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Affiliation
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Hospital of the University of Pennsylvania, Department of Obstetrics & Gynecology, PA; Perelman School of Medicine, Division of Traumatology, Surgical Critical Care & Emergency Surgery, University of Pennsylvania, PA. Electronic address: OxfordC@uphs.upenn.edu. |
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Abstract
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BACKGROUND: Trauma is the leading non-obstetric cause of death in women of reproductive age, and pregnant women in particularly may be at increased risk of violent trauma. Management of trauma in pregnancy is complicated by altered maternal physiology, provider expertise, potential disparate imaging, and distorted anatomy. Little is known about the impact of trauma on maternal mortality.
OBJECTIVE: (1) To characterize non-violent and violent trauma among pregnant women, (2) to determine whether pregnancy is associated with increased mortality following traumatic injury, and (3) to identify risk factors for trauma-related death in pregnant women METHODS: We studied 1,148 trauma events among pregnant women and 43,608 trauma events among non-pregnant women of reproductive age (14-49) who presented to any accredited trauma center in Pennsylvania for treatment of trauma-related injuries between 2005-2015, as captured in the Pennsylvania Trauma Outcomes Study (PTOS). Traumas were categorized as violent (e.g. homicide, assault) or non-violent (motor vehicle accident, accidental fall). We used modified Poisson regression to estimate relative rate of trauma-related death, adjusting for demographic characteristics and severity of trauma.
RESULTS: Compared to non-pregnant women, pregnant women had a lower injury severity score (8.9 versus 10.9, p<0.001) and were significantly more likely to suffer violent trauma (15.9% vs. 9.8%, p<0.001). Pregnant trauma victims had a 1.6-fold higher rate of mortality compared to their non-pregnant counterparts (p<0.001); and were both more likely to be dead on arrival and to die during their hospital course (adjusted relative risk (aRR)=2.33, p <0.001 and aRR=1.79, p=0.004, respectively). Pregnancy was associated with increased mortality in both victims of non-violent and violent trauma (aRR=1.69, p=0.002 and aRR=1.60, p=0.007, respectively). Pregnant trauma victims were less likely to undergo surgery (aRR=0.70, p=0.001) and more likely to be transferred to another facility (aRR=1.72, p <0.001). Even after adjusting for demographics and injury severity score, violent trauma was associated with 3.14-fold higher mortality in pregnant women compared to non-violent trauma (aRR=3.14, p=0.003).
CONCLUSION: Pregnant women are nearly twice as likely to die after trauma and twice as likely to experience violent trauma. Universal screening for violence and trauma during pregnancy may provide an opportunity to identify women at risk for death during pregnancy.
Copyright © 2017. Published by Elsevier Inc.
Language: en |