Predictors of outcome in trauma during pregnancy: identification of patients who can be monitored for less than 6 hours.
BACKGROUND
The first objective of this study was to identify risk factors in pregnant patients suffering blunt trauma predictive for uterine contractions, preterm labor, or fetal loss. The second objective was to identify patients who can safely undergo fetal monitoring for 6 hours or less after blunt trauma by selecting out those patients demonstrating the identified risk factors.


METHODS
A retrospective chart review was performed from January 1, 1990, through December 31, 1998. Charts were reviewed for numerous possible risk factors for adverse outcomes. Statistical analysis was performed by using logistic regression.


RESULTS
A total of 271 pregnant patients admitted after blunt trauma were identified. Risk factors significantly predictive of fetal death included ejections, motorcycle and pedestrian collisions, maternal death, maternal tachycardia, abnormal fetal heart rate, lack of restraints, and Injury Severity Score > 9. Risk factors significantly predictive of contractions or preterm labor included gestational age >35 weeks, assaults, and pedestrian collisions.


CONCLUSIONS
Pregnant patients who present after blunt trauma with any of the identified risk factors for contractions, preterm labor, or fetal loss should be monitored for at least 24 hours. Patients without these risk factors can safely be monitored for 6 hours after trauma before discharge.
Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque 87131, USA.
M J
MJ
Curet
C R
CR
Schermer
G B
GB
Demarest
E J
EJ
Bieneik
L B
LB
Curet
D000037:Abruptio Placentae / Q000453:epidemiology / Q000209:etiology; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000209:etiology; D005323:Fetal Monitoring; D006340:Heart Rate, Fetal; D006801:Humans; D015601:Injury Severity Score; D008499:Medical Records; D009516:New Mexico / Q000453:epidemiology; D007752:Obstetric Labor, Premature / Q000453:epidemiology* / Q000517:prevention & control; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000517:prevention & control; D011296:Prenatal Diagnosis / Q000592:standards*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000453:epidemiology*