Document Detail


Predictors of fetal mortality in pregnant trauma patients.
MedLine Citation:
PMID:  9191656     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Fetal mortality after trauma is significant. This study was aimed at identifying factors responsible for this high fetal mortality. METHODS: All pregnant trauma patients admitted to the two major Toronto trauma institutions during the period of November of 1991 to February of 1996 with an Injury Severity Score (ISS) > or = 12 were assessed. Data on age, gestation, hypotension, ISS, hemoglobin, blood transfusion, length of stay, disseminated intravascular coagulation (DIC), and specific maternal injury were analyzed retrospectively to determine predictors of fetal mortality by comparison of patients with and without fetal survival. RESULTS: Twenty of a total of 68 pregnant trauma patients qualified for entry into the trauma registry by having an ISS > or = 12. Overall fetal mortality was 65% (13 of 20) for ISS > or = 12, and there was one maternal death (age, 29 years; ISS, 66). There were no statistically significant differences between the fetal death and fetal survival groups in age (29.2 +/- 6.2 vs. 30.4 +/- 3.9 years), gestation (25.3 +/- 10.5 vs. 24.1 +/- 9.2 weeks), lowest systolic blood pressure (98.3 +/- 33.8 vs. 112 +/- 18.0 mm Hg), head injury rate (3 of 13 vs. 1 of 7), extremity injury rate (8 of 13 vs. 2 of 7), abdominal injury rate (4 of 13 vs. 0 of 7), pelvic fracture rate (6 of 13 vs. 1 of 7), and chest injury rate (5 of 13 vs. 3 of 7). However, ISS (27.7 +/- 3.5 vs. 14.2 +/- 11.4), lowest hemoglobin level (78.8 +/- 17.0 vs. 101.9 +/- 17.1), blood transfusions (10.8 +/- 6.3 vs. 0.9 +/- 1.6 units), length of stay (20.9 +/- 16.7 vs. 8.2 +/- 4.9 days), and the incidence of DIC (8 of 13 vs. 0 of 7) were statistically significantly different between the two groups (p < 0.05). All eight patients with abruptio placentae had associated fetal mortality. CONCLUSIONS: Apart from ISS, blood loss, and abruptio placentae; the presence of DIC was the most significant predictor of fetal mortality. This finding may represent stimulation of DIC by placental products entering the maternal circulation after significant intrauterine injury.
Authors:
J Ali; A Yeo; T J Gana; B A McLellan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  42     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  1997 May 
Date Detail:
Created Date:  1997-07-10     Completed Date:  1997-07-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  782-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Abruptio Placentae / etiology
Adult
Cause of Death
Disseminated Intravascular Coagulation / etiology
Female
Fetal Death / etiology*
Hemorrhage / etiology
Humans
Injury Severity Score
Multiple Trauma / complications*
Predictive Value of Tests
Pregnancy
Pregnancy Complications*
Retrospective Studies
Risk Factors
Survival Analysis
Trauma Centers

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


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