title: Trauma during pregnancy: a population-based analysis of maternal outcome.
abstract: BACKGROUND
  Serious injury during pregnancy is known to cause adverse maternal outcomes. However, the significance of minor injuries in adverse maternal outcomes requires clarification because most injuries sustained during pregnancy are minor ones.
  
  
  METHODS
  Two population-based databases (inpatient and ambulatory care) were used to identify pregnant women who had severe (required hospitalization) or minor injuries (required ambulatory care only) prenatally. ICD-9-CM coding was used to categorize the types of prenatal injury and complications during delivery. The patient demographics, types and timing of the injuries, and their association with adverse maternal outcomes were compared among the uninjured, those with minor injury, and those with severe injury. Odds ratios were calculated to estimate the risks of having adverse outcomes in injured pregnant women compared with those who are uninjured.
  
  
  RESULTS
  The severely injured women tended to be younger (<20 years old), lived in less urbanized regions, and had lower income levels than those who were uninjured or had minor injury. Motor vehicle crash was the most common mechanism of injury. While minor injuries were associated with preterm labor [odds ratio (OR)=1.25], a severe injury was strongly associated with increased risks of preterm labor, placental abruption, uterine rupture, and maternal death, especially during the third trimester (OR=2.71, 6.12, 7.79, and 20.15, respectively). Injuries away from the trunk could also lead to adverse maternal outcomes.
  
  
  CONCLUSIONS
  Trauma during pregnancy, whether minor or severe, is associated with unfavorable maternal outcomes. Injuries considered minor for the general population are not minor for pregnant women. Therefore, these patients should be monitored carefully.
authors.affiliation: Department of Acute Care Surgery, China Medical University Hospital, and School of Medicine, China Medical University,2 Yuh-Der Road, Taichung, 404, Taiwan, ROC.
authors.forename: Han-Tsung
authors.initials: HT
authors.lastname: Cheng
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Wang
authors.forename: Hung-Chieh
authors.initials: HC
authors.lastname: Lo
authors.forename: Li-Ting
authors.initials: LT
authors.lastname: Su
authors.forename: Chiu-Hsiu
authors.initials: CH
authors.lastname: Lin
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
authors.forename: Chi-Hsun
authors.initials: CH
authors.lastname: Hsieh
mesh_terms: D000293:Adolescent; D000328:Adult; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D016017:Odds Ratio; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality; D055815:Young Adult