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A Multi-institutional Study of Factors Associated With Fetal Death in Injured Pregnant Patients
Frederick B. Rogers, MD;
Grace S. Rozycki, MD;
Turner M. Osler, MD;
Steven R. Shackford, MD;
Jennifer Jalbert;
Orlando Kirton, MD;
Thomas Scalea, MD;
John Morris, MD;
Steven Ross, MD;
Mark Cipolle, MD;
John Fildes, MD;
Thomas Cogbill, MD;
Jack Bergstein, MD;
David Clark, MD;
Heidi Frankel, MD;
Richard Bell, MD;
David Gens, MD;
Daniel Cullinane, MD;
Donald Kauder, MD;
Raymond P. Bynoe, MD
Arch Surg. 1999;134:1274-1277.
Hypothesis Factors associated with fetal death in injured pregnant patients are related to increasing injury severity and abnormal maternal physiologic profile.
Design A multi-institutional retrospective study of 13 level I and level II trauma centers from 1992 to 1996.
Main Outcome Measure Fetal survival.
Results Of 27,715 female admissions, there were 372 injured pregnant patients (1.3%); 84% had blunt injuries and 16% had penetrating injuries. There were 14 maternal deaths (3.8%) and 35 fetal deaths (9.4%). The population suffering fetal death had higher injury severity scores (P<.001), lower Glascow Coma Scale scores (P<.001), and lower admitting maternal pH (P=.002). Most women who lost their fetus arrived in shock (P=.005) or had a fetal heart rate of less than 110 beats/min at some time during their hospitalization (P<.001). An Injury Severity Score greater than 25 was associated with a 50% incidence of fetal death. Placental abruption was the most frequent complication, occurring in 3.5% of patients and associated with 54% mortality. Cardiotrophic monitoring to detect potentially threatening fetal heart rates was performed on only 61% of pregnant women in their third trimester. Of these patients, 7 had abnormalities on cardiotrophic monitoring and underwent successful cesarean delivery.
Conclusions Fetal death was more likely with greater severity of injury. Cardiotrophic monitoring is underused in injured pregnant patients in their third trimester even after admission to major trauma centers. Increased use of cardiotrophic monitoring may decrease the mortality caused by placental abruption.
From the Departments of Surgery, Fletcher Allen Health Care, Burlington, Vt (Drs Rogers, Osler, and Shackford, and Ms Jalbert); Hartford Hospital, Hartford, Conn (Dr Kinton); Cooper Health System, Camden, NJ (Dr Ross); LeHigh Valley Hospital, Allentown, Pa (Dr Cippolle); University Medical Center, Las Vegas, Nev (Dr Fildes); Gundersen Lutheran Medical Center, LaCrosse, Wis (Dr Cogbill); West Virginia University School of Medicine, Morgantown (Dr Bergstein); Maine Medical Center, Portland (Dr Clark); The Trauma Center at Penn, Philadelphia, Pa (Drs Frankel and Kauder); University of South Carolina, Columbia (Drs Bell and Bynoe); and Emory University School of Medicine, Atlanta, Ga (Dr Rozycki); the R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore (Dr Scalea); Trauma Patient Care Center, Vanderbilt University Medical Center, Nashville, Tenn (Dr Morris); the University School of Medicine Program in Trauma, University of Maryland Medical Systems, Baltimore (Dr Gens); and the Mayo Clinic, Rochester, Minn (Dr Cullinane).
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