Profile of mothers at risk: an analysis of injury and pregnancy loss in 1,195 trauma patients.
BACKGROUND
Trauma is the number one cause of maternal death during pregnancy, but incidence of fetal loss exceeds maternal loss by more than 3 to 1. We hypothesized that we could identify women at risk for injury during pregnancy and focus our prevention efforts.


METHODS
Women of childbearing age in the American College of Surgeon's National Trauma Data Bank served as the study population. Pregnant patients were compared with nonpregnant patients with respect to age, race, mechanism of injury, injury patterns and severity, risk-taking behaviors, and outcomes. Multivariate logistic regression analysis was used to identify risk factors for loss of pregnancy in mothers who survived their trauma.


RESULTS
Pregnant trauma patients (n = 1,195) were younger, less severely injured, and more likely to be African American or Hispanic as compared with the nonpregnant cohort (n = 76,126). Twenty percent of injured pregnant patients tested positive for drugs or alcohol, and approximately one-third of those involved in motor vehicle crashes were not using seatbelts. Independent risk factors for fetal loss after trauma included Injury Severity Score > 15; Adjusted Injury Score > or = 3 in the head, abdomen, thorax, or lower extremities; and Glasgow Coma Score < or = 8.


CONCLUSIONS
Young, African-American, and Hispanic pregnant women are at higher risk for trauma in pregnancy and are most likely to benefit from primary trauma prevention efforts. Those with severe head, abdominal, thoracic, or lower extremity injuries are at high risk for pregnancy loss. Reduction of secondary insults and early recognition of fetal distress may improve outcomes for both the mother and fetus in this high-risk group.
Ikossi
Danagra G
DG
Department of Surgery, University of California-San Francisco, and San Francisco Injury Center, San Francisco, CA 94110, USA.
Lazar
Ann A
AA
Morabito
Diane
D
Fildes
John
J
Knudson
M Margaret
MM
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002648:Child; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000209:etiology*; D015438:Health Behavior; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008423:Maternal Age; D008875:Middle Aged; D011247:Pregnancy; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000209:etiology* / Q000401:mortality