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Traumatic injuries to the pregnant patient: a critical literature review

Abstract

Introduction

Trauma during pregnancy is the leading non-obstetrical cause of maternal death and a significant public health burden. This study reviews the most common causes of trauma during pregnancy, morbidity, and mortality, and the impact upon perinatal outcomes associated with trauma, providing a management approach to pregnant trauma patients.

Materials and methods

A systematic review of the current literature from January 2006 to July 2016 was performed.

Results

Fifty-one articles were identified, including a total of 95,949 patients. Motor vehicle crash was the most frequent cause of blunt trauma, followed by falls, assault both domestic and interpersonal violence, and penetrating injuries (gunshot and stab wounds).

Conclusions

Trauma in pregnant women is associated with high rates of adverse maternal and neonatal outcomes. Knowledge of the mechanism of injury is important to identify the potential injuries and the complexity of the management of these patients. As in all traumatic events, prevention is of paramount importance.

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Fig. 1

Modified from Petrone P, Tillou A. Gynecologic injuries: trauma to gravid and nongravid uterus and female genitalia. In: Current therapy of trauma and surgical critical care. (Elsevier, Philadelphia, 2016), pp 401–407

References

  1. Petrone P, Talving P, Browder T, Teixeira PG, Fisher O, Lozornio A, Chan LS. Abdominal injuries in pregnancy: a 155-month study at two level 1 trauma centers. Injury. 2011;42(1):47–9.

    PubMed  Article  Google Scholar 

  2. Metz TD, Abbott JT. Uterine trauma in pregnancy after motor vehicle crashes with airbag deployment: a 30-case series. J Trauma. 2006;61(3):658–61.

    PubMed  Article  Google Scholar 

  3. El Kady D, Gilbert WM, Xing G, Smith LH. Association of maternal fractures with adverse perinatal outcomes. Am J Obstet Gynecol. 2006;195(3):711–6.

    PubMed  Article  Google Scholar 

  4. Barré M, Winer N, Caroit Y, Boog G, Philippe HJ. Abdominal trauma during pregnancy: pertinence of monitoring elements. J Gynecol Obstet Biol Reprod. 2006;35(7):673–7.

    Article  Google Scholar 

  5. Aniuliene R, Proseviciūte L, Aniulis P, Pamerneckas A. Trauma in pregnancy: complications, outcomes, and treatment. Medicina (B Aires). 2006;42(7):586–91.

    Google Scholar 

  6. Weintraub AY, Levy A, Holcberg G, Sheiner E. The outcome of blunt abdominal trauma preceding birth. Int J Fertil Womens Med. 2006;51(6):275–9.

    PubMed  Google Scholar 

  7. Sperry JL, Casey BM, McIntire DD, Minei JP, Gentilello LM, Shafi S. Long-term fetal outcomes in pregnant trauma patients. Am J Surg. 2006;192(6):715–21.

    PubMed  Article  Google Scholar 

  8. Hitosugi M, Motozawa Y, Kido M, Yokoyama T, Kawato H, Kuroda K, Tokudome S. Traffic injuries of the pregnant women and fetal or neonatal outcomes. Forensic Sci Int. 2006;159(1):51–4.

    PubMed  Article  Google Scholar 

  9. Kuo C, Jamieson DJ, McPheeters ML, Meikle SF, Posner SF. Injury hospitalizations of pregnant women in the United States, 2002. Am J Obstet Gynecol. 2007;196(2):161.e1–6. (Erratum in: Am J Obstet Gynecol 2007;196(6):614–5).

    Article  Google Scholar 

  10. Aboutanos SZ, Aboutanos MB, Dompkowski D, Duane TM, Malhotra AK, Ivatury RR. Predictors of fetal outcome in pregnant trauma patients: a five-year institutional review. Am Surg. 2007;73(8):824–7.

    PubMed  Google Scholar 

  11. Greene W, Robinson L, Rizzo AG, Sakran J, Hendershot K, Moore A, et al. Pregnancy is not a sufficient indicator for trauma team activation. J Trauma. 2007;63(3):55 – 5.

    Article  Google Scholar 

  12. Patteson SK, Snider CC, Meyer DS, Enderson BL, Armstrong JE, Whitaker GL, Carroll RC. The consequences of high-risk behaviors: trauma during pregnancy. J Trauma. 2007;62(4):1015–20.

    PubMed  Article  Google Scholar 

  13. Kvarnstrand L, Milsom I, Lekander T, Druid H, Jacobsson B. Maternal fatalities, fetal and neonatal deaths related to motor vehicle crashes during pregnancy: a national population-based study. Acta Obstet Gynecol Scand. 2008;87(9):946–52.

    PubMed  Article  Google Scholar 

  14. Weiss HB, Sauber-Schatz EK, Cook LJ. The epidemiology of pregnancy-associated emergency department injury visits and their impact on birth outcomes. Accid Anal Prev. 2008;40(3):1088–95.

    PubMed  Article  Google Scholar 

  15. Cahill AG, Bastek JA, Stamilio DM, Odibo AO, Stevens E, Macones GA. Minor trauma in pregnancy–is the evaluation unwarranted? Am J Obstet Gynecol. 2008;198(2):208.e1–5.

    Article  Google Scholar 

  16. Klinich KD, Flannagan CA, Rupp JD, Sochor M, Schneider LW, Pearlman MD. Fetal outcome in motor-vehicle crashes: effects of crash characteristics and maternal restraint. Am J Obstet Gynecol. 2008;198(4):450–9.

    PubMed  Article  Google Scholar 

  17. Aboutanos MB, Aboutanos SZ, Dompkowski D, Duane TM, Malhotra AK, Ivatury RR. Significance of motor vehicle crashes and pelvic injury on fetal mortality: a five-year institutional review. J Trauma. 2008;65(3):616 – 20.

    PubMed  Article  Google Scholar 

  18. Schiff MA. Pregnancy outcomes following hospitalization for a fall in Washington State from 1987 to 2004. BJOG. 2008;115(13):1648–54.

    CAS  PubMed  Article  Google Scholar 

  19. Nannini A, Lazar J, Berg C, Barger M, Tomashek K, Cabral H, et al. Physical injuries reported on hospital visits for assault during the pregnancy-associated period. Nurs Res. 2008;57(3):144–9.

    PubMed  Article  Google Scholar 

  20. Dunning K, Lemasters G, Bhattacharya A. A major public health issue: the high incidence of falls during pregnancy. Matern Child Health J. 2010;14(5):720–5.

    PubMed  Article  Google Scholar 

  21. Cannada LK, Pan P, Casey BM, McIntire DD, Shafi S, Leveno KJ. Pregnancy outcomes after orthopedic trauma. J Trauma. 2010;69(3):694–8.

    PubMed  Article  Google Scholar 

  22. Tinker SC, Reefhuis J, Dellinger AM, Jamieson DJ. National birth defects prevention study. Epidemiology of maternal injuries during pregnancy in a population-based study, 1997–2005. J Womens Health (Larchmt) 2010;19(12):2211–8.

    Article  Google Scholar 

  23. Vladutiu CJ, Evenson KR, Marshall SW. Physical activity and injuries during pregnancy. J Phys Act Health. 2010;7(6):761–9.

    PubMed  PubMed Central  Article  Google Scholar 

  24. Schiff MA, Mack CD, Kaufman RP, Holt VL, Grossman DC. The effect of air bags on pregnancy outcomes in Washington State: 2002–2005. Obstet Gynecol. 2010;115(1):85–92.

    PubMed  Article  Google Scholar 

  25. Preeti R, hiozawa A, Haut ER, Efron DT, Haider A, Cornwell EE 3rd, Chang D. An assessment of the impact of pregnancy on trauma mortality. Surgery. 2011;149(1):94–8.

    Article  Google Scholar 

  26. Vivian-Taylor J, Roberts CL, Chen JS, Ford JB. Motor vehicle accidents during pregnancy: a population-based study. BJOG. 2012;119(4):499–503.

    CAS  PubMed  Article  Google Scholar 

  27. Fischer PE, Zarzaur BL, Fabian TC, Magnotti LJ, Croce MA. Minor trauma is an unrecognized contributor to poor fetal outcomes: a population-based study of 78,552 pregnancies. J Trauma. 2011;71(1):90–3.

    PubMed  Article  Google Scholar 

  28. Lin P, Gill JR. Homicides of pregnant women. Am J Forensic Med Pathol. 2011;32(2):161–3.

    PubMed  Article  Google Scholar 

  29. Meuleners LB, Lee AH, Janssen PA, Fraser ML. Maternal and foetal outcomes among pregnant women hospitalised due to interpersonal violence: a population based study in Western Australia, 2002–2008. BMC Pregnancy Childbirth. 2011–2012;11:70.

  30. Melamed N, Aviram A, Silver M, Peled Y, Wiznitzer A, Glezerman M, Yogev Y. Pregnancy course and outcome following blunt trauma. J Matern Fetal Neonatal Med. 2012;25(9):1612–7.

    PubMed  Article  Google Scholar 

  31. Karadaş S, Gönüllü H, Oncü MR, Kurdoğlu Z, Canbaz Y. Pregnancy and trauma: analysis of 139 cases. J Turk Ger Gynecol Assoc. 2012;13(2):118–22.

    PubMed  PubMed Central  Article  Google Scholar 

  32. Mesdaghinia E, Sooky Z, Mesdaghinia A. Causes of trauma in pregnant women referred to Shabih-Khani maternity hospital in Kashan. Arch Trauma Res. 2012;1(1):23–6.

    PubMed  PubMed Central  Article  Google Scholar 

  33. Njoku OI, Joannes UO, Christian MC, Azubike OK. Trauma during pregnancy in a Nigerian setting: patterns of presentation and pregnancy outcome. Int J Crit Illn Inj Sci. 2013;3(4):269–73.

    PubMed  PubMed Central  Article  Google Scholar 

  34. Luley T, Fitzpatrick CB, Grotegut CA, Hocker MB, Myers ER, Brown HL. Perinatal implications of motor vehicle accident trauma during pregnancy: identifying populations at risk. Am J Obstet Gynecol. 2013;208(6):466.

    PubMed  Article  Google Scholar 

  35. Vladutiu CJ, Marshall SW, Poole C, Casteel C, Menard MK, Weiss HB. Adverse pregnancy outcomes following motor vehicle crashes. Am J Prev Med. 2013;45(5):629–36.

    PubMed  Article  Google Scholar 

  36. Periyanayagam U, Crandall M. The cost of injury: hospital charges for pregnant trauma patients, 1999 to 2003. Am J Surg. 2014;208(1):130–5.

    PubMed  Article  Google Scholar 

  37. Brookfield KF, Gonzalez-Quintero VH, Davis JS, Schulman CI. Maternal death in the emergency department from trauma. Arch Gynecol Obstet. 2013;288(3):507–12.

    PubMed  Article  Google Scholar 

  38. Zangene M, Ebrahimi B, Najafi F. Trauma in pregnancy and its consequences in Kermanshah, Iran from 2007 to 2010. Glob J Health Sci. 2014;7(2):304–9.

    PubMed  PubMed Central  Article  Google Scholar 

  39. Wall SL, Figueiredo F, Laing GL, Clarke DL. The spectrum and outcome of pregnant trauma patients in a metropolitan trauma service in South Africa. Injury. 2014;45(8):1220–3.

    CAS  PubMed  Article  Google Scholar 

  40. Okeke TC, Ugwu EO, Ikeako LC, Adiri CO, Ezenyeaku CC, Ekwuazi KE, Okoro OS. Falls among pregnant women in Enugu, Southeast Nigeria. Niger J Clin Pract. 2014;17(3):292–5.

    CAS  PubMed  Article  Google Scholar 

  41. Harland KK, Saftlas AF, Yankowitz J, Peek-Asa C. Risk factors for maternal injuries in a population-based sample of pregnant women. J Womens Health. 2014;23(12):1033–8.

    Article  Google Scholar 

  42. Ibrahim ZM, Sayed Ahmed WA, El-Hamid SA, Hagras AM. Intimate partner violence among Egyptian pregnant women: incidence, risk factors, and adverse maternal and fetal outcomes. Clin Exp Obstet Gynecol. 2015;42(2):212–9.

    CAS  PubMed  Google Scholar 

  43. Chibber R, Al-Harmi J, Fouda M, El-Saleh E. Motor-vehicle injury in pregnancy and subsequent feto-maternal outcomes: of grave concern. J Matern Fetal Neonatal Med. 2015;28(4):399–402.

    PubMed  Article  Google Scholar 

  44. Jackson CL, Ciciolla L, Crnic KA, Luecken LJ, Gonzales NA, Coonrod DV. Intimate partner violence before and during pregnancy: related demographic and psychosocial factors and postpartum depressive symptoms among Mexican American women. J Interpers Violence. 2015;30(4):659–79.

    PubMed  Article  Google Scholar 

  45. Azar T, Longo C, Oddy L, Abenhaim HA. Motor vehicle collision-related accidents in pregnancy. J Obstet Gynaecol Res. 2015;41(9):1370–6.

    PubMed  Article  Google Scholar 

  46. Van der Knoop BJ, van Schie PE, Vermeulen RJ, Pistorius LR, van Weissenbruch MM, de Vries JI. Effect of (minor or major) maternal trauma on fetal motility: a prospective study. Early Hum Dev. 2015;91(9):511–7.

    PubMed  Article  Google Scholar 

  47. Shakerian R, Thomson BN, Judson R, Skandarajah AR. Radiation fear: impact on compliance with trauma imaging guidelines in the pregnant patient. J Trauma Acute Care Surg. 2015;78(1):88–93.

    PubMed  Article  Google Scholar 

  48. Weiner E, Gluck O, Levy M, Ram M, Divon M, Bar J, Kovo M. Obstetric and neonatal outcome following minor trauma in pregnancy. Is hospitalization warranted? Eur J Obstet Gynecol Reprod Biol. 2016;203:78–81.

    PubMed  Article  Google Scholar 

  49. Miller N, Biron-Shental T, Peleg K, Fishman A, Olsha O, Givon A, Kessel B. Are pregnant women safer in motor vehicle accidents? J Perinat Med. 2016;44(3):329–32.

    PubMed  Article  Google Scholar 

  50. Battaloglu E, McDonnell D, Chu J, Lecky F, Porter K. Epidemiology and outcomes of pregnancy and obstetric complications in trauma in the United Kingdom. Injury. 2016;47(1):184–7.

    PubMed  Article  Google Scholar 

  51. Distelhorst JT, Krishnamoorthy V, Schiff MA. Association between hospital trauma designation and maternal and neonatal outcomes after injury among pregnant women in Washington State. J Am Coll Surg. 2016;222(3):296–302.

    PubMed  Article  Google Scholar 

  52. Moore EE, Jurkovich GJ, Knudson MM, Cogbill TH, Malangoni MA, Champion HR, Shackford SR. Organ injury scaling VI: extrahepatic biliary, esophagus, stomach, vulva, vagina, uterus (non-pregnant), uterus (pregnant), fallopian tube, and ovary. J Trauma. 1995;39:1069–70.

    CAS  PubMed  Article  Google Scholar 

  53. Pearlman MD, Viano D. Automobile crash simulation with the first pregnant crash test dummy. Am J Obstet Gynecol. 1996;175:977–81.

    CAS  PubMed  Article  Google Scholar 

  54. Dunning K, Lemasters G, Bhattacharya A. A major public health issue: The high incidence of falls during pregnancy. Matern Child Health J. 2010;14:720‑5.

    Article  Google Scholar 

  55. American College of Obstetricians and Gynecologists. ACOG educational bulletin. Obstetric aspects of trauma management. Int J Gynaecol Obstet 1999;64:87–94.

    Article  Google Scholar 

  56. Higgins SD, Garite TJ. Late abruptio placenta in trauma patients: implications for monitoring. Obstet Gynecol. 1984;63(3Suppl):10S-12S.

    PubMed  Google Scholar 

  57. Petrone P, Marini CP. Trauma in pregnant patients. Curr Probl Surg. 2015;52(8):330 – 51.

    PubMed  Article  Google Scholar 

  58. Mendez-Figueroa H, Dahlke JD, Vrees RA, Rouse DJ. Trauma in pregnancy: an updated systematic review. Am J Obstet Gynecol. 2013;209(1):1–10.

    PubMed  Article  Google Scholar 

  59. Petrone P, Asensio JA. Trauma in pregnancy: assessment and treatment. Scand J Surg. 2006;95(1):4–10.

    CAS  PubMed  Article  Google Scholar 

  60. Petrone P, Tillou A. Gynecologic injuries: trauma to gravid and nongravid uterus and female genitalia. In: Asensio JA, Trunkey D, editors. Current therapy of trauma and surgical critical care. Philadelphia: Elsevier; 2016. pp. 401–7. Second Edition.

    Google Scholar 

  61. Jain V, Chari R, Maslovitz S, Farine D;, Bujold E, et al. Maternal Fetal Medicine Committee. Guidelines for the management of a pregnant trauma patient. J Obstet Gynaecol Can. 2015;37(6):553–74.

    PubMed  Article  Google Scholar 

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Correspondence to P. Petrone.

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Patrizio Petrone, Patricia Jiménez Morillas, Alexander Axelrad, and Corrado P. Marini declare that they have not conflict of interest.

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This research consisted of literature review only, and, therefore, did not involve human participants or animals.

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Petrone, P., Jiménez-Morillas, P., Axelrad, A. et al. Traumatic injuries to the pregnant patient: a critical literature review. Eur J Trauma Emerg Surg 45, 383–392 (2019). https://doi.org/10.1007/s00068-017-0839-x

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  • DOI: https://doi.org/10.1007/s00068-017-0839-x

Keywords

  • Trauma
  • Pregnancy
  • Fetal injuries
  • Blunt
  • Penetrating