The frequency, type and outcomes of trauma during pregnancy in patients referring to the trauma referral center in Guilan from July 2017 to July 2019

Document Type : Original Article

Authors

1 M.Sc. in Human Resources Management, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.

2 Assistant professor, Department of Research, PhD in Health Economics, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.

3 Medical student, Guilan Road Trauma Research Center, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

4 B.Sc. in Nursing, Poursina Teaching Center, Guilan University of Medical Sciences, Rasht, Iran.

5 Assistant professor, Department of Research, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Abstract

Introduction: Trauma is the first cause of mortality due to non-obstetric causes in pregnant women. There is a limited knowledge on mechanisms of trauma in pregnancy. Therefore, this study was performed with aim to determine the frequency, type and outcomes of trauma in pregnancy period in patients referring to the major trauma center in Guilan.
Methods: This retrospective cross-sectional study was conducted using the data registered in triage unit of Poursina Teaching center, Guilan from July 2017 when the Hospital Information System was being implemented for the first time. Using complete enumeration, all mothers with trauma histories until July 2018 (n=138) were entered into the study. They were then interviewed via telephone about the maternal and fetal outcomes after discharge, and 77 mothers answered. Data were analyzed using SPSS software (Version 21).
Results:The mean of maternal age was 29.24±5.25 years and mean gestational age was 20.92±10.12 weeks. The most common mechanism of trauma was falling (35.5%) and then traffic accidents (31.9%), other mechanisms (sharp objects penetrating in the limbs, falling of the object on the person, dog bite, etc.) (21%), violence (10.9%) and self-immolation (0.7%). In terms of frequency, the most reported fetal outcomes were without outcome (87%), preterm birth (7.8%) and abortion (5.2%), respectively; the most common maternal outcomes were reported as uncomplicated (67.5%), bleeding (11.7%), bone fractures (11.7%), uterine contractions and cervical dilatation (9.1%).
Conclusion: The most common type of trauma during pregnancy was falling. Preterm birth and abortion were the fetal outcomes and vaginal bleeding, bone fracture, uterine contraction, and cervical opening were dangerous maternal outcomes which are reported. Future programs should prioritize trauma prevention in pregnancy and follow-up of maternal outcomes after discharge from trauma center.

Keywords

References

  1. Kvarnstrand L, Milsom IA, Lekander T, Druid H, Jacobsson BO. Maternal fatalities, fetal and neonatal deaths related to motor vehicle crashes during pregnancy: A national population‐based study. Acta obstetricia et gynecologica Scandinavica 2008; 87(9):946-52.
  2. Nazri Panjaki A, Haghighi M, Zeynali Bujani M, Heidari M. High Risk Pregnancy (Report of a shotgun case). Iran J Obstet Gynecol Infertil 2018; 21(9):118-23.
  3. Weiner E, Gluck O, Levy M, Ram M, Divon M, Bar J, et al. Obstetric and neonatal outcome following minor trauma in pregnancy. Is hospitalization warranted?. European Journal of Obstetrics & Gynecology and Reproductive Biology 2016; 203:78-81.
  4. Huls CK, Detlefs C. Trauma in pregnancy. Seminars in perinatology 2018; 42(1):13-20.
  5. Leach MR, Zammit CG. Traumatic brain injury in pregnancy. InHandbook of clinical neurology 2020; 172:51-61.
  6. Petrone P, Jiménez-Morillas P, Axelrad A, Marini CP. Traumatic injuries to the pregnant patient: a critical literature review. European journal of trauma and emergency surgery 2019; 45(3):383-92.
  7. Azmoude E, Ashrafizaveh A, Tara F, Dinpanah H, Azmoude H. Management of Trauma in Pregnancy: A Practical Approach to Evidence Based Care. Iran J Obstet Gynecol Infertil 2018; 21(9):101-17.
  8. Mulder MB, Quiroz HJ, Yang WJ, Lasko DS, Perez EA, Proctor KG, et al. The unborn fetus: The unrecognized victim of trauma during pregnancy. Journal of pediatric surgery 2020; 55(5):938-43.
  9. Van Der Knoop BJ, Zonnenberg IA, Otten VM, Van Weissenbruch MM, De Vries JI. Trauma in pregnancy, obstetrical outcome in a tertiary centre in the Netherlands. The Journal of Maternal-Fetal & Neonatal Medicine 2018; 31(3):339-46.
  10. Mendez-Figueroa H, Dahlke JD, Vrees RA, Rouse DJ. Trauma in pregnancy: an updated systematic review. American journal of obstetrics and gynecology 2013; 209(1):1-10.
  11. Cardoso SQ, Cardoso MF, Leite JC, das Neves Nascimento ER, Nascimento MH, dos Santos EM. Maternal-fetal Protection in Automobile Accidents and Reliability in the use of Existing Safety Belts. International Journal of Advanced Engineering Research and Science 2019; 6(7):708-10.
  12. 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. American journal of obstetrics and gynecology 2008; 198(4):450-e1.
  13. Schellenberg M, Ruiz NS, Cheng V, Heindel P, Roedel EQ, Clark DH, et al. The impact of seat belt use in pregnancy on injuries and outcomes after motor vehicle collisions. Journal of surgical research 2020; 254:96-101.
  14. Scantling D, Schmidt A, Swaszek L, Saif A, Jankowski M. Seatbelt use in females of childbearing age at an urban safety-net Level 1 trauma center. Journal of surgical research 2019; 243:47-51.
  15. Hill A, Pallitto C, McCleary-Sills J, Garcia-Moreno C. A systematic review and meta-analysis of intimate partner violence during pregnancy and selected birth outcomes. International Journal of Gynecology & Obstetrics 2016; 133(3):269-76.
  16. Hassan M, Kashanian M, Hassan M, Roohi M, Yousefi H. Domestic violence: prevalence during pregnancy and associated maternal outcomes. Studies in Medical Sciences 2014; 24(11):894-903.
  17. Danna-Dos-Santos A, Magalhães AT, Silva BA, Duarte BS, Barros GL, Maria De Fátima CS, et al. Upright balance control strategies during pregnancy. Gait & posture 2018; 66:7-12.
  18. National Research Council. Weight gain during pregnancy: reexamining the guidelines. The National Academies Press; 2010.
  19. Wu X, Yeoh HT. Intrinsic factors associated with pregnancy falls. Workplace health & safety 2014; 62(10):403-8.
  20. Dunning K, LeMasters G, Levin L, Bhattacharya A, Alterman T, Lordo K. Falls in workers during pregnancy: risk factors, job hazards, and high risk occupations. American journal of industrial medicine 2003; 44(6):664-72.
  21. Curtin SC. Pregnancy rates for US women continue to drop. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2013.
  22. Hitosugi M, Motozawa Y, Kido M, Yokoyama T, Kawato H, Kuroda K, et al. Traffic injuries of the pregnant women and fetal or neonatal outcomes. Forensic science international 2006; 159(1):51-4.
  23. Azar T, Longo C, Oddy L, Abenhaim HA. Motor vehicle collision‐related accidents in pregnancy. Journal of Obstetrics and Gynaecology Research 2015; 41(9):1370-6.
  24. Battaloglu E, McDonnell D, Chu J, Lecky F, Porter K. Epidemiology and outcomes of pregnancy and obstetric complications in trauma in the United Kingdom. Injury 2016; 47(1):184-7.
  25. Masoudi M, Asti P. High risk pregnancy due to physical traumas in pregnant women referred to forensic medicine center and university treatment centers of Khorramabad. yafte 2009; 10(2):39-44
  26. Ashrafganjoie T, Mangeli F, Niknafs F. Evaluating the Outcomes of Trauma among Pregnant Women Referring to Educational Hospitals of Kerman during 2003-2009. Avicenna J Clin Med 2011; 17(4):34-38
  27. Sadrzadeh SM, Mousavi SM, Rezvani Kakhki B, Deldar K, Rahmani Sh. Trauma in Pregnancy: A Case Series and Literature Review. Iran J Obstet Gynecol Infertil 2018; 21(6):92-99.
  28. World Health Organization. Injuries, Violence Prevention Department, World Health Organization, World Health Organization. Department of Injuries, Violence Prevention. The injury chart book: a graphical overview of the global burden of injuries. World Health Organization; 2002.
  29. Ogbogu CJ, Uduezue A, Anetekhai WI, Agunwa CC. Burn injuries in pregnancy in a regional burns center in Nigeria: Presentation, maternal and fetal outcome. Burns Open 2018; 2(1):53-8.
  30. Hitosugi M, Koseki T, Hariya T, Maeda G, Moriguchi S, Hiraizumi S. Shorter pregnant women restrained in the rear seat of a car are at risk for serious neck injuries: Biomechanical analysis using a pregnant crash test dummy. Forensic science international 2018; 291:133-7.
  31. Al-Thani H, El-Menyar A, Sathian B, Mekkodathil A, Thomas S, Mollazehi M, et al. Blunt traumatic injury during pregnancy: a descriptive analysis from a level 1 trauma center. European journal of trauma and emergency surgery 2019; 45(3):393-401.
  32. Suchecki G, Tilden H, Roloff K, Chandwani D, Neeki M. Management of Traumatic Uterine Rupture in Blunt Abdominal Trauma: A Case Report and Literature Review. Cureus 2020; 12(6).
  33. Mirkamali SM, Javanak Liavali M, Yeganeh MR. Correlation between Organizational Culture with Clinical Governance in Public Hospitals in Rasht. Hayat 2014; 20(1).
  34. Acar BS, Edwards AM, Aldah M. Correct use of three-point seatbelt by pregnant occupants. Safety 2018; 4(1):1.
  35. Lam WC, To WW, Ma ES. Seatbelt use by pregnant women: a survey of knowledge and practice in Hong Kong. Hong Kong Med J 2016; 22(5):420-7.
  36. Morikawa M, Yamada T, Kogo H, Sugawara M, Nishikawa A, Fukushi Y, et al. Effect of an educational leaflet on the frequency of seat belt use and the rate of motor vehicle accidents during pregnancy in Japan in 2018: a prospective, non-randomised control trial with a questionnaire survey. BMJ open 2019; 9(9):e031839.
  37. Guruge S, Jayasuriya-Illesinghe V, Gunawardena N, Perera J. Intimate partner violence in Sri Lanka: a scoping review. Ceylon Med J 2015; 60(4):133-8.
  38. Thakur A, Lalwani M, Tiwari G, Verma P. Prevalence and Determinants of Intimate Partner Violence During Pregnancy in Central India. Indian Journal of Forensic Medicine & Toxicology 2018; 12(2).
  39. Abdollahi F, Abhari FR, Delavar MA, Charati JY. Physical violence against pregnant women by an intimate partner, and adverse pregnancy outcomes in Mazandaran Province, Iran. Journal of family & community medicine 2015; 22(1):13.
  40. Ferdos J, Rahman MM, Jesmin SS, Rahman MA, Sasagawa T. Association between intimate partner violence during pregnancy and maternal pregnancy complications among recently delivered women in Bangladesh. Aggressive behavior 2018; 44(3):294-305.
  41. Moffatt SE, Goldberg B, Kong VY, Smith MT, Bruce JL, Laing GL, et al. Trauma in pregnancy at a major trauma centre in South Africa. South African Medical Journal 2020; 110(7):667-70.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 24, Issue 6
September 2021
Pages 80-89

Files

Share

How to cite

Statistics