A Multi-institutional Study of Factors Associated With Fetal Death in Injured Pregnant Patients

Rogers, Frederick B.; Rozycki, Grace S.; Osler, Turner M.; Shackford, Steven R.; Jalbert, Jennifer; Kirton, Orlando C.; Scalea, Thomas M.; Morris, John A.; Ross, Steven E.; Cipolle, Mark; Fildes, John; Cogbill, Thomas H.; Bergstein, Jack M.; Clark, David E.; Frankel, Heidi L.; Bell, Richard M.; Gens, David; Cullinane, Daniel C.; Kauder, Donald R.; Bynoe, Raymond P.

doi:10.1001/archsurg.134.11.1274

Cited by 92 publications

(44 citation statements)

References 12 publications

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“…What is known is that like in our patient, 7% of all pregnancies are complicated by traumatic injury while trauma is responsible for < 1% of hospitalizations in pregnancy [4]. In addition, trauma accounts for almost 4% of maternal mortality and 9% of fetal mortality [5]. However, on reviewing the literature (including this case), there is an equal frequency of traumatic and atraumatic etiologies for the occurrence of PVS in a pregnant woman [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, trauma accounts for almost 4% of maternal mortality and 9% of fetal mortality [5]. However, on reviewing the literature (including this case), there is an equal frequency of traumatic and atraumatic etiologies for the occurrence of PVS in a pregnant woman [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. As expected, there is a disparity favoring an atraumatic etiology in pregnant patients with brain death [22][23][24][25][26][27][28][29][30][31].…”

Section: Discussionmentioning

confidence: 99%

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One Hundred and Fourteen Days of Somatic Support in a Severely Brain Injured Pregnant Woman: Case Report and Review of the Literature

Adekola¹

2014

J Clin Gynecol Obstet

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The management of a previable pregnancy complicated by severe brain injury raises the question of whether to provide somatic support in order to maintain the pregnancy or not. Obstetricians who encounter this clinical scenario are faced with emotional, medical and ethical complexities, which require multidisciplinary input. A 19-year-old woman with an unremarkable medical history suffered severe brain injury and remained in a persistent vegetative state following a gunshot wound to the neck. She was discovered to be 15 weeks pregnant during resuscitative efforts. Following consultation with her family and power of attorney it was agreed to continue somatic support in order to maintain the pregnancy. A literature review to determine the best evidence based care from a multidisciplinary perspective is performed addressing issues of ethics, simulation and management of changes in maternal physiology, as well as pregnancy outcomes based on the neurological sequelae following severe brain injury. Previable pregnancies complicated by severe brain injury may be maintained until viability. Based on limited data, the obstetric outcomes may differ depending on whether the neurological sequelae are brain death or a persistent vegetative state. This management should be performed following consultation with the patient's power of attorney in conjunction with the ethics committee and legal department of the hospital. Maternal physiological changes of pregnancy must be considered for successful somatic support.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

One Hundred and Fourteen Days of Somatic Support in a Severely Brain Injured Pregnant Woman: Case Report and Review of the Literature

Adekola¹

2014

J Clin Gynecol Obstet

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“…Çalışmamızda düşme dışında ikinci en sık durum trafik kazaları olarak dikkat çekmektedir. Gebelikte travmaya bağlı ciddi maternal yaralanmalar ve fetal kayıplara neden olan en sık durum trafik kazaları olmasına karşın, gebelerin emniyet kemeri kullanım sıklığı nispeten düşük orandadır [11][12][13][14]. Gebelik sırasın-da geçirilen trafik kazalarına bağlı maternal ve fetal ölümlerin önlenmesinde uygun şekilde emniyet kemeri kullanım bilincinin oluşturulması son derece önemlidir [7].…”

Section: Discussionunclassified

Minor Trauma in Pregnancy: Evaluation of 173 Cases

Üstünyurt¹

2015

Ann Clin Anal Med

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ÖzetAmaç: Bu çalışmanın amacı gebelikte minör travma sıklığının, türlerinin ve sonuçlarının araştırılmasıdır. Gereç ve Yöntem: Nisan 2011-Ekim 2012 tarihleri arasında Bursa Şevket Yılmaz Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Acil Polikliniğine başvuran 33000 hasta kaydı incelenerek, minör travma şikayeti bulunan 173 gebe kadın çalışma kapsamına alındı. Bulgular: Gebelikte minör travma nedeni ile acil polikliniğe başvurma sıklığı % 0.5 olarak saptandı. Olguların yaş ortalaması 26.8 ± 5.4 idi. En sık travma şekli düşme (% 54.9) olarak belirlendi. Hastaneye başvuru sırasında ortalama gebelik haftası 21.6 ± 9.2 ve olguların % 51'i ikinci trimesterdeydi. Hastaların % 83.2'sinin başvuru sırasında, travma öyküsü haricinde ek şikayeti yoktu. Geri kalan grupta en sık şikayet karın ağrısı idi (%13.3). Başvuru sırasında yapılan ultrasonografilerde 1 olguda intrauterin fetal kayıp tespit edildi. Hastaların hospitalizasyon oranı % 5.2 olarak gerçekleşti. Minör travma olgularının hiçbirisinde travma sonrası erken dönemde (1 hafta içerisinde) abortus, fetal kayıp ya da preterm doğum meydana gelmedi. Tartışma: Gebelikteki minör travma sonuçları genel olarak olumlu olduğundan, anormal bulguları olmayan bu tür olgularda ayrıntılı inceleme gerekli değildir. Anahtar KelimelerTravma; Gebelik Abstract Aim: The aim of this study is to investigate the incidence, types and the outcomes of trauma in pregnancy. Material and Method: The medical reports of 33000 patients, who were admitted to the emergency outpatient clinic of Obstetrics and Gynecology Department of Bursa Şevket Yılmaz Research and Education Hospital between April 2011 and October 2012, were analyzed and 173 pregnant women with minor trauma were included in the study. Results: The incidence of admittance for minor trauma during pregnancy was 0.5 %. The mean age of the cases was 26.8 ± 5.4. The most common type of trauma was found as the falling (54.9 %). The mean gestational age was 21.6 ± 9.2 weeks and 51 % of the cases were in the second trimester at the time of admission. At the time of admission, 83 % of patients had no other complaints except trauma. Abdominal pain was the most common symptom among the rest of the group (13.3 %). One fetal death was determined by ultrasonography at the time of admittance. The hospitalization rate was 5.2 %. There were no preterm delivery or fetal death during the early period after the trauma (1 week). Discussion: As the outcomes of minor trauma in pregnancy are favorable generally, extensive evaluation is unnecessary in those cases without abnormal signs.

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“…The effect of trauma on pregnancy depends on the gestational age, intensity of maternal-fetal aggression, and type and severity of the injury. Rogers et al, in a multiinstitutional study of trauma during pregnancy, detected 3.8% of maternal mortality rate and 9.4% of fetal mortality rate (14). Motor vehicle accidents, falls, and assaults account for the most frequently cited causes of injury during pregnancy (15).…”

Section: Discussionmentioning

confidence: 99%

“…Of those, all mothers delivered viable infants but only four mothers survived. Such patients need special nutrition and maternal and fetal monitoring in an intensive care unit (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). As shown in our patient, a successful fetal outcome could be obtained in a mother who suffered from hypovolemic shock, anemia, hypoxia, had operations under general anesthesia, was treated with nu-merous medications from 4 weeks' gestation, and survived premature labor at 33 weeks' gestation in a persistent vegetative state.…”

Section: Discussionmentioning

confidence: 99%

Maternal persistent vegetative state with successful fetal outcome

Sim¹

2001

J Korean Med Sci

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A Multi-institutional Study of Factors Associated With Fetal Death in Injured Pregnant Patients

Cited by 92 publications

References 12 publications

One Hundred and Fourteen Days of Somatic Support in a Severely Brain Injured Pregnant Woman: Case Report and Review of the Literature

One Hundred and Fourteen Days of Somatic Support in a Severely Brain Injured Pregnant Woman: Case Report and Review of the Literature

Minor Trauma in Pregnancy: Evaluation of 173 Cases

Maternal persistent vegetative state with successful fetal outcome

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