Abdominal injuries in pregnancy: a 155-month study at two level 1 trauma centers

Introduction: Trauma in pregnancy is the leading cause of non-obstetrical maternal death and remains a major cause of fetal demise. The objective of this study was to examine the outcomes of pregnant patients sustaining abdominal injury. Patients and methods: This is a retrospective analysis of all pregnant trauma patients admitted to two level 1 trauma centers from February 1, 1996 to December 31, 2008. Patient data abstracted included mechanism of injury, physiologic parameters on admission, Injury Severity Score (ISS), abdominal Abbreviated Injury Scale (AIS), gestational age, diagnostic and surgical procedures performed, complications, and maternal and fetal mortality. Univariate analysis and logistic regression analysis were used. Results: During the 155-month study period, 321 pregnant patients were included, of which 291 (91%) sustained a blunt injury, while 30 (9%) were victims of penetrating trauma. Of the penetrating injuries, 22 (73%) were gunshot wounds, 7 (23%) stab wounds, and 1 (4%) shotgun injury. The overall maternal and fetal mortality was 3% (n = 9) and 16% (n = 45), respectively. Mean age was 22 +/- 6 year-old, and the mean ISS was 12 +/- 16. The overall mean abdominal AIS was 2 +/- 1.2. When adjusted for age, abdominal AIS, ISS, and diastolic blood pressure, the penetrating trauma group experienced higher maternal mortality [7% vs. 2% (adjusted OR: 7; 95% CI: 0.65-79), p = 0.090], significantly higher fetal mortality [73% vs. 10% (adjusted OR: 34; 95% CI: 11-124), p < 0.0001] and maternal morbidity [66% vs. 10% (adjusted OR: 25; 95% CI: 9-79) p < 0.0001]. Conclusions: Fetal mortality and overall maternal morbidity remains exceedingly high, at 73% and 66%, respectively, following penetrating abdominal injury. Penetrating injury mechanism, severity of abdominal injury and maternal hypotension on admission were independently associated with an increased risk for fetal demise following traumatic insult during pregnancy. (C) 2010 Elsevier Ltd. All rights reserved.