Pregnant Women Experiencing Violent Trauma Have Higher Death Rates Despite Less Severe Injuries [36G

Abstract

INTRODUCTION: Trauma is the leading non-obstetric cause of maternal death with 5-8% incidence in the United States. We compared violence-related outcomes between pregnant women and their non-pregnant counterparts. METHODS: We studied 197 pregnant and 4658 non-pregnant women of reproductive age (14-49) who experienced violent trauma between 2005-2015 as captured in the Pennsylvania Trauma Outcomes Study. We used modified Poisson regression to estimate relative rates of trauma-related outcomes. All models were adjusted for injury severity score and age. RESULTS: Compared to non-pregnant women, pregnant women were younger (mean age=24.3 versus 30.6 years, p < 0.001), more likely to be African-American (54.3% versus 40.1%, p< 0.001), and to have Medicaid insurance (63.1% versus 57.6%, p=0.04). They were less likely to have preexisting psychiatric, drug use, and alcohol use disorders (18.8%, 8.6%, and 2.0% for pregnant women versus 30.1%, 14.2%, and 8.8% for non-pregnant women, respectively, p < 0.03 for all). Pregnant women had a mean injury severity score of 8.7 compared to 9.5 for non-pregnant women (p=0.3), and were significantly more likely to suffer trauma secondary to assault (adjusted relative rate-aRR)=1.06, 95%CI: 1.00-1.12, p=0.04). Pregnant women were more likely to require surgery (aRR=1.06, 95%CI1.01-1.12, p=0.03), and were 3.4 times more likely to undergo hospital transfer (aRR=3.41, 95%CI: 2.32-5.00, p < 0.001). Pregnant women had mortality rates twice that of their non-pregnant counterparts despite lower injury severity scores (aRR=1.98, 95%CI: 1.24-3.07, p=0.004). CONCLUSION: After violent trauma, pregnant women have twice the death rate of their non-pregnant counterparts. Screening for violence during pregnancy is paramount for prevention of trauma-related death.