A multi-institutional study of factors associated with fetal death in injured pregnant patients

Hypothesis: Factors associated with fetal death in injured pregnant patients are related to increasing injury severity and abnormal maternal physiologic profile. Design: A multi-institutional retrospective study of 13 level I and level II trauma centers from 1992 to 1996. Main Outcome Measure: Fetal survival. Results: Of 27 715 female admissions, there were 372 injured pregnant patients (1.3%); 84% had blunt injuries and 16% had penetrating injuries. There were 14 maternal deaths (3.8%) and 35 fetal deaths (9.4%). The population suffering fetal death had higher injury severity scores (P < .001), lower Glascow Coma Scale scores (P < .001), and lower admitting maternal pH (P = .002). Most women who lost their fetus arrived in Shock (P = .005) or had a fetal heart rate of less than 110 beats/min at some time during their hospitalization (P < .001). An Injury Severity Score greater than 25 was associated with a 50% incidence of fetal death. Placental abruption was the most frequent complication, occurring in 3.5% of patients and associated with 54% mortality. Cardiotrophic monitoring to detect potentially threatening fetal heart rates was performed on only 61% of pregnant women in their third trimester. Of these patients, 7 had abnormalities on cardiotrophic monitoring and underwent successful cesarean delivery. Conclusions: Fetal death was more likely with greater severity of injury. Cardiotrophic monitoring is under-used in injured pregnant patients in their third trimester even after admission to major trauma centers. Increased use of cardiotrophic monitoring may decrease the mortality caused by placental abruption.