383 Evaluating minor trauma in pregnancy – can we limit cost without affecting outcomes?

Abstract

The purpose of this study was to determine whether laboratory tests and extended fetal monitoring alter management and/or predict outcomes in women with viable pregnancies who endure minor trauma. A retrospective observational study of pregnant women who presented to Cooper University Hospital (CUH) between January 2010 to April 2019 for evaluation after sustaining minor trauma (defined as an Injury Severity Score less than 3). Standard protocol at CUH is to perform fetal and uterine contraction monitoring for up to 6 hours post-trauma, and collect a CBC, Type and Screen, Kleihauer-Betke, Fibrinogen, PT, and PTT. For this study, all fetal and uterine contraction monitoring was reviewed by a single investigator. Data was analyzed using Independent-t, Mann-Whitney U, Kruskal-Wallis, and x2 tests as indicated. Of the 260 women that met inclusion criteria for this study, 66 (25%) required admission and monitoring for greater than 6 hours. Laboratory values were not significantly different between women discharged after evaluation versus required prolonged observation (Table 1). The overall preterm delivery rate for this study (7.3%) and neonatal ICU admission rate (15%) was similar to the general population. There were no fetal demises; however, one placental abruption occurred. Pregnant women with less than 4 uterine contractions per hour in the first hour did not change their subsequent uterine contraction pattern for the remainder of monitoring. Routine laboratory tests drawn in pregnant women who sustained minor trauma did not determine admission for observation or discharge, nor did they predict adverse outcomes such as placental abruption, preterm birth, low birth weight, or NICU admission. Our study suggests that women with a reassuring fetal heart tracing and less than 4 uterine contractions in 1 hour of post trauma monitoring should not undergo routine laboratory tests or additional monitoring. Cost savings for the hospital are estimated to be more than $187,000 when using this approach for evaluation.