Evaluating maternal mortality, risk factors, and emergency c-section timing in polytrauma pregnant patients

Trauma is a leading non-obstetric cause of maternal morbidity and mortality, yet standardized guidelines for the management of pregnant polytrauma patients remain limited. Physiologic changes of pregnancy may alter trauma response and complication risk, but data guiding risk stratification and time-sensitive interventions are sparse.

To evaluate maternal mortality and complications among pregnant polytrauma patients, with particular focus on maternal age, early blood transfusion, and timing of emergency cesarean section.

This retrospective cohort study analyzed data from the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP-PUF) from 2017 to 2023. Pregnant trauma patients aged 18-45 years with moderate to severe injuries (ISS ≥9) were included. Maternal outcomes were assessed across subgroups stratified by maternal age, receipt of blood products within 4 h of hospital presentation, and timing of emergency cesarean section (≤4 h vs >4 h).

Among 2086 pregnant polytrauma patients, maternal age was not independently associated with statistically significant differences in mortality or major complications; however, older patients demonstrated higher point estimates for thromboembolic complications and longer ICU length of stay. Receipt of blood products within 4 h was strongly associated with increased 24-h mortality (aOR 10.923, p = 0.003) and in-hospital mortality (aOR 15.033, p = 0.005). Emergency cesarean section after 4 h of admission was associated with a significantly shorter ICU length of stay (β: -3.196, 95% CI: -6.25 to -0.14, p = 0.040).

In pregnant polytrauma patients, early blood transfusion identified a subgroup at markedly increased risk of early and in-hospital mortality, underscoring injury severity and resuscitation needs as primary drivers of adverse outcomes rather than maternal age alone. These findings emphasize the importance of timely, multidisciplinary trauma-obstetric decision-making & risk-stratification approach to optimize maternal outcomes.