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Trauma-associated pregnancy outcomes examined by injury type

      Objective

      To determine maternal and neonatal/infant outcomes by type of traumatic injury in pregnant women.

      Study design

      This is a population-based retrospective cohort study of pregnancy outcomes in hospitalized trauma patients in California from 1991-1999. Hospital discharge records were searched for ICD-9-CM codes for injury classification including (1) fractures, dislocations, sprains, strains; (2) intracranial injuries; (3) internal injuries; (4) open wounds; (5) injury to blood vessels; (6) nerve and spinal cord injuries; (7) burns; and (8) superficial injuries, contusions, and crushing injuries.

      Results

      Of 4,824,926 deliveries, a total of 14,110 women were hospitalized for trauma in pregnancy. The most common type of injury was fractures, dislocations, sprains, strains (37%), followed by superficial injuries (28%). For women delivering at the trauma hospitalization, internal injuries had the worst outcomes, including a 24-fold increased risk of placental abruption (CI 18, 33), the highest risk of maternal death OR 385 (CI 209, 712), and the highest risk of fetal death OR 37 (CI 26, 52). For undelivered trauma patients, injury to blood vessels had the highest risk of maternal death OR 58.6 (CI 7.9, 436). All injury types were associated with significant maternal and fetal morbidity and mortality with increased rates of PTL, PROM, and uterine rupture. Although superficial injuries carried the lowest risk compared to all injury types, there still remained a 12-fold increased risk of placental abruption (CI 9.7, 15), a 10-fold increased risk of maternal death (CI 1.5, 75), and a 6-fold increased risk of fetal death (CI 4.4, 8.7).

      Conclusion

      Women sustaining trauma in pregnancy had significant morbidity and mortality, with internal injuries carrying the worst maternal and neonatal outcomes. Pregnant women sustaining even minor superficial injuries had significantly increased risks of adverse outcomes and should be managed aggressively.