Unveiling the impact of trauma during pregnancy

Am J Surg. 2024 Nov 28:240:116124. doi: 10.1016/j.amjsurg.2024.116124. Online ahead of print.

Abstract

Background: Pregnant trauma patients present unique challenges in terms of assessment and management. This study assesses the impact of traumatic injuries on pregnant patients using a national trauma database.

Methods: ACS-TQIP (2020-2021) identified traumatically injured females aged ≥15 and ​≤ ​55. Propensity score matching compared pregnant and not-pregnant patients. Primary outcome was mortality, with secondary outcomes including length of stay (LOS), emergency department and discharge disposition, interventions, and complications.

Results: Of 947,000 traumatically injured females, 8421 (0.9 ​%) were pregnant. Pregnant patients (6.0 ​%) sustained firearm injuries more than not-pregnant patients (5.4 ​%) (p ​= ​0.02). Pregnant patients had more severe thoracic (47.2%vs.9.4 ​%) and abdominal injuries (7.1%vs.4.8 ​%) compared to not-pregnant patients (p ​< ​0.001). Among pregnant patients, 5.6 ​% had preterm labor, 2.6 ​% had cesarean sections, and 1.9 ​% had abortions. After matching, there was no significant difference in mortality between both groups (p ​= ​0.40). Pregnant patients had longer ICU LOS (p ​< ​0.05) and higher rates of unplanned return to ICU (p ​< ​0.05).

Conclusions: Pregnant patients are more often victims of firearm violence, sustaining critical thoracic and abdominal injuries. These injuries demand increased interventions, introduce complications, and can be fatal.

Keywords: Obstetric; Pregnancy; Trauma.