Trauma in pregnancy. Predicting pregnancy outcome
D. P. Kissinger, G. S. Rozycki, J. A. Morris Jr, M. M. Knudson, W. S. Copes, S. M. Bass, H. K. Yates and H. R. Champion
Trauma, Surgical Critical Care, Washington Hospital Center, Washington, DC 20010-2975.
A multicenter study involving three American College of Surgeons Level 1
trauma centers was undertaken to assess parameters that may predict fetal
outcome. The records of 93 injured pregnant patients admitted from April 1,
1985, to March 31, 1990, were reviewed. There were three maternal deaths
(3%) (mean Injury Severity Score, 43). Fourteen fetal/neonatal deaths (15%)
occurred during the acute care admission period. Of these, eight were fetal
deaths (two associated with maternal death), four were cases of elective
abortions, and two were neonatal deaths. In general, the maternal
physiologic and laboratory parameters assessed failed to accurately predict
pregnancy outcome, while Injury Severity Score did differ significantly
between patients whose pregnancies were viable (Injury Severity Score =
6.2) and those whose pregnancies were nonviable (Injury Severity Score =
21.6). Unique to this study were the findings that the Glasgow Coma Score
also differed significantly in patients with viable (Glasgow Coma Score,
14.5) and nonviable (Glasgow Coma Score, 12.0) pregnancies, while fetal
heart rate at admission to the emergency department did not. In this study,
the incidence of fetal death was increased following direct uteroplacental
fetal injury (100% of cases), maternal shock (67%), pelvic fracture (57%),
severe head injury (56%), and hypoxia (33%). The adequacy of noninvasive
maternal monitoring in assessing fetal well-being is challenged, and a
discussion of diagnostic modalities for assessment for the injured gravida
is set forth.
