WHAT TO EXPECT WHEN YOUR PATIENT IS EXPECTING: AN ANALYSIS OF OUTCOMES AFTER TRAUMA IN OBSTETRIC PATIENTS

Objectives: Traumatic injury in obstetric patients has been shown to correlate with adverse fetal outcomes, even in patients with minor injury. As such, triage mechanisms are in place to ascertain injury in a timely fashion for obstetric patients. However, the data in this area is dated and new technology and guidelines for triage have been developed to guide therapy. This study was conducted to evaluate maternal and fetal outcomes of injury over a 10 year period.

Methods: Retrospective review from 2010-2020 of all pregnant patients seen after a traumatic mechanism at a Level 1 Trauma Center. Categorical Data were compared with Chi-square or Fisher’s Exact Test and continuous data with Mann-Whitney U test. Multivariate analysis was performed to determine risk factors for poor fetal outcomes and then used to create a logistic regression analysis. A p-value of 0.05 was considered statistically significant.

Results: 775 injured pregnant patients were seen from 1/2010 to 12/2020. 571 pregnant patients were then compared to a control group of non-pregnant child-bearing age women. Injury Severity Scores (ISS) was higher in non-pregnant patients (5 vs 0, p< 0.001), however mortality was similar between groups (p=0.07). Of the 571 pregnant patients seen, 558 (98%) had an ISS < 9, with 368 (64%) having an ISS of 0. 122 (21%) pregnant patients suffered from adverse fetal outcomes including spontaneous abortion, fetal demise, preterm labor, placental abruption, or preterm premature rupture of membranes. Compared to the pregnant patients without adverse fetal outcomes, these patients had a higher ISS (p < 0.001), higher abbreviated injury scales (AIS) for thorax, abdomen, spine, lower extremities (p < 0.05), and lower gestational age (p=0.005). Age, GCS, AIS Abdomen and Lower Extremity, and not having a term pregnancy were predictive of adverse fetal outcomes on logistic regression. 17 (3%) patients went into labor in the hospital after trauma. Logistic regression modeling revealed race (p=0.044), gestational age (p=0.037), and having a term pregnancy (p=0.001) as predictive of going into labor during admission for traumatic injury.

Conclusion: Minor injury is a significant source of morbidity for pregnant trauma patients. Appropriate triage and monitoring after injury may help identify those in danger of adverse fetal outcomes.