Trauma during pregnancy: An analysis of maternal and fetal outcomes in a large population
Trauma during pregnancy: An analysis of maternal and fetal outcomes in a large population
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DOI：
10.1016/j.ajog.2004.02.051
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发表时间：
2004-06-01
影响因子：
9.8
通讯作者：
Smith, LH
中科院分区：
文献类型：
--
作者：
El Kady, D;Gilbert, WM;Smith, LH
目标：这项研究是为了确定的发生率，结果，危险因素，产科分娩的创伤持续在pregnancy.Study design：这是一个回顾性队列研究妇女创伤在加州（1991-1999）。国际疾病分类，第九次修订，临床修改代码，和外部原因代码的伤害被确定。分析了产妇和胎儿/新生儿的结果，在创伤住院的妇女（组1），妇女持续创伤产前（组2），与非创伤对照组。损伤严重度评分和损伤类型用于对与结果相关的风险进行分层。统计学比较表示为比值比（OR）与95%CIs.Results：在4,833,286总交付中，共有10,316交付符合研究标准。骨折、脱位、扭伤和拉伤是最常见的损伤类型。第1组与最差结局相关：孕产妇死亡OR 69（95% CI 42-115）、胎儿死亡OR 4.7（95% CI 3.4-6.4）、子宫破裂OR 43（95% CI 19-97）和胎盘脱垂OR 9.2（95% CI 7.8-11）。第2组也导致分娩风险增加：胎盘脱垂OR 1.6（95% CI 1.3-1.9），早产OR 2.7（95% CI 2.5-2.9），孕产妇死亡OR 4.4（95% CI 1.4-14）。随着损伤严重度评分的增加，结局恶化，但在统计学上无预测性。最常见的导致产妇死亡的伤害类型是内伤。胎儿，新生儿和婴儿死亡的风险是强烈的影响孕龄在deliver.Conclusion：妇女在创伤住院（组1）有最坏的结果，无论损伤的严重程度。第2组妇女（产前损伤）分娩时不良结局的风险增加，因此在随后的妊娠过程中应密切监测。这项研究强调了优化妊娠期创伤预防教育的必要性。(C)2004年爱思唯尔公司All rights reserved.
Objective: This study was undertaken to determine the occurrence rates, outcomes, risk factors, and timing of obstetric delivery for trauma sustained during pregnancy.Study design: This is a retrospective cohort study of women for trauma in California (1991-1999). International Classification of Disease, ninth revision, Clinical Modification codes, and external causation codes for injury were identified. Maternal and fetal/neonatal outcomes were analyzed for women delivering at the trauma hospitalization (group 1), and women sustaining trauma prenatally (group 2), compared with nontrauma controls. Injury severity scores and injury types were used to stratify risk in relation to outcome. Statistical comparisons are expressed as odds ratios (ORs) with 95% CIs.Results: A total of 10,316 deliveries fulfilling study criteria were identified in 4,833,286 total deliveries. Fractures, dislocations, sprains, and strains were the most common type of injury. Group 1 was associated with the worst outcomes: maternal death OR 69 (95% CI 42-115), fetal death OR 4.7 (95% CI 3.4-6.4), uterine rupture OR 43 (95% CI 19-97), and placental abruption OR 9.2 (95% CI 7.8-11). Group 2 also resulted in increased risks at delivery: placental abruption OR 1.6 (95% CI 1.3-1.9), preterm labor OR 2.7 (95% CI 2.5-2.9), maternal death OR 4.4 (95% CI 1.4-14). As injury severity scores increased, outcomes worsened, yet were statistically nonpredictive. The type of injury most commonly leading to maternal death was internal injury. The risk of fetal, neonatal, and infant death was strongly influenced by gestational age at the time of delivery.Conclusion: Women delivering at the trauma hospitalization (group 1) had the worst outcomes, regardless of the severity of the injury. Group 2 women (prenatal injury) had an increased risk of adverse outcomes at delivery, and therefore should be monitored closely during the subsequent course of the pregnancy. This study highlights the need to optimize education in trauma prevention during pregnancy. (C) 2004 Elsevier Inc. All rights reserved.