Trauma in Pregnancy

Abstract

Trauma during pregnancy is a common source of morbidity and mortality for both mother and fetus. Although the precise incidence is unknown, trauma is estimated to complicate 1 in 12 pregnancies.1 It is the leading cause of nonobstetric maternal mortality in the United States, accounting for up to 46% of maternal deaths.2 According to a fetal death certificate study, the rate of fetal death from maternal trauma is calculated to be 2.3 per 100,000 live births.3 Most incidents are minor, with only 4.1 injury-related hospitalizations of pregnant women per 1000 deliveries in the United States. Of women requiring admission, 24% to 38% proceed to delivery during hospitalization.4 The incidence of hospital admission parallels increasing gestational age.5 A pregnancy complicated by trauma can be hazardous for both the mother and the fetus. Maternal complications associated with trauma in pregnancy include maternal injury or death, shock, and internal hemorrhage.6 Possible fetal complications include spontaneous abortion, preterm birth, preterm premature rupture of membranes, direct fetal injury, uterine rupture, abruption, and stillbirth. Motor vehicle collision (MVC) is the leading cause of injury (49%) followed by falls (25%), assaults (18%), gunshots (4%), and burns (1%) (Figure 1).7 It is important to note that intimate partner violence (IPV) is emerging as one of the leading causes of maternal injury and death during pregnancy, according to the Centers for Disease Control and Prevention.8 Risk factors associated with trauma in pregnancy include younger maternal age, drug and alcohol use, and history of domestic violence.2 Consequently, it is important for the obstetrician/gynecologist to screen patients for all risk factors in an attempt to decrease the incidence of trauma during pregnancy. All obstetrician/gynecologists will encounter patients with pregnancy-related trauma and will need to provide accurate diagnosis and management. Although much has been written on the subject, there is a paucity of good evidence to direct optimal management of pregnant women after trauma. Thus, there is an inherent gap in information available to help physicians manage these relatively common events. The goal of this article is to review the currently available data to address this gap in knowledge and help develop an evidencebased approach that will optimize both maternal and fetal outcomes.