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A Review of 79 Cases

Thomas J. Esposito, MD, MPH; David R. Gens, MD; Lynn Gerber Smith, RN, MS; Ronald Scorpio, MD; Timothy Buchman, MD

Arch Surg. 1991;126(9):1073-1078.

Abstract
• Few studies provide data on pregnant trauma patients that can be used to direct management decisions. Therefore, this retrospective study of 79 pregnant patients who were injured and admitted to a trauma center during a 9-year period was conducted to obtain such information. Maternal mortality for these pregnant patients was 10%, which was not different from that for nonpregnant females. Overall, rate of fetal loss was 34%. Rates of fetal loss were not different in patients with and without evidence of shock and/or hypoxia or in restrained and unrestrained automobile occupants. Diagnostic peritoneal lavage proved to be 95% accurate and safe. Based on these findings, we concluded the following: pregnancy does not increase maternal mortality from trauma. Blood pressure, pulse rate, and PO₂ are unreliable indicators of adequate maternal resuscitation and fetal wellbeing. Assumption of maternal and fetal stability based solely on these usually standard criteria is unwise. Use of seat belts during pregnancy is advisable in the absence of evidence that restraints increase the rate of fetal loss.

(Arch Surg. 1991;126:1073-1078)

Author Affiliations
From the Department of Surgery, Maryland Institute for Emergency Medical Services Systems, Baltimore. Dr Esposito is now with the Department of Surgery, Loyola University Medical Center and the Shock Trauma Institute, Loyola University, Maywood, Ill. Dr Scorpio is now with the Department of Surgery, Trauma Program, The Hospital for Sick Children, Toronto, Ontario. Dr Buchman is now with the Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.

Footnotes
Accepted for publication May 19, 1991.

Reprint requests to The Shock Trauma Institute, Loyola University Medical Center, 2160 S First Ave, Maywood, IL 60153 (Dr Esposito).

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