Document Detail

Infant survival after cesarean section for trauma.
MedLine Citation:
PMID:  8651739     Owner:  NLM     Status:  MEDLINE    
HYPOTHESIS: Emergency cesarean sections in trauma patients are not justified and should be abandoned. SETTING AND DESIGN: A multi-institutional, retrospective cohort study was conducted of level 1 trauma centers. METHODS: Trauma admissions from nine level 1 trauma centers from January 1986 through December 1994 were reviewed. Pregnant women who underwent emergency cesarean sections were identified. Demographic and clinical data were obtained on all patients undergoing a cesarean section. Fetal distress was defined by bradycardia, deceleration, or lack of fetal heart tones (FHTs). Maternal distress was defined by shock (systolic blood pressure < 90) or acute decompensation. Statistical analyses were performed. RESULTS: Of the 114,952 consecutive trauma admissions, more than 441 pregnant women required 32 emergency cesarean sections. All were performed for fetal distress, maternal distress, or both. Overall, 15 (45%) of the fetuses and 23 (72%) of the mothers survived. Of 33 fetuses delivered, 13 had no FHTs and none survived. Twenty infants (potential survivors) had FHTs and an estimated gestational age (EGA) of greater than or equal to 26 weeks, and 75% survived. Infant survival was independent of maternal distress or maternal Injury Severity Score. The five infant deaths in the group of potential survivors resulted from delayed recognition of fetal distress, and 60% of these deaths were in mothers with mild to moderate injuries (Injury Severity Score < 16). CONCLUSIONS: In pregnant trauma patients, infant viability is defined by the presence of FHTs, estimated gestational age greater than or equal to 26 weeks. In viable infants, survival after emergency cesarean section is acceptable (75%). Infant survival is independent of maternal distress or Injury Severity Score. Sixty percent of infant deaths resulted from delay in recognition of fetal distress and cesarean section. These were potentially preventable. Given the definition of fetal viability, our initial hypothesis is invalid.
J A Morris; T J Rosenbower; G J Jurkovich; D B Hoyt; J D Harviel; M M Knudson; R S Miller; J M Burch; J W Meredith; S E Ross; J M Jenkins; J G Bass
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Annals of surgery     Volume:  223     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  1996 May 
Date Detail:
Created Date:  1996-07-19     Completed Date:  1996-07-19     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  481-8; discussion 488-91     Citation Subset:  AIM; IM    
Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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MeSH Terms
Cesarean Section* / statistics & numerical data
Cohort Studies
Gestational Age
Infant Mortality*
Infant, Newborn
Pregnancy Outcome
Retrospective Studies
Treatment Outcome
United States / epidemiology
Wounds and Injuries / mortality,  therapy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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