Trauma in pregnant women: an experience from a level 1 trauma center

Mishal Gillani,Sabah Uddin Saqib,Hasnain Zafar,Russell Seth Martins

doi:10.34172/jept.2020.20

Abstract

Objective: Trauma is the significant non-obstetrical cause of maternal mortality in women aged 35 years or younger. It is expected to complicate around 1 in 12 pregnancies and accounts for 46% of such deaths. In this study, we present our experience of trauma during pregnancy at a tertiary care hospital in Karachi. Methods: A standardized form was used to extract data from online records for all pregnant women who presented with traumatic injuries to the Aga Khan University Hospital from 2014 to 2019. Analysis was performed using SPSS v. 21. Chi-squared tests were performed for comparison of categorical data. Results: A total of 48 pregnant females with a mean age of 28.80 ± 6.50 years were included in this study. Road traffic accidents (RTA) accounted for the commonest cause of injury in the first (66.7%) and second (65%) trimesters. However, fall (45.5%) followed by RTA (27.3%) was the most frequent mechanism of injury during the third trimester. Gunshot injuries were seen in 4 patients only. Overall, fetal ultrasound was the most commonly performed imaging (87.5%) followed by limb X-ray and focused abdominal sonography for trauma (FAST) ultrasound. Out of total, 52.1% of the patients were surgically managed. Fetal demise in utero and spontaneous abortion was reported in 2 patients only. Conclusion: Road traffic accidents and falls comprise a significant burden of maternal and fetal morbidity and mortality. In terms of prevention, several policies and interventions at the government level need to be introduced in order to reduce the incidence of traumatic events.

Highlights

Trauma is the significant non-obstetrical cause of maternal mortality in women aged 35 years or younger (1)
Around 58.3% of patients presented directly to the emergency room (ER), while others came to the consultant clinics
A previous study by Weiss et al showed that the mean age of pregnant women who came to the emergency department for treatment was 24.6 years (5) which is close to the mean age in our study

Summary

Introduction

Trauma is the significant non-obstetrical cause of maternal mortality in women aged 35 years or younger (1). It is expected to complicate around 1 in 12 pregnancies (2). Notable causes accounting for high fetal mortality are placental abruption, maternal shock, uterine rupture, disseminated intravascular shock, direct fetal injury and pre-term delivery (3). The mechanisms of injury and mortality are classified into various types, including falls, burns, assaults, blunt and penetrating trauma (4). Motor vehicle collisions account for around 80% of all major traumatic incidents during pregnancy, followed by fall and assault (5). Literature shows that every 1 in 3 pregnant women inflicted with trauma is expected to deliver when hospitalized (6). Acquaintance with common mechanisms of injuries and their management will allow physicians to provide appropriate treatment to pregnant women. We present our experience of trauma during pregnancy at a tertiary care hospital in Karachi, Hospital

Methods

Results

Discussion

Conclusion