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Incidental pregnancy in trauma patients
G V Bochicchio1, L M Napolitano, J Haan
1University of Maryland School of Medicine and R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.
Journal of the American College of Surgeons
|May 3, 2001
Summary
Incidental pregnancies in trauma patients are often diagnosed late, leading to significant fetal radiation exposure and high mortality. Early pregnancy screening in female trauma patients is crucial to improve outcomes.
Area of Science:
- Trauma Care
- Obstetrics
- Radiology
Background:
- Incidental pregnancy rates and fetal outcomes in trauma patients remain largely unreported.
- Elimination of rapid pregnancy tests complicates early diagnosis in trauma settings.
- Delayed diagnosis of pregnancy in trauma patients can lead to adverse fetal sequelae.
Purpose of the Study:
- To determine the incidence of incidental pregnancy in trauma patients.
- To assess the impact of delayed diagnosis on fetal radiation exposure and mortality.
- To evaluate the necessity of early pregnancy screening in female trauma patients.
Main Methods:
- Retrospective analysis of pregnant trauma patients admitted between 1995 and 1999.
- Pregnancy confirmation via beta-HCG testing and gestational age estimation by ultrasonography.
- Prospective telephone survey to ascertain pregnancy outcomes.
Main Results:
- 114 (2.9%) of 3,976 female trauma patients were pregnant; 13% were incidental pregnancies.
- Newly diagnosed incidental pregnancies had significantly lower gestational age (6.9 vs. 20.5 weeks) and higher fetal mortality (100% vs. 25%).
- 85% of patients received cumulative radiation exposure exceeding 5 rads, surpassing recommended guidelines.
Conclusions:
- Trauma patients with incidental pregnancies often exceed recommended fetal radiation exposure limits.
- Reinstating rapid pregnancy testing for all female trauma patients is recommended.
- Early screening may reduce fetal radiation exposure and mortality in newly diagnosed incidental pregnancies.