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Infant survival after cesarean section for trauma
J A Morris1, T J Rosenbower, G J Jurkovich
1Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Annals of Surgery
|May 1, 1996
Summary
Emergency cesarean sections in pregnant trauma patients can be life-saving for viable fetuses. Survival rates are acceptable for infants with fetal heart tones and gestational age over 26 weeks, but delays in care are detrimental.
Area of Science:
- Trauma Surgery
- Maternal-Fetal Medicine
- Emergency Medicine
Background:
- Emergency cesarean sections in trauma patients are controversial.
- The justification and outcomes of these procedures require further investigation.
Purpose of the Study:
- To evaluate the outcomes of emergency cesarean sections in pregnant trauma patients.
- To determine factors influencing fetal and maternal survival.
Main Methods:
- Retrospective cohort study of trauma admissions across nine level 1 trauma centers (1986-1994).
- Analysis of demographic and clinical data for pregnant women undergoing emergency cesarean sections.
- Definition of fetal distress (bradycardia, deceleration, absent fetal heart tones) and maternal distress (shock, acute decompensation).
Main Results:
- 32 emergency cesarean sections were performed on pregnant trauma patients.
- Overall survival rates: 45% for fetuses and 72% for mothers.
- For viable infants (fetal heart tones present, gestational age ≥26 weeks), survival was 75%.
- Infant survival was independent of maternal distress or Injury Severity Score.
- Delayed recognition of fetal distress contributed to 60% of preventable infant deaths.
Conclusions:
- Infant viability in pregnant trauma patients is defined by fetal heart tones and gestational age ≥26 weeks.
- Emergency cesarean sections offer acceptable survival rates (75%) for viable infants.
- Prompt recognition and intervention for fetal distress are critical to improve outcomes and prevent infant mortality.