Association of Traumatic Injury With Adverse Pregnancy Outcomes in Taiwan, 2004 to 2014

Pai, Chih Wei; Wiratama, Bayu Satria; Lin, Hsiao-Yu; Chen, Ping-Ling

doi:10.1001/jamanetworkopen.2021.7072

Cited by 8 publications

(8 citation statements)

References 46 publications

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“…Our findings revealed that pregnant women who received treatment at clinical institutions within 3 days after crashes had an increased risk of adverse pregnancy outcomes. The finding was consistent with those of studies that indicated that such women hospitalised or treated at an emergency department due to injury had a higher risk of adverse outcomes 5 8 24. Relevant literature has shown that pregnancy-induced termination is also associated with an increased risk of haemorrhage among pregnant women 25.…”

Section: Discussionsupporting

confidence: 87%

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Maternal outcomes in association with motor vehicle crashes during pregnancy: a nationwide population-based retrospective study

et al. 2023

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BackgroundLimited studies have assessed the association of motor vehicle crashes (MVCs) during pregnancy with adverse maternal outcomes using a population-based nationwide dataset that covers all MVCs.MethodsA total of 20 844 births from women who had been involved in MVCs during pregnancy were obtained from the National Birth Notification (BN) Database in Taiwan. We randomly selected 83 274 control births from women in the BN matched on age, gestational age and crash date. All study subjects were linked to medical claims and the Death Registry to identify the maternal outcomes after crashes. Conditional logistic regression models were used to estimate the adjusted odds ratio (aOR) and 95% CI of adverse outcomes associated with MVCs during pregnancy.ResultsPregnant women involved in MVCs had significantly higher risks of placental abruption (aOR=1.51, 95% CI 1.30 to 1.74), prolonged uterine contractions (aOR=1.31, 95% CI 1.11 to 1.53), antepartum haemorrhage (aOR=1.19, 95% CI 1.12 to 1.26) and caesarean delivery (aOR=1.05, 95% CI 1.02 to 1.09) than the controls. Such elevated risks tended to be higher in the MVCs with greater severity. Scooter riders had higher ORs of various adverse maternal outcomes than car drivers.ConclusionsWomen involved in MVCs during pregnancy were at increased risk of various adverse maternal outcomes, especially in those with severe MVCs and riding scooters at MVCs. These findings suggest that clinicians should be aware of these effects, and educational materials that include the above information should be provided as part of prenatal care.

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Section: Discussionsupporting

confidence: 87%

“…Injury during pregnancy may result in adverse maternal outcomes, such as splenic rupture, uterine rupture, pelvic fracture, placental abruption and maternal death 5 6. Severe trauma has also been associated with a higher risk of premature delivery or fetal death 7 8. Injured pregnant women have a huge impact on maternal outcomes.…”

Section: Introductionmentioning

confidence: 99%

Maternal outcomes in association with motor vehicle crashes during pregnancy: a nationwide population-based retrospective study

et al. 2023

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“…Longitudinal data have previously established that PTPs have worse outcomes in pregnancy compared with noninjured pregnant patients, with higher rates of preterm labor and associated complications (e.g., low birth weight and fetal death). 2,8,13,25,[27][28][29][30] However, there is a paucity of high-quality data on index trauma hospitalization outcomes for PTPs. This multicenter retrospective study encompassing 6 years of data from 12 Levels I and II trauma centers identified a FD rate of 10.7% in PTPs presenting at 24 weeks or later gestational age.…”

Section: Discussionmentioning

confidence: 99%

“…While much of the currently available data focuses on catastrophic complications in PTPs (e.g., maternal and fetal death) and long-term pregnancy outcomes, 1,[3][4][5][6]25,27,[30][31][32][33] there is a paucity of data regarding predictors of FD for clinical decision making in terms of monitoring PTPs postinjury. In current practice, clinicians rely on the absence of abnormal findings to inform when it is safe to discharge a PTP from the hospital.…”

Section: Discussionmentioning

confidence: 99%

Predictors of fetal delivery in pregnant trauma patients: A multicenter study

Santos

Grigorian

Lucas

et al. 2023

J Trauma Acute Care Surg

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Background Pregnant trauma patients (PTPs) undergo observation and fetal monitoring following trauma due to possible fetal delivery (FD) or adverse outcome. There is a paucity of data on PTP outcomes, especially related to risk factors for FD. We aimed to identify predictors of post-traumatic FD in potentially viable pregnancies. Methods All PTPs (≥ 18 years old) with ≥24-weeks gestational age were included in this multicenter retrospective study at 12 Level-I and II trauma centers between 2016-2021. PTPs who underwent FD ((+) FD) were compared to those who did not deliver ((-) FD) during the index hospitalization. Univariate analyses and multivariable logistic regression were performed to identify predictors of FD. Results Of 591 PTPs, 63 (10.7%) underwent FD, with 4 (6.3%) maternal deaths. The (+) FD group was similar in maternal age (27 vs. 28 years, p = 0.310) but had older gestational age (37 vs. 30 weeks, p < 0.001) and higher mean injury severity score (7.0 vs. 1.5, p < 0.001) compared to the (-) FD group. The (+) FD group had higher rates of vaginal bleeding (6.3% vs. 1.1%, p = 0.002), uterine contractions (46% vs. 23.5%, p < 0.001), and abnormal fetal heart tracing (FHT) (54.7% vs. 14.6%, p < 0.001). On multivariate analysis, independent predictors for (+) FD included abdominal injury (OR 4.07, CI 1.11-15.02, p = 0.035), gestational age (OR 1.68 per week ≥24 weeks, CI 1.44-1.95, p < 0.001), abnormal FHT (OR 12.72, CI 5.19-31.17, p < 0.001), and premature rupture of membranes (OR 35.97, CI 7.28-177.74, p < 0.001). Conclusions The FD rate was approximately 10% for PTPs with viable fetal gestational age. Independent risk factors for (+) FD included maternal and fetal factors, many of which are available on initial trauma bay evaluation. These risk factors may help predict FD in the trauma setting and shape future guidelines regarding the recommended observation of PTPs. Level of Evidence Level III, Therapeutic/Care Management

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“…In comparison to non-pregnant females, the occurrence of TBI in a pregnancy increases the risk of complications both to mother and foetus including increase rate of instrumental vaginal deliveries, unplanned caesarean sections, preterm birth, increased need of analgesia during labour and there will be an increased health impairment risk to neonate 3,23,45) . In addition pharmacologic therapies and diagnostic studies where the ionizing radiation is used will increase the risk teratogenicity, placental abruption, and risk of preterm labour 1) .…”

Section: Complicationsmentioning

confidence: 99%

Neurocritical Care Perspective of Traumatic Brain Injury During Pregnancy

Haldar

Raj

Maurya

et al. 2023

J Neurointensive Care

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Trauma is a leading cause of morbidity and mortality amongst females of childbearing age, and traumatic brain injury (TBI) carries a significant proportion of share amongst trauma of all kinds. Trauma during pregnancy has a twofold impact on the patient and the foetus, who, most of the time, remains unnoticed. Understanding and managing altered maternal physiology in the background of TBI is a challenge and requires close monitoring to avoid any unwanted outcome. The challenges initiate right from the resuscitation following trauma to the rehabilitation of these patients with TBI during pregnancy. Good collaboration with the interdisciplinary departments is the backbone to avoid teratogenicity, a better pregnancy outcome and prevention of expected complications in these complex clinical scenarios.

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Association of Traumatic Injury With Adverse Pregnancy Outcomes in Taiwan, 2004 to 2014

Cited by 8 publications

References 46 publications

Maternal outcomes in association with motor vehicle crashes during pregnancy: a nationwide population-based retrospective study

Maternal outcomes in association with motor vehicle crashes during pregnancy: a nationwide population-based retrospective study

Predictors of fetal delivery in pregnant trauma patients: A multicenter study

Neurocritical Care Perspective of Traumatic Brain Injury During Pregnancy

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