Trauma during pregnancy: An analysis of maternal and fetal outcomes in a large population

Dina El Kady, William M. Gilbert, John T Anderson, Beate Danielsen, Dena Towner, Lloyd H Smith

Research output: Contribution to journalArticle

145 Citations (Scopus)

Abstract

Objective This study was undertaken to determine the occurrence rates, outcomes, risk factors, and timing of obstetric delivery for trauma sustained during pregnancy. Study design This is a retrospective cohort study of women hospitalized for trauma in California (1991-1999). International Classification of Disease, ninth revision, Clinical Modification codes, and external causation codes for injury were identified. Maternal and fetal/neonatal outcomes were analyzed for women delivering at the trauma hospitalization (group 1), and women sustaining trauma prenatally (group 2), compared with nontrauma controls. Injury severity scores and injury types were used to stratify risk in relation to outcome. Statistical comparisons are expressed as odds ratios (ORs) with 95% CIs. Results A total of 10,316 deliveries fulfilling study criteria were identified in 4,833,286 total deliveries. Fractures, dislocations, sprains, and strains were the most common type of injury. Group 1 was associated with the worst outcomes: maternal death OR 69 (95% CI 42-115), fetal death OR 4.7 (95% CI 3.4-6.4), uterine rupture OR 43 (95% CI 19-97), and placental abruption OR 9.2 (95% CI 7.8-11). Group 2 also resulted in increased risks at delivery: placental abruption OR 1.6 (95% CI 1.3-1.9), preterm labor OR 2.7 (95% CI 2.5-2.9), maternal death OR 4.4 (95% CI 1.4-14). As injury severity scores increased, outcomes worsened, yet were statistically nonpredictive. The type of injury most commonly leading to maternal death was internal injury. The risk of fetal, neonatal, and infant death was strongly influenced by gestational age at the time of delivery. Conclusion Women delivering at the trauma hospitalization (group 1) had the worst outcomes, regardless of the severity of the injury. Group 2 women (prenatal injury) had an increased risk of adverse outcomes at delivery, and therefore should be monitored closely during the subsequent course of the pregnancy. This study highlights the need to optimize education in trauma prevention during pregnancy.

Original languageEnglish (US)
Pages (from-to)1661-1668
Number of pages8
JournalAmerican Journal of Obstetrics and Gynecology
Volume190
Issue number6
DOIs
StatePublished - Jun 2004

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Mothers
Pregnancy
Wounds and Injuries
Odds Ratio
Population
Maternal Death
Hospitalization Insurance
Abruptio Placentae
Injury Severity Score
Fetal Death
Prenatal Injuries
Obstetric Delivery
Uterine Rupture
Sprains and Strains
Premature Obstetric Labor
International Classification of Diseases
Causality
Gestational Age
Cohort Studies
Retrospective Studies

Keywords

  • Injury severity
  • Pregnancy outcomes
  • Trauma in pregnancy

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Trauma during pregnancy : An analysis of maternal and fetal outcomes in a large population. / El Kady, Dina; Gilbert, William M.; Anderson, John T; Danielsen, Beate; Towner, Dena; Smith, Lloyd H.

In: American Journal of Obstetrics and Gynecology, Vol. 190, No. 6, 06.2004, p. 1661-1668.

Research output: Contribution to journalArticle

El Kady, Dina ; Gilbert, William M. ; Anderson, John T ; Danielsen, Beate ; Towner, Dena ; Smith, Lloyd H. / Trauma during pregnancy : An analysis of maternal and fetal outcomes in a large population. In: American Journal of Obstetrics and Gynecology. 2004 ; Vol. 190, No. 6. pp. 1661-1668.
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abstract = "Objective This study was undertaken to determine the occurrence rates, outcomes, risk factors, and timing of obstetric delivery for trauma sustained during pregnancy. Study design This is a retrospective cohort study of women hospitalized for trauma in California (1991-1999). International Classification of Disease, ninth revision, Clinical Modification codes, and external causation codes for injury were identified. Maternal and fetal/neonatal outcomes were analyzed for women delivering at the trauma hospitalization (group 1), and women sustaining trauma prenatally (group 2), compared with nontrauma controls. Injury severity scores and injury types were used to stratify risk in relation to outcome. Statistical comparisons are expressed as odds ratios (ORs) with 95{\%} CIs. Results A total of 10,316 deliveries fulfilling study criteria were identified in 4,833,286 total deliveries. Fractures, dislocations, sprains, and strains were the most common type of injury. Group 1 was associated with the worst outcomes: maternal death OR 69 (95{\%} CI 42-115), fetal death OR 4.7 (95{\%} CI 3.4-6.4), uterine rupture OR 43 (95{\%} CI 19-97), and placental abruption OR 9.2 (95{\%} CI 7.8-11). Group 2 also resulted in increased risks at delivery: placental abruption OR 1.6 (95{\%} CI 1.3-1.9), preterm labor OR 2.7 (95{\%} CI 2.5-2.9), maternal death OR 4.4 (95{\%} CI 1.4-14). As injury severity scores increased, outcomes worsened, yet were statistically nonpredictive. The type of injury most commonly leading to maternal death was internal injury. The risk of fetal, neonatal, and infant death was strongly influenced by gestational age at the time of delivery. Conclusion Women delivering at the trauma hospitalization (group 1) had the worst outcomes, regardless of the severity of the injury. Group 2 women (prenatal injury) had an increased risk of adverse outcomes at delivery, and therefore should be monitored closely during the subsequent course of the pregnancy. This study highlights the need to optimize education in trauma prevention during pregnancy.",
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N2 - Objective This study was undertaken to determine the occurrence rates, outcomes, risk factors, and timing of obstetric delivery for trauma sustained during pregnancy. Study design This is a retrospective cohort study of women hospitalized for trauma in California (1991-1999). International Classification of Disease, ninth revision, Clinical Modification codes, and external causation codes for injury were identified. Maternal and fetal/neonatal outcomes were analyzed for women delivering at the trauma hospitalization (group 1), and women sustaining trauma prenatally (group 2), compared with nontrauma controls. Injury severity scores and injury types were used to stratify risk in relation to outcome. Statistical comparisons are expressed as odds ratios (ORs) with 95% CIs. Results A total of 10,316 deliveries fulfilling study criteria were identified in 4,833,286 total deliveries. Fractures, dislocations, sprains, and strains were the most common type of injury. Group 1 was associated with the worst outcomes: maternal death OR 69 (95% CI 42-115), fetal death OR 4.7 (95% CI 3.4-6.4), uterine rupture OR 43 (95% CI 19-97), and placental abruption OR 9.2 (95% CI 7.8-11). Group 2 also resulted in increased risks at delivery: placental abruption OR 1.6 (95% CI 1.3-1.9), preterm labor OR 2.7 (95% CI 2.5-2.9), maternal death OR 4.4 (95% CI 1.4-14). As injury severity scores increased, outcomes worsened, yet were statistically nonpredictive. The type of injury most commonly leading to maternal death was internal injury. The risk of fetal, neonatal, and infant death was strongly influenced by gestational age at the time of delivery. Conclusion Women delivering at the trauma hospitalization (group 1) had the worst outcomes, regardless of the severity of the injury. Group 2 women (prenatal injury) had an increased risk of adverse outcomes at delivery, and therefore should be monitored closely during the subsequent course of the pregnancy. This study highlights the need to optimize education in trauma prevention during pregnancy.

AB - Objective This study was undertaken to determine the occurrence rates, outcomes, risk factors, and timing of obstetric delivery for trauma sustained during pregnancy. Study design This is a retrospective cohort study of women hospitalized for trauma in California (1991-1999). International Classification of Disease, ninth revision, Clinical Modification codes, and external causation codes for injury were identified. Maternal and fetal/neonatal outcomes were analyzed for women delivering at the trauma hospitalization (group 1), and women sustaining trauma prenatally (group 2), compared with nontrauma controls. Injury severity scores and injury types were used to stratify risk in relation to outcome. Statistical comparisons are expressed as odds ratios (ORs) with 95% CIs. Results A total of 10,316 deliveries fulfilling study criteria were identified in 4,833,286 total deliveries. Fractures, dislocations, sprains, and strains were the most common type of injury. Group 1 was associated with the worst outcomes: maternal death OR 69 (95% CI 42-115), fetal death OR 4.7 (95% CI 3.4-6.4), uterine rupture OR 43 (95% CI 19-97), and placental abruption OR 9.2 (95% CI 7.8-11). Group 2 also resulted in increased risks at delivery: placental abruption OR 1.6 (95% CI 1.3-1.9), preterm labor OR 2.7 (95% CI 2.5-2.9), maternal death OR 4.4 (95% CI 1.4-14). As injury severity scores increased, outcomes worsened, yet were statistically nonpredictive. The type of injury most commonly leading to maternal death was internal injury. The risk of fetal, neonatal, and infant death was strongly influenced by gestational age at the time of delivery. Conclusion Women delivering at the trauma hospitalization (group 1) had the worst outcomes, regardless of the severity of the injury. Group 2 women (prenatal injury) had an increased risk of adverse outcomes at delivery, and therefore should be monitored closely during the subsequent course of the pregnancy. This study highlights the need to optimize education in trauma prevention during pregnancy.

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