title: Fetal death after trauma in pregnancy.
abstract: Trauma in pregnancy places the mother and fetus at risk. The objective of this study is to identify risk factors independently associated with acute termination of pregnancy and/or fetal mortality after trauma. The medical and trauma registry records of 80 injured pregnant patients were reviewed. Data were collected and then analyzed by univariate and multivariate analysis. Three patients died (3.7%), 23 had the pregnancy acutely terminated (30%), and 14 suffered fetal death (17.5%). The only independent risk factors for fetal mortality were an Injury Severity Score (ISS) > or =9 and a nonviable pregnancy (<23 weeks). The combination of both risk factors increased the likelihood of fetal mortality by fivefold over that of patients without either risk factor. Maternal hemodynamic parameters did not predict fetal loss. Two patients lost their fetuses despite insignificant trauma (ISS = 1) and normal hemodynamic parameters, whereas eight delivered normal babies despite major trauma (ISS > or = 16). Hemodynamic stability on admission does not predict fetal mortality. Although the presence of moderate to severe injuries (ISS > or = 9) increases the likelihood of fetal mortality, this complication may occur even with insignificant trauma. Close maternal and fetal monitoring is justified, regardless of maternal hemodynamic presentation or severity of injury.
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Theodorou
authors.forename: G C
authors.initials: GC
authors.lastname: Velmahos
authors.forename: I
authors.initials: I
authors.lastname: Souter
authors.forename: L S
authors.initials: LS
authors.lastname: Chan
authors.forename: P
authors.initials: P
authors.lastname: Vassiliu
authors.forename: R
authors.initials: R
authors.lastname: Tatevossian
authors.forename: J A
authors.initials: JA
authors.lastname: Murray
authors.forename: D
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D015998:Abbreviated Injury Scale; D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D000704:Analysis of Variance; D002423:Cause of Death; D016001:Confidence Intervals; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D005323:Fetal Monitoring; D005544:Forecasting; D015600:Glasgow Coma Scale; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D016013:Likelihood Functions; D008991:Monitoring, Physiologic; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000145:classification / Q000503:physiopathology; D011256:Pregnancy Outcome; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014947:Wounds and Injuries / Q000145:classification / Q000150:complications* / Q000503:physiopathology