Association of maternal fractures with adverse perinatal outcomes.
OBJECTIVE
We sought to assess the effects of fracture injuries on maternal and fetal/neonatal outcomes in a large obstetric population.


METHODS
We performed a retrospective cohort study using a database in which maternal and neonatal hospital discharge summaries were linked with birth and death certificates to identify any relation between maternal fractures and maternal and perinatal morbidity. Fracture injuries and perinatal outcomes were identified with the use of the International Classification of Diseases, 9th revision, Clinical Modification codes. Outcomes were further subdivided on the basis of anatomic site of fracture.


RESULTS
A total of 3292 women with > or = 1 fractures were identified. Maternal mortality (odds ratio, 169 [95% CI, 83.2,346.4]) and morbidity (abruption and blood transfusion) rates were increased significantly in women who were delivered during hospitalization for their injury. Women who were discharged undelivered continued to have delayed morbidity, which included a 46% increased risk of low birth weight infants (odds ratio, 1.5 [95% CI, 1.3,1.7]) and a 9-fold increased risk of thrombotic events (odds ratio, 9.2 [95% CI, 1.3,65.7]) Pelvic fractures had the worst outcomes.


CONCLUSIONS
Fractures during pregnancy are an important marker for poor perinatal outcomes.
El Kady
Dina
D
Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA.
Gilbert
William M
WM
Xing
Guibo
G
Smith
Lloyd H
LH
D000058:Accidental Falls; D000063:Accidents, Traffic; D001134:Arm Injuries / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007869:Leg Injuries / Q000453:epidemiology; D008428:Maternal Mortality; D009017:Morbidity; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology