Fetal deaths related to maternal injury

Context Maternal and fetal trauma is an important cause of adverse fetal ou tcomes. However, systematic exclusion from US injury surveillance programs of even the most severe outcome, fetal/neonatal death, has led to a lack of understanding about frequency, causes, and prevention. Objective To determine the rate of traumatic fetal deaths reported instate fetal death registries and the types of trauma and physiologic diagnoses as sociated with these deaths. Design and Setting Retrospective descriptive study of fetal death certifica tes from 1995 through 1997 obtained from 16 states, which accounted for 55% of US live births and approximately 15000 fetal death registrations per ye ar. Main Outcome Measure Rate of fetal injury deaths, based on fetal death cert ificates coded with an underlying cause of death due to maternal injury at 20 weeks' gestation or later, by cause. Results During the 3-year study period, 240 traumatic fetal injury deaths w ere identified (3.7 fetal deaths per 100000 live births). Motor vehicle cra shes were the leading trauma mechanism (82% of cases; 2.3 fetal deaths per 100000 live births), followed by firearm injuries (6% of cases) and falls ( 3% of cases). In 3 states, reported crash-related fetal deaths exceeded tha t of crash-related infant deaths. Placental injury was mentioned in 100 cas es (42%) and maternal death was noted in 27 cases (11%). A peak rate of 9.3 fetal deaths per 100000 live births was observed among 15- to 19-year-old women. Conclusions Motor vehicle crashes are the leading cause of fetal deaths rel ated to maternal trauma. improved tracking of traumatic fetal injury deaths is important to stimulate and guide research and efforts to reduce the ris ks to women and fetuses from injury during pregnancy.