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Abstract
Objective
To estimate the predictive factors associated with traffic injury severity and pregnancy outcomes in traffic accidents during pregnancy.
Methods
We performed a retrospective case review study to assess 109 pregnant women who were injured by traffic accidents and were admitted to Gangneung Asan Hospital and KyungHee University Hospital from September 1996 to January 2009. The clinical data of maternal age, parity, gestational age, symptoms of the patients that happened after accidents, accident location, seat position in vehicle, maternal injury severity which was quantified with injury severity score (ISS), pregnancy outcomes, and subchorionic hematoma were reviewed with the medical records or the telephone interviews. Adverse pregnant outcomes included abortion, preterm delivery and fetal death in uterus. Multiple logistic regression analysis was performed to evaluate the predictive factors for injury severity and pregnancy outcomes after traffic accidents.
Results
Pedestrian injury and first trimester were significantly associated with severity of maternal injury. Multivariate analysis revealed that abdominal pain was independently predictive factor for the severity of maternal injury. The second trimester, pedestrian injury, right front seat of vehicle, severity of maternal injury and subchorionic hematoma were significantly associated with adverse pregnancy outcomes. Multivariate analysis revealed that severity of maternal injury and subchorionic hematoma were independently predictive factors for adverse pregnancy outcomes.
Figures and Tables
Table 2
Comparison of clinical characteristics associated with severe maternal injury
Lowest tertile is reference category.
Odds ratios (OR) and 95% confidence intervals (CI) calculated by simple logistic regression.
ISS: injury severity score, NS: not significant.
*P-value was derived from chi-square test.
†Pedestrian including pregnant women who were involved in a motorcycle accident.
Table 3
Estimated odds ratios of maternal injury severity score (ISS) with clinical variables from multiple logistic regression
Table 4
Comparison of clinical characteristics associated with adverse pregnancy outcomes
Lowest tertile is reference category.
ORs and 95% CIs calculated by simple logistic regression.
OR: odds rations, CI: confidence intervals, NS: not significant.
*Adverse fetal outcomes included abortion, preterm delivery and fetal death in uterus.
†P-value was derived from Chi-square test.
‡Pedestrian including pregnant women who were involved in a motorcycle accident.
References
1. Schiff MA, Holt VL. Pregnancy outcomes following hospitalization for motor vehicle crashes in Washington State from 1989 to 2001. Am J Epidemiol. 2005. 161:503–510.
2. Klinich KD, Flannagan CA, Rupp JD, Sochor M, Schneider LW, Pearlman MD. Fetal outcome in motor-vehicle crashes: effects of crash characteristics and maternal restraint. Am J Obstet Gynecol. 2008. 198:450.e1–450.e9.
3. Association for the Advancement of Automotive Medicine. The abbreviated injury scale. 1990 Revision. 1990. Des Plaines, IL: Association for the Advancement of Automotive Medicine.
4. Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974. 14:187–196.
5. Cho YH, Song JS, Park IH, Lee JW. A Study on the method of description for mass casualties based on abbreviated injury scale and injury severity score. J Korean Orthoped Assoc. 1989. 24:912–917.
6. Kissinger DP, Rozycki GS, Morris JA Jr, Knudson MM, Copes WS, Bass SM, et al. Trauma in pregnancy. Predicting pregnancy outcome. Arch Surg. 1991. 126:1079–1086.
7. Drost TF, Rosemurgy AS, Sherman HF, Scott LM, Williams JK. Major trauma in pregnant women: maternal/fetal outcome. J Trauma. 1990. 30:574–578.
8. Scorpio RJ, Esposito TJ, Smith LG, Gens DR. Blunt trauma during pregnancy: factors affecting fetal outcome. J Trauma. 1992. 32:213–216.
9. George ER, Vanderkwaak T, Scholten DJ. Factors influencing pregnancy outcome after trauma. Am Surg. 1992. 58:594–598.
10. Ali J, Yeo A, Gana TJ, McLellan BA. Predictors of fetal mortality in pregnant trauma patients. J Trauma. 1997. 42:782–785.
11. Baerga-Varela Y, Zietlow SP, Bannon MP, Harmsen WS, Ilstrup DM. Trauma in pregnancy. Mayo Clin Proc. 2000. 75:1243–1248.
12. Esposito TJ, Gens DR, Smith LG, Scorpio R, Buchman T. Trauma during pregnancy. A review of 79 cases. Arch Surg. 1991. 126:1073–1078.
13. Ball RH, Ade CM, Schoenborn JA, Crane JP. The clinical significance of ultransonographically detected subchorionic hemorrhages. Am J Obstet Gynecol. 1996. 174:996–1002.
14. Glantz C, Purnell L. Clinical utility of sonography in the diagnosis and treatment of placental abruption. J Ultrasound Med. 2002. 21:837–840.
15. Sholl JS. Abruptio placentae: clinical management in nonacute cases. Am J Obstet Gynecol. 1987. 156:40–51.
16. Jaffe MH, Schoen WC, Silver TM, Bowerman RA, Stuck KJ. Sonography of abruptio placentae. AJR Am J Roentgenol. 1981. 137:1049–1054.
17. Richards JR, Ormsby EL, Romo MV, Gillen MA, McGahan JP. Blunt abdominal injury in the pregnant patient: detection with US. Radiology. 2004. 233:463–470.
18. Bernstein MP. Imaging of traumatic injuries in pregnancy. Am Roentgen Radiol Soc. 2008. 2:203–210.
19. Lavin JP Jr, Miodovnik M. Delayed abruption after maternal trauma as a result of an automobile accident. J Reprod Med. 1981. 26:621–624.
20. Dahmus MA, Sibai BM. Blunt abdominal trauma: are there any predictive factors for abruptio placentae or maternal-fetal distress? Am J Obstet Gynecol. 1993. 169:1054–1059.
21. Towery R, English TP, Wisner D. Evaluation of pregnant women after blunt injury. J Trauma. 1993. 35:731–735.
22. Oxford CM, Ludmir J. Trauma in pregnancy. Clin Obstet Gynecol. 2009. 52:611–629.
23. Brown HL. Trauma in pregnancy. Obstet Gynecol. 2009. 114:147–160.
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