Screening sonography in pregnant patients with blunt abdominal trauma

The purpose of this study was to evaluate the accuracy of screening sonography for the detection of clinically significant abdominal injury in pregnant patients with blunt trauma.

We retrospectively reviewed the records of 5173 patients with blunt abdominal trauma who underwent screening sonography. Pregnant patients were identified, and the prospective sonographic interpretations were compared with surgical findings, computed tomography (CT), subsequent sonography, cystography, and the clinical course.

Of 1567 female patients with trauma, 947 were of reproductive age and, 102 (11%) of these 947 were pregnant. One patient was excluded because a truth standard was not available. Five (5%) of these 101 patients were found to have injuries at surgery. These injuries involved the placenta (2 injuries), spleen (2 injuries), liver (1 injury), and kidney (1 injury); all required surgery. Initial sonographic findings were positive in 4 of 5 patients with injuries. The missed injury was a placental injury detected 15 hours after screening sonography because of fetal bradycardia. After screening sonography, 6 patients underwent additional abdominal imaging: CT (3 patients), cystography (1 patient), and additional sonography (2 patients). Of 101 patients, 95 (94%) required no additional tests, and 97 (96%) required no test involving ionizing radiation. No pregnant patient underwent diagnostic peritoneal lavage. Sensitivity was 80% (95% confidence interval, 28%-100%), and specificity was 100% (96 of 96; 95% confidence interval, 96%-100%) for detecting major abdominal injury.

Sonography is an effective screening examination that can obviate more hazardous tests such as CT, cystography, and peritoneal lavage in most pregnant patients with trauma requiring objective evaluation of the abdomen.