32 - OBSTETRICAL TRAUMA: REDUCING THE BURDEN OF TRAUMA TRANSFER TO TERTIARY CARE CENTERS

Objectives: In rural state trauma systems, management of the obstetrical trauma patient often defaults in transfer to Level I Trauma Centers. In the absence of severe maternal injury these transfers displace patients from family and peer support of their community escalating cost to their pre-natal care. We evaluate the necessity to transfer obstetrical trauma patients in the absences of severe maternal injury.

Methods: A retrospective 5 year review of obstetrical trauma patients admitted to a rural states level I Trauma Center was conducted. Patient demographic and outcome measures of both maternal and fetal outcomes were collected. Injury severity measures such as abdominal AIS, ISS, and GCS were correlated with outcomes. Furthermore, the impact of maternal and gestational age on uterine compromise, uterine irritability and the need for cesarean section intervention is also presented.

Results: Twenty one percent of patients were transferred in from outside facilities with a median age of 29 years old, average ISS of 3.9 ± standard deviation (SD) of 5.6, GCS of 13.8 ± 3.6 and maximum abdominal AIS of 1.6 ± 0.8. Outcomes consisted of maternal fatality of 2%, fetal demise of 4%, 6% experienced premature rupture of membranes, 9% experienced fetal placental compromise, 15% had uterine contractions, 15% ended up with caesarean intervention and fetal decelerations occurred in 4%. Predictors of fetal compromise are strongly associated with high maternal ISS and low GCS. Gestational age of fetus correlates with early cesarean sections and increased uterine contraction following injury. Greater maternal age is correlated with uterine irritability following trauma.

Conclusion: The frequency of traumatic injury in this unique populous of patients is fortunately limited. The best predictor for fetal demise and uterine irritability remains maternal severity of injury as measured by ISS and GCS. With a 96% frequency of fetal monitoring in this population only a 4% frequency of decelerations was noted giving concern for fetal distress in isolation of severe maternal injury. Therefore in the absences of severe maternal trauma obstetrical trauma patients with minor injuries can safely be managed at non-tertiary care facilities with obstetrical capabilities.