TRAUMA IN PREGNANCY: A SIX-YEAR RETROSPECTIVE ANALYSIS OF A TRAUMA CENTER IN A DEVELOPING COUNTRY
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Keywords
Trauma, Pregnancy, motor vehicle accidents, placental abruption, Abortion
Abstract
Background: Even though trauma in pregnancy is rare, trauma is one of the most common causes of morbidity and mortality in pregnant women. This study aimed to identify the leading causes of trauma in pregnant women and to evaluate the outcome of the pregnancy and the consequences of trauma in this critical period in a level 1 trauma center in a developing country.
Methods: We performed a retrospective study of pregnant women admitted to Shahid Kamyab trauma center, Mashhad, Iran, from 2011 to 2017. Clinical histories of trauma, hospital records, operative reports, Imaging studies, admission days, and Glasgow coma scale (GCS) score were assessed, and data related to trauma and pregnancy were collected. Pregnancy-related complications were recorded based on ultrasound reports. The pregnancy outcome and delivery type were recorded from health care data sets. Chi-square, Fisher exact, t-tests, and nonparametric tests were utilized for univariate and multivariate analysis. Potential confounders were controlled with a logistic regression model. Data analysis was performed by the SPSS software v.16.
Results: There were 5,617 women between 16-45 years of age; 330 (5.9%) were pregnant, and 284 patients (5 twin pregnancies) were eligible to include in this study. The mean age was 27.2, and the mean gestational age was 21.3 weeks. Blunt trauma accounted for the majority of cases (87%). The most common cause of trauma was motor vehicle accidents (72.8%), followed by falling (13.7%) and violence (9.8%). 48.1 % of patients were admitted for Head trauma, and 26.5 % were admitted to the hospital with polytrauma. Nineteen patients (6.6%) underwent non-obstetrical surgical operations. The most common pregnancy-related complication was placental abruption (8.2%). Three cases of maternal death occurred due to severe head and cervical spine injuries. 36 fetal death (12.4%) from 34 pregnancies were recorded as the outcome of pregnancies. Most cases of fetal death (88%) occurred during the first two trimesters. Higher fetal death rates were accompanied by placental abruption, surgery, and lower gestational age.
Conclusion: Trauma in pregnancy is related to high rates of fetal death. Placental abruption, surgery, and lower gestational age were associated with higher risks of unfavorable fetal outcomes.
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Sayyed Hadi Sayyed Hosseinian
Associated Professor of Orthopedic Surgery, Orthopedic research center, Mashhad University of Medical Sciences, Mashhad, Iran
Yashar Shahbaz
Orthopedic research center, Mashhad University of Medical Sciences, Mashhad, Iran
Sajjad Ezzati
Orthopedic research center, Mashhad University of Medical Sciences, Mashhad, Iran
Seyeed mola Nouri Hosseini
Orthopedic research center, Mashhad University of Medical Sciences, Mashhad, Iran
Mohammad Hosein Ebrahimzadeh
Orthopedic research center, Mashhad University of Medical Sciences, Mashhad, Iran