Burns in pregnancy: effect on maternal and fetal outcomes

Burn injury during pregnancy is known to have adverse effects on fetal and maternal survival. Any hope of reducing the high mortality lies in identifying the risk factors responsible for the poor maternal and fetal outcome. A prospective study cohort of 50 pregnant burned patients, a comparison cohort of 50 uncomplicated singleton pregnancies and another comparison cohort of 50 non-pregnant burned females were followed up for fetal and maternal survival or death at the Government Medical College & Hospital, Nagpur, India. The effect of maternal factors on the maternal and fetal survival were assessed. Most of the patients (64 per cent) were severely burned, i.e. > 60 per cent TBSA with 100 per cent fetal and maternal mortality. There was 50 per cent maternal and fetal loss in the 40-59 per cent TBSA group. A fetal loss of 11.1 per cent was noted in the 20-39 per cent TBSA group with no maternal loss. Survival analyses using the Kaplan-Meier survival analysis and the Cox Proportional Hazards model showed that TBSA burned was the only factor found to be statistically significantly (P < 0.0001) responsible for the adverse fetal and maternal outcome. Pregnancy did not alter the maternal survival. Adequate shock management and early excision with grafting could reduce the mortality figures. Prevention of injury during pregnancy still appears to be the best option.