[Abdominal trauma during pregnancy: Pertinence of monitoring elements]

The objective of this study is to evaluate current means of monitoring of pregnant women victims of abdominal trauma and to determine whether systematic hospitalization is warranted.

and methods. This was a retrospective study of pregnant women who consulted the Nantes hospital during a three-year period for abdominal trauma during pregnancy. Four principal means of monitoring (examination, fetal heart rate or ERCF, ulstrasonography, Kleihauer test) were evaluated according to the fetal outcomes.

Ninety-five patients were including in the study. The abdominal trauma resulted from a traffic accident for 49 patients (51%), a fall for 39 patients (41%) and high-energy trauma for 7 patients (8%). Three patients (3%) presented fetal complications: one fetal death, one fetal porencephaly, one premature birth at 34 weeks gestation for premature rupture of the membranes and abruptio placentae. These three women were traffic accident victims who also suffered extra-abdominal trauma. Ultrasonographic signs (npv=99%) and anomalies foetal monitoring (npv=98%) were also observed in two cases (fetal death and premature birth). The porencephaly was fortuitously discovered 3 weeks after trauma at a routine ultrasound. The Kleihauer test remained negative in all patients. The other traumas did not give lead to fetal complications. The incidence of premature births did not increase after trauma. Fetal outcome was good when monitoring parameters were normal at admission.

Ultrasonography and fetal heart rate monitoring enable proper assessment of fetal well-being but only have predictive value if they are negative. A negative Kleihauer test, useful for Rh negative patients to determine the amount of anti-D antibody to inject, does not provide any information about fetal outcome when it is negative. The complications observed were related only to traffic accidents. Hospitalization is probably not very useful when monitoring elements are normal at admission and when the women has suffered mild trauma.