Abruptio placentae after auto accidents - A case-control study

OBJECTIVE: To compare accident and injury characteristics il I pregnant wom en with and without abruptio placentae involved in auto accidents (AAs). STUDY DESIGN: A retrospective, case-control study involving 12 pregnant wom en (16-39 weeks) with a diagnosis of abruptio placentae after AAs and 12 co ntrol subjects matched for gestational age (+/-2 weeks) involved in AAs wit hout abruptio placentae from 1988 through 1997. Numerous variables were com pared, including restraint system use, estimated speed of the collision, in jury severity score (ISS), clinical findings and patient position in the ve hicle. Patient complaints and physical examination on admission were also r ecorded, and obstetric and neonatal outcomes were compared. Statistical ana lysis was performed using the independent sample t, Mann-Whitney and Fisher 's exact tests, a,when appropriate RESULTS: There was no significant difference in the frequency of unrestrain ed subjects or position in the vehicle between cases and controls. Estimate d speed of the vehicle at the time of collision was significantly higher in the abruptio placentae group (>30 mph, 92% vs. 50%, P =.03), as was the me an ISS code (20 [SD 12.71] vs. 4 [SD 5.13], P<.001).Abdominal pain and vagi nal bleeding were seen more frequently in women with abruptio placentae as compared to controls (58% vs. 25% and 33% vs. 0, respectively). Patients wi th abruptio placentae had a higher incidence of preterm delivery (mean gest ational age at delivery = 29 weeks [SD 7.99] vs. 36 weeks [SD 7.21], P =.00 8) and stillbirth (57% vs. 0%, P =.002) and lower mean birth weight (1,924g [SD 931] vs. 3,069 g [SD 450], P=.003). There was no significant differenc e in cesarean section rates between the groups (58% vs. 30%, P=.23). There was no difference in the two groups in placental location on ultrasonograph y. CONCLUSION: Pregnant women were involved in severe accidents (i.e., higher speed or ISS) were more likely to suffer abruptio placentae. In severe acci dents, proper restraints were frequently not used. Because of the severity of these accidents, current restraint systems may not be sufficient to prev ent abruptio placentae even with proper restraint use. Efforts toward desig ning new restraint systems for pregnant women should be encouraged.