title: Minor trauma is an unrecognized contributor to poor fetal outcomes: a population-based study of 78,552 pregnancies.
abstract: BACKGROUND
  Fetal outcomes after minor injury (MI) to pregnant women are difficult to study because these patients are discharged after emergency room evaluation and not entered in trauma registries. The purpose of this study was to determine the association of both minor and severe injury on fetal demise and prematurity/low birth weight (LBW) in a large population-based study using robust state databases.
  
  
  METHODS
  The Tennessee State Fetal Birth and Death Data Systems were merged with the Tennessee State Hospital Discharge Data System using patient identifiers. All women with an e-code requiring inpatient admission during their pregnancy were considered severely injured, whereas those discharged after emergency room evaluation were considered to have MI. The impact of trauma on unintended fetal demise and premature birth/LBW was assessed using multivariable logistic regression.
  
  
  RESULTS
  In 2005, there were 376 fetal deaths and 78,176 viable deliveries of which 11,817 were premature/LBW. Severe injury was significantly associated with fetal demise and prematurity/LBW. Unexpectedly, first- and second-trimester MI was associated with both fetal demise and prematurity/LBW.
  
  
  CONCLUSIONS
  As expected, fetal mortality and morbidity increased after severe injury. Surprisingly, MI was associated with fetal demise, premature delivery, and LBW. Pregnant women who sustain MI should be told that they are at increased risk for an adverse outcome.
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA. pfischer@uthsc.edu
authors.forename: Peter E
authors.initials: PE
authors.lastname: Fischer
authors.forename: Ben L
authors.initials: BL
authors.lastname: Zarzaur
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Magnotti
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
mesh_terms: D000328:Adult; D005260:Female; D005313:Fetal Death / Q000453:epidemiology* / Q000209:etiology; D046689:Fetal Mortality / Q000639:trends; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D015601:Injury Severity Score; D011159:Population Surveillance; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology*; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology