Trauma in pregnancy

Objective: To determine whether the severity of maternal injury or other ma ternal and fetal variables will predict the outcome of pregnancy in the inj ured pregnant patient. Patients and Methods: In this retrospective review of pregnant patients hos pitalized at a level 1 trauma center from 1986 to 1996, we analyzed the mat ernal Injury Severity Score, maternal mortality, fetal-neonatal mortality, maternal hypotension, and fetal heart rate. Results: Sixty-one pregnant women were identified who were hospitalized aft er trauma, The mean +/- SD maternal age was 26.6+/-6.6 years. The distribut ion of trauma per gestational age was 21%, 20%, and 59% for the first, seco nd, and third trimester, respectively. The most common mechanism of injury was motor vehicle crashes. Long-term pregnancy outcome was available in 53 patients (87%). There was 1 maternal death. Fetal-neonatal death occurred i n 8 (15%) of 53 pregnancies. Most maternal physiologic variables were not p redictors of pregnancy outcome. We were unable to detect a difference in th e distribution of Injury Severity Scores between viable and nonviable pregn ancies. However, maternal hypotension and low fetal heart rate were common in nonviable pregnancies (P=.02). Conclusions: Maternal hypotension and fetal heart rate are potential predic tors of pregnancy outcome after trauma. Other maternal and fetal physiologi c variables are poor measures of fetal well-being and are unable to predict fetal outcome. Fetal-neonatal death does not necessarily correlate with se verity of maternal injury.