Trauma during pregnancy. A review of 79 cases
T. J. Esposito, D. R. Gens, L. G. Smith, R. Scorpio and T. Buchman
Department of Surgery, Maryland Institute for Emergency Medical Services Systems, Baltimore.
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
well-being. 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.
