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Trauma in pregnancy. Predicting pregnancy outcome
D P Kissinger1, G S Rozycki, J A Morris
1Trauma, Surgical Critical Care, Washington Hospital Center, Washington, DC 20010-2975.
Archives of Surgery (Chicago, Ill. : 1960)
|September 11, 1991
Summary
Injury Severity Score and Glasgow Coma Score predict fetal outcomes in trauma patients. Maternal physiological parameters were less reliable for assessing fetal well-being after injury.
Area of Science:
- Trauma Surgery
- Obstetrics & Gynecology
- Perinatology
Background:
- Assessing fetal outcomes in injured pregnant patients is critical.
- Previous studies have not definitively identified reliable predictors of fetal survival following maternal trauma.
Purpose of the Study:
- To evaluate maternal parameters for predicting fetal outcomes in trauma patients.
- To identify key indicators of fetal viability after maternal injury.
Main Methods:
- A multicenter retrospective review of 93 injured pregnant patients admitted to Level 1 trauma centers.
- Analysis of maternal physiological and laboratory data, Injury Severity Score, and Glasgow Coma Score in relation to fetal outcomes.
Main Results:
- Maternal physiological parameters generally failed to predict pregnancy outcomes.
- Injury Severity Score (ISS) and Glasgow Coma Score (GCS) significantly differed between viable and nonviable pregnancies (ISS: 6.2 vs. 21.6; GCS: 14.5 vs. 12.0).
- Fetal death incidence increased with direct uteroplacental injury, maternal shock, pelvic fracture, severe head injury, and hypoxia.
Conclusions:
- Maternal physiological monitoring may be inadequate for assessing fetal well-being in trauma.
- ISS and GCS are valuable predictors of fetal outcome in injured pregnant individuals.
- Further discussion on diagnostic modalities for assessing injured gravidas is warranted.