INFANT SURVIVAL AFTER CESAREAN-SECTION FOR TRAUMA

Hypothesis Emergency cesarean sections in trauma patients are not just ified and should be abandoned. Setting and Design A multi-institutiona l, retrospective cohort study was conducted of level I trauma centers. Methods Trauma admissions from nine level I trauma centers from Janua ry 1986 through December 1994 were reviewed. Pregnant women who underw ent emergency cesarean sections were identified. Demographic and clini cal data were obtained on all patients undergoing a cesarean section. Fetal distress was defined by bradycardia, deceleration, or lack of fe tal heart tones (FHTs). Maternal distress was defined by shock (systol ic 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. Ove rall, 15 (45%) of the fetuses and 23 (72%) of the mothers survived. Of 33 fetuses delivered, 13 had no FHTs and none survived. Twenty infant s (potential survivors)had FHTs and an estimated gestational age (EGA) of greater than or equal to 26 weeks, and 75% survived. Infant surviv al was independent of maternal distress or maternal injury Severity Sc ore. The five infant deaths in the group of potential survivors result ed 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 d efined by the presence of FHTs, estimated gestational age greater than or equal to 26 weeks. In viable infants, survival after emergency ces arean section is acceptable (75%). infant survival is independent of m aternal distress or Injury Severity Score. Sixty percent of infant dea ths resulted from delay in recognition of fetal distress and cesarean section. These were potentially preventable. Given the definition of f etal viability, our initial hypothesis is invalid.