Maternal trauma: short- and long-term complications are possible

  • J Pediatr Surg

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Maternal trauma can have acute fetal effects and longer-term fetal and infant effects post-trauma discharge.

Why this matters

  • Trauma is a leading cause of nonobstetric morbidity and mortality during pregnancy.
  • Increased antepartum surveillance after trauma may be warranted.

Key results

  • Trauma admission occurred most commonly in the third trimester (40%).
  • 81% of cases involved blunt trauma, most commonly from motor vehicle accidents.
  • 22% of fetuses were immediately affected by the traumatic event.
  • Risks for adverse events at subsequent admission compared with trauma admission:
    • Cesarean delivery: 12% vs 80% (P<.001>
    • Abnormal Apgar scores: 5% vs 60% (P<.001>
    • Low birth weight: 5% vs 65% (P<.001>
    • Placental abruption: 2% vs 40% (P=.008); and
    • Fetal mortality: 0% vs 25% (P<.001>
  • Overall infant mortality rate was 14% 

Study design

  • Retrospective review.
  • Cohort obtained from a trauma registry between 2009 and 2017 (n=5654).
  • Clinical outcomes of fetuses delivered during index trauma (n=20) and those delivered during a subsequent admission after the index trauma (n=43) compared.
  • Funding: None.

Limitations

  • Small numbers in study.
  • Study is from a trauma center; traumas may be more severe than in the general population, and results may not be generalizable.
  • No comparison with group without trauma.