The results indicate that in the setting of critical access hospitals, external accreditation appears to result in modestly better performance.

No abstract

In a review of pregnant women suffering blunt trauma, 70% of major injuries were due to MV As. l Most serious maternal trauma results in placental abruption, with concomitant fetal injury and death.:!-:1 Fetal cerebral trauma and intracranial hemorrhage have been associated with serious maternal injury, placental abruption, and fetal death.3-S We present a case of maternal trauma secondary to an MV A with major fetal cerebral injuries and subsequent neonatal neurologic impairment. CASE REPORTA 20 year old gravida 2, para 0 0 1 0 woman who was serology nonreactive, rubella immune, and hepatitis surface antigen negative was involved in a head-on motor vehicle accident at approximately 25 weeks' gestation. Collision was with a semi•tractor trailer with both vehicles traveling at 40 to 45 miles per hour. The patient was not wearing a scat belt at the time and sustained a blunt injury to the abdomen against the steering column of the automobile. She suffered multiple facial lacerations, cuts, and contusions when her face hit the windshield. The patient was evaluated in the emergency room and was found to have a right upper quadrant retroperitoneal hematoma, a drop in hemoglobin to 6.9%, and severe facial lacerations. The fetal heart rate tracing was found to be reactive, with a baseline rate of 150 beats per minute. The patient had contractions every 3 to 4 minutes, which stopped with simple hydration. No vaginal bleeding or other signs of fetal distress were present. The patient was admitted to the hospital for observation and 10 hours after the MV A a fetal sonogram was performed, which revealed bilateral foci of increased echogenicity in the frontoparietal cerebral cortex adjacent to the lateral ventricles, demonstrated in axial (Fig. IA) and coronal (Fig. 18) scans. These had not been present on routine anatomy scan performed 4 weeks prior to the MV A and were believed to represent intracerebral hematomas secondary to trauma. All biometric measurements were consistent with a gestational age of 25 weeks, which agreed with the two prior scans at 14 and 22 weeks. No obvious skull abnormalities were seen, nor was there any evidence of placental abruption. The patient was observed for 2 days in the hospital with reassuring fetal heart rate tracings.

Adequate preparation and a team approach will provide optimal care for a pregnant patient who has an allergic reaction to a contrast agent.