The unborn fetus: The unrecognized victim of trauma during pregnancy
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In brief
In brief
Retrospective study of 188 pregnant trauma patients reveals significant fetal burden, with 14% infant mortality and 66% overall adverse fetal outcomes including preterm delivery, stillbirth, and long-term disability. Findings highlight the previously underrecognized impact of maternal trauma on fetal health beyond immediate maternal survival.
Written by the GCMD Library team from the article.
Background
Trauma is the leading cause of non-obstetric death in pregnancy. While maternal management is defined, few studies have examined the effects on the fetus.
Methods
Following IRB approval, all pregnant females (2010–2017) at a level-1 trauma center were retrospectively reviewed. Maternal and fetal demographics, interventions, and clinical outcomes were analyzed.
Results
There were 188 pregnancies in 5654 females. Maternal demographics were 26 ± 7 years old, gestational age at trauma 21 ± 12 weeks, 81% blunt mechanism, and maternal mortality 6%. Forty-one (22%) fetuses were immediately affected by the trauma including 20 (11%) born alive, 12 (7%) fetal demise, and 9 (5%) stillbirths. Of those that initially survived (n = 20), 5 (25%) expired during neonatal hospitalization. Two mothers returned immediately after trauma discharge with stillbirths for an overall infant mortality of 14% (n = 26). There were 84 patients with complete data to delivery including the 41 born at trauma and 43 born on a subsequent hospitalization. Those born at the time of trauma had significantly more delivery/neonatal complications and worse outcomes. Overall trauma burden to the fetus (preterm delivery, stillbirth, delivery/neonatal complication, or long-term disability) was 66% (56/84).
Conclusions
Trauma during pregnancy has significant immediate mortality and delayed effects on the unborn fetus. This study has uncovered a previously hidden burden and mortality of trauma during pregnancy.
Level of Evidence
Level III.