title: Computed tomographic imaging interpretation improves fetal outcomes after maternal trauma.
abstract: Computed tomography (CT) has been validated to identify and classify placental abruption following blunt trauma. The purpose of this study was to demonstrate improvement in fetal survival when delivery occurs by protocol at the first sign of class III fetal heart rate tracing in pregnant trauma patients with a viable fetus on arrival and CT evidence of placental perfusion 50% or less secondary to placental abruption.
  
  
  
  This is a retrospective review of pregnant trauma patients at 26 weeks' gestation or greater who underwent abdominopelvic CT as part of their initial evaluation. Charts were reviewed for CT interpretation of placental pathology with classification of placental abruption based upon enhancement (Grade 1, >50% perfusion; Grade 2, 25%-50% perfusion; Grade 3, <25% perfusion), as well as need for delivery and fetal outcomes.
  
  
  
  Forty-one patients met inclusion criteria. Computed tomography revealed evidence of placental abruption in six patients (15%): Grade 1, one patient, Grade 2, one patient, and Grade 3, four patients. Gestational ages ranged from 26 to 39 weeks. All patients with placental abruption of Grade 2 or greater developed concerning fetal heart tracings and underwent delivery emergently at first sign. Abruption was confirmed intraoperatively in all cases. Each birth was viable, and Apgar scores at 10 minutes were greater than 7 in 80% of infants, all of whom were ultimately discharged home. The remaining infant was transferred to an outside facility.
  
  
  
  Delivery at first sign of nonreassuring fetal heart rate tracings in pregnant trauma patients (third trimester) with placental abruption of Grade 2 or greater can lead to improved fetal outcome.
  
  
  
  Therapeutic/care management study, level III.
authors.affiliation: From the Division of Burns, Trauma Surgery, and Surgical Critical Care, Department of Surgery(T.R.K., J.B., J.W., O.G., K.D., P.P., S.V., M.P.), and Department of Radiology(D.G.), Maricopa Medical Center, Phoenix, Arizona.
authors.forename: Tammy R
authors.initials: TR
authors.lastname: Kopelman
authors.forename: James N
authors.initials: JN
authors.lastname: Bogert
authors.forename: Jarvis W
authors.initials: JW
authors.lastname: Walters
authors.forename: Daniel
authors.initials: D
authors.lastname: Gridley
authors.forename: Oscar
authors.initials: O
authors.lastname: Guzman
authors.forename: Karole M
authors.initials: KM
authors.lastname: Davis
authors.forename: Paola G
authors.initials: PG
authors.lastname: Pieri
authors.forename: Sydney J
authors.initials: SJ
authors.lastname: Vail
authors.forename: Melissa
authors.initials: M
authors.lastname: Pressman
mesh_terms: D000037:Abruptio Placentae / Q000000981:diagnostic imaging* / Q000628:therapy; D000328:Adult; D002985:Clinical Protocols; D036861:Delivery, Obstetric; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000628:therapy