologic and anatomic criteria criteria in pregnant patients.

Pregnancy in trauma—A Western Trauma Association algorithm

“…The trauma activation criteria for the injured pregnant trauma patients to alert those resources that may be required for care. 8,9 Pregnancy should not be the only reason for activation, physiologic, physical, and mechanistic criteria should be used. 10 Members of this team would include the standard members of a trauma code team: trauma resident, trauma attending, respiratory therapy, emergency department personnel, nursing, pharmacy, radiology, and subspecialist care as needed.…”

“…Pregnancy is still a rarity in the trauma population. The American College of Surgeons Committee on Trauma recommends trauma activation criteria for the injured pregnant trauma patients to alert those resources that may be required for care 8,9 . Pregnancy should not be the only reason for activation, physiologic, physical, and mechanistic criteria should be used 10 .…”