Minor Trauma Is an Unrecognized Contributor to Poor Fetal Outcomes: A Population-Based Study of 78,552 Pregnancies

Abstract

Fetal outcomes after minor injury (MI) to pregnant women are difficult to study because these patients are discharged after emergency room evaluation and not entered in trauma registries. The purpose of this study was to determine the association of both minor and severe injury on fetal demise and prematurity/low birth weight (LBW) in a large population-based study using robust state databases. The Tennessee State Fetal Birth and Death Data Systems were merged with the Tennessee State Hospital Discharge Data System using patient identifiers. All women with an e-code requiring inpatient admission during their pregnancy were considered severely injured, whereas those discharged after emergency room evaluation were considered to have MI. The impact of trauma on unintended fetal demise and premature birth/LBW was assessed using multivariable logistic regression. In 2005, there were 376 fetal deaths and 78,176 viable deliveries of which 11,817 were premature/LBW. Severe injury was significantly associated with fetal demise and prematurity/LBW. Unexpectedly, first- and second-trimester MI was associated with both fetal demise and prematurity/LBW. As expected, fetal mortality and morbidity increased after severe injury. Surprisingly, MI was associated with fetal demise, premature delivery, and LBW. Pregnant women who sustain MI should be told that they are at increased risk for an adverse outcome.