Urgent delivery, the treatment of choice in term pregnant women with extended burn injury

Ullmann, Yehuda; Blumenfeld, Z.; Hakim, Marwan; Mahoul, I.; Sujov, Polo; Peled, Isaac J.

doi:10.1016/s0305-4179(96)00092-7

Cited by 15 publications

(6 citation statements)

References 7 publications

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“…In our series, maternal mortality was 28%, less than in other studies conducted in Iran [2,7], and reports from other countries vary [6,8,10,[16][17][18]. Maternal and fetal death in our study was significantly affected by maternal age, percentage of TBSA burned, presence of inhalation injury, and intentional burning, but not by trimester of pregnancy, year of admission, or cause of burn.…”

Section: Discussioncontrasting

confidence: 62%

Burn injuries during pregnancy in Iran

Karimi

Momeni

et al. 2008

Intl J Gynecology & Obste

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Section: Discussioncontrasting

confidence: 62%

Burn injuries during pregnancy in Iran

Karimi

Momeni

et al. 2008

Intl J Gynecology & Obste

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“…If burn wound exceeds 50% TBSA and foetus is at risk, obstetric intervention is indicated within the first 24 hours for high risk third trimester pregnancies. 18 Other indications for obstetric intervention include progressive foetal distress or significant maternal complications.…”

Section: Discussionmentioning

confidence: 99%

Thermal injury in pregnancy: predicting maternal and fetal outcome

Agarwal

2005

Indian J Plast Surg

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This study was undertaken to assess the parameters that may predict maternal and foetal outcome in 49 thermally injured pregnant women in a Plastic surgery unit in tertiary referral center in the last five years. There were 33 maternal deaths and 34 fetal deaths. In general, pregnancy as such does not influence maternal outcome after thermal injury. In first and second trimester best chance for foetal survival is to ensure maternal survival and in the last trimester fetal survival depends upon fetal maturity. Maternal survival is less likely if the burn wound exceeds 50% total body surface area. Thermal injury does increase the risk of spontaneous abortion and premature labour. Early obstetric intervention is indicated in patients with fatal burn and complications.

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“…Some authors have suggested that delivery of the fetus, if >26 weeks, should be considered the first-line therapy. 40 Our Neonatal Intensive Care Unit abilities have increased drastically in the past 10 years, making preterm delivery far less risky. Delivery of the fetus would allow direct administration of 100% oxygen (either normobaric or hyperbaric) which would result in a much faster elimination half-life than in utero therapy.…”

Section: Treatment Options For Co Toxicitymentioning

confidence: 99%

Smoke Inhalation Injury in a Pregnant Patient

Roderique¹,

Gebre-Giorgis²,

Stewart³

et al. 2012

Journal of Burn Care & Research

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For smoke inhalation injury of a pregnant woman, one must treat two patients and be aware of the potential effects of carbon monoxide (CO) and cyanide (CN) poisoning on both the mother and the fetus. In a pregnant woman, the size and age of the fetus and the degree of poisoning allow for tremendous variability in the toxicity of CO and CN and their respective treatment options. The authors will review a case of a 32-year-old woman who was at 37 weeks of gestation and admitted to the Evans-Haynes Burn Center after a house fire and received hydroxocobalamin (Cyanokit) for suspected CN poisoning. In addition, a review of the literature, current guidelines, and treatment options of inhalation injury during pregnancy will be discussed. The authors will focus only on the toxic components of smoke inhalation injury rather than the mechanical components from heat and particulate damage. Literature review clearly identifies that the treatment of pregnant women with inhalation injury remains a controversial subject. The use of hydroxocobalamin (Cyanokit) as a treatment modality for potential CN poisoning in a pregnant patient has not been reported in the literature. Animal studies have shown that combined CO and CN poisoning are more lethal than either one alone and at lower concentrations. Due to the synergistic effects of CO and CN, and because these two toxins concentrate at even higher levels in the fetus than the mother, the authors will clarify the urgent seriousness of prompt administration of hydroxocobalamin in a pregnant patient with suspected smoke inhalation injury. This case review details the treatment of a 32-year-old woman who was at 36 weeks of gestation on admission to the Evans-Haynes Burn Center. The authors will report her injuries and the course of treatment. Although burned and presenting with concomitant smoke inhalation injury, both the woman and her child fared well with no significant complications due to the smoke inhalation at 6 months of follow-up. Smoke inhaled from modern structural fires potentially contains both CN and CO gases. This makes the prompt recognition of this injury and selection of appropriate therapy an emergent priority. In October 2010, the Food and Drug Administration approved hydroxocobalamin for use in pregnant patients in the acute setting when CN toxicity is suspected. Because CO and CN have additive effects when both are present in the body, the prompt administration of hydroxocobalamin not only eliminates the effects of CN but also potentially attenuates its synergistic effects on CO. It is only through a better understanding of the details of smoke inhalation injury, the current treatment options, and the considerations regarding their use that new research and strong guidelines can be developed to better serve our patients.

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Urgent delivery, the treatment of choice in term pregnant women with extended burn injury

Cited by 15 publications

References 7 publications

Burn injuries during pregnancy in Iran

Burn injuries during pregnancy in Iran

Thermal injury in pregnancy: predicting maternal and fetal outcome

Smoke Inhalation Injury in a Pregnant Patient

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