The spectrum and outcome of pregnant trauma patients in a metropolitan trauma service in South Africa

Abstract

IntroductionPregnant patients involved in trauma pose unique diagnostic and treatment challenges as the physiological and anatomical changes associated with pregnancy, and the need to preserve foetal well-being, result in a number of nuances in the standard resuscitation algorithms. This clinical audit within a busy developing world trauma service describes the spectrum and outcome of pregnant trauma patients. MethodsAll pregnant patients presenting to the Pietermaritzburg Metropolitan Hospital Complex following trauma were included in the study. Data were retrieved from the trauma registry and analyzed using descriptive statistics on a spreadsheet. The study ran from the 1st of July 2011 to the 31st of December 2013. ResultsDuring the study period, 1075 female trauma patients were admitted, with a 4% incidence of pregnant patients (42/1075). The mean age of the patients in the study was 24.9 years with an average age of gestation of 21.4 weeks. Blunt trauma accounted for the majority of injuries (57%). Trauma was by way of intentional assault in 52% of the cases. Of the cases of assault, 81% of the time, the assailant was known to the victim and in the majority of cases (55%) the assailant was the patient's intimate partner. Polytrauma predominated as the most common pattern of injury. Foetal death occurred in more than a third of cases (15/42). In 90% of the patients with an Injury Severity Score greater than fifteen, there was foetal death. Eighty-six percent (6/7) of the patients who required surgery had an unfavourable foetal outcome. In 73% of the cases of foetal death, the pregnancies were less than 28 weeks gestation. ConclusionIn an environment with high rates of interpersonal violence, trauma in pregnancy is not an uncommon occurrence. It is most commonly due to assault and the assailant is known to the victim in the majority of cases. Blunt trauma still predominates in this setting but there is a high incidence of penetrating trauma. Foetal mortality in this group is high and reflects the severity of the trauma experienced.