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Abstract
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The effects of traumatic injury on pregnancy have been observed for millennia. While the oldest cases are lost in the fog of antiquity, known instances are referenced in the 15th century BCE Code of Hammurabi (Buchsbaum, 1976) and the Old Testament (Exodus 22:21).
In the medical literature of the late Nineteenth and mid-Twentieth centuries, the issue received increasingly detailed coverage, primarily in the forms of case reports and series. While the earliest of these papers described incidents pertaining to falls, ‘blows’ and assaults (Brinton, 1884), as society mechanized and automobile use expanded, clinical reports increasingly contained references to automobile related incidents.
Woodhull referred to one of the earlier known motor vehicle-related fetal deaths in 1940 (Woodhull, 1942). A 20-year-old, 7-month pregnant woman was ejected from a vehicle with fetal death reportedly due to uterine rupture. In another early report a 21-year-old pregnant women was involved in a head-on automobile collision resulting in a fractured pelvis and subsequent fetal death due to fetal skull fracture (Seear and Woeppel, 1953). Dyer and Barclay (1962) reported a case series of 53 pregnancy related trauma cases in which 30 were automobile-related, five were from penetrating wounds, 13 were from falls and three from assaults.
METHODS: Rates and causes of traumatic injury-related fetal deaths in Pennsylvania were determined from a manual review of all fetal death certificates filed from 1995 to 1997 (7,131 cases). RESULTS: Thirty one traumatic injury cases were identified (6.5/100,000 live births). Most cases (94%) could be identified from the diagnosis code of 760.5 (maternal injury) and 87% contained narratives indicating specific injury mechanisms. Motor vehicles were the leading cause of injury (81%). Placental separation was the leading diagnosis (42%). CONCLUSIONS: The ICD-9-CM code 760.5 appears to be a specific indicator of traumatic fetal death, though it is not known how sensitive an indicator it is. Though not usually E-coded, the death certificates contained enough information to allow ascertainment of injury mechanism. These are very conservative estimates of the burden of the problem. The major role that motor vehicle injuries have on reported traumatic fetal injury deaths was shown and a significant new challenge for child passenger safety advocates is indicated. |