Screening Sonography in Pregnant Patients With Blunt Abdominal Trauma

Abstract

Abdominal injury of pregnant women, if not recognized, may cause preventable fetal deaths. The physical findings are very unreliable. Computed tomography (CT) screening entails the assessment of many patients, and the findings are negative in 90% or more of cases. In addition, potential harm from exposure to ionizing radiation must be considered, and this is also the case for intravenous urography and cystography. Diagnostic peritoneal lavage is an invasive procedure. For all these reasons, the investigators retrospectively evaluated abdominal sonography-a relatively safe procedure-in 5173 women screened after blunt abdominal trauma. There were 947 women of reproductive age (15-45 years), and 102 of them (11%) were pregnant. Certified sonographers performed the examination using equipment with Doppler capabilities. Five of the 101 women evaluated, 5% of the total, had injury confirmed and underwent either laparotomy or emergency cesarean delivery. Sonography was positive in four of the five injured women, for a sensitivity of 80% (95% confidence interval [CI], 28-100%). The placenta and spleen were injured in two patients each, and both the liver and kidney in one patient. There was a single false-negative study that missed a placental hematoma. All 96 noninjured women had negative sonography findings, for a specificity of 100% (95% CI, 96-100%). Sonography had a positive predictive value of 100% (95% CI, 40-100%) and a negative predictive value of 99% (95% CI, 94-100%. Three patients had their positive sonographic findings confirmed (and localized) by CT scanning. These findings affirm the value of sonography as a screening measure to detect injury in pregnant women subjected to blunt abdominal trauma. It is a safe examination that in most cases precludes the need for more risky tests such as CT and peritoneal lavage. Any woman with negative sonographic findings must be observed.