Thurs., 10/8/09 Pediatrics & Injury Prevention, Paper #31, 3:26 pm OTA-2009
Outcomes in Pregnant Trauma Patients with Orthopaedic Injuries
Lisa K. Cannada, MD1 (4,7-Smith &Nephew; 5A-Medtronic Sofamor Danek; 7-Zimmer,
Synthes, DePuy, A Johnson &Johnson Company); Ping Pan, BS2 (n); Brian M. Casey, MD3 (n);
Donald D. McIntire, PhD3 (n); Shahid Shafi, MD, MPH4(n); Kenneth J. Leveno, MD3 (n);
1Department of Orthopaedic Surgery, Saint Louis University Hospital,
Saint Louis, Missouri, USA;
2University of Texas Southwestern Medical School, Dallas, Texas, USA;
3Department of Obstetrics and Gynecology &
4Trauma Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Purpose: Trauma in pregnancy is a major cause of morbidity and mortality for both the mother and the fetus. The incidence of trauma during pregnancy has been estimated to be as high as 10% to 20%, although the percentage of women who are hospitalized is much lower. The purpose of our project is to determine the effects of orthopaedic trauma on pregnancy outcomes in pregnant trauma patients.
Methods: This is a study completed of all patients who presented with a medical comorbidity code of pregnancy during the years of 1995 to 2007 to our Level 1 trauma center. Selected pregnancy outcomes in women who delivered at our trauma center either during or after their trauma admission were evaluated according to the presence of orthopaedic injuries: Abbreviated Injury Score–Extremity of ≥1 and presence of pelvic trauma. Statistical analysis included chi-square, Student t test, and Wilcoxon rank-sum test. P values less than 0.05 were considered statistically significant.
Results: Of the 1,682 pregnant women evaluated for trauma, 1,055 subsequently delivered singleton infants at our hospital. There were 65 patients with orthopaedic injuries (6%) and 990 pregnant trauma patients without orthopaedic injuries. The average age of the women was 24 years (range, 13-44 years) in both groups. The patients with orthopaedic trauma had an average gestational age of 28 weeks versus 31 weeks for the patients without orthopaedic trauma. The average ISS of the patients with orthopaedic injuries was 7 (rang,: 1-33). Of the patients with orthopaedic injuries, there were 9 women with pelvic fractures. Compared to the patients without orthopaedic injuries, those patients with orthopaedic injuries had a significant increased risk of preterm delivery (estimated gestational age of <37 weeks), 30% versys 3% (P <0.0001); significant increased risk of placental abruption, 8% versus 1%, P <0.0001; and significant increased risk of perinatal mortality, 8% versus 1%, P <0.0001. The infants born to these patients had a significant increased risk of admission to the ICU nursery (15% vs 3%, P <0.001) and time spent on a ventilator (14% vs 3%, P <0.001). A pregnant trauma patient with a pelvic fracture bode a poor outcome, with a placental abruption rate of 33% versus 4% for orthopaedic injury without pelvic fracture (P <0.002) and a perinatal death rate of 33% versus 4% (P <0.002).
Conclusions: Our study demonstrated that pregnant trauma patients with orthopaedic injuries become high-risk obstetrical patients. At the time of their trauma, they are at a significant increased risk of placental abruption and perinatal mortality. They are at a significant increased risk for preterm delivery, which carries its own set of complications. Those patients with pelvic trauma have very serious risks to the fetus in terms of placental abruption and perinatal mortality. Because pregnant trauma patients with orthopaedic injuries have serious and significant increased pregnancy risks compared to those without orthopaedic injuries, such women may benefit from referral to a center capable of handling both the primary injury and the potential preterm birth associated with the injury.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant