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Fetal death after trauma in pregnancy
D A Theodorou1, G C Velmahos, I Souter
1Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA.
The American Surgeon
|September 19, 2000
Summary
Trauma in pregnant patients can lead to pregnancy termination or fetal death. Injury Severity Score (ISS) greater than or equal to 9 and nonviable pregnancy (<23 weeks) are key risk factors for fetal mortality.
Area of Science:
- Obstetrics and Gynecology
- Trauma Surgery
- Perinatology
Background:
- Trauma during pregnancy poses significant risks to both mother and fetus.
- Identifying predictors of adverse pregnancy outcomes after trauma is crucial for clinical management.
Purpose of the Study:
- To determine independent risk factors associated with acute pregnancy termination and/or fetal mortality following maternal trauma.
- To evaluate the predictive value of maternal hemodynamic parameters and injury severity on fetal outcomes.
Main Methods:
- Retrospective review of medical and trauma registry records for 80 injured pregnant patients.
- Univariate and multivariate analyses were performed on collected data.
Main Results:
- Fetal mortality occurred in 17.5% of cases, with 30% experiencing acute pregnancy termination.
- Independent risk factors for fetal mortality included Injury Severity Score (ISS) ≥9 and nonviable pregnancy (<23 weeks).
- The combination of ISS ≥9 and nonviable pregnancy increased fetal mortality risk fivefold; maternal hemodynamics did not predict fetal loss.
Conclusions:
- Moderate to severe maternal injuries (ISS ≥9) increase fetal mortality risk, but it can occur even with minor trauma.
- Maternal hemodynamic stability upon admission is not a reliable predictor of fetal mortality.
- Close maternal and fetal monitoring is essential for all pregnant trauma patients, irrespective of injury severity or hemodynamic status.