Predictive risk factors of adverse perinatal outcomes following blunt abdominal trauma in pregnancy

Abstract

Background

The primary objective was to identify predictive risk factors of preterm delivery following blunt abdominal trauma. The secondary objective was to identify risk factors of other adverse outcomes, Neonatal Intensive Care Unit (NICU) admission, placental abruption, fetal demise, and Cesarean Delivery (CD).

Methods

This retrospective study included pregnant patients with gestational age (GA) ≥23 weeks who presented after blunt abdominal trauma to Richmond University Medical Center from October 2015 to January 2020. Patients were identified using the following diagnostic International diagnostic classification (ICD-10) codes: O9A.212, O9A.213, and 071.89, and excluded if trauma did not involve the abdomen, penetrating, <23 weeks, or incomplete records. Collected data points included maternal demographic factors, clinical laboratory values, maternal clinical findings at presentation, abdominal ultrasound, results of fetal monitoring, Abbreviated Injury Score (AIS) for abdomen, and Injury Severity Score (ISS). Univariate analyses were compared using the Student’s t-test or Mann-Whitney U-test. Categorical data were compared using the chi-squared test or Fisher’s exact test with P-value < .05 as significant.

Results

154 patients were included in the final analysis. The incidence of the primary outcome, preterm delivery before 37 weeks, was 11.0% (17/154). The incidence of secondary outcomes following blunt abdominal trauma were abruption 0% (0/154), fetal demise 0.6% (1/154), CD 44% (68/154), NICU admission 24% (37/154). Maternal demographic factors, presence of uterine contractions, maternal clinical conditions (abdominal pain, abdominal tenderness, vaginal bleeding), hematologic and coagulation studies, ultrasound findings, fetal heart rate tracing category, AIS score for abdomen, and ISS score were not predictive of preterm delivery or other secondary outcomes.

Conclusion

The incidence of adverse maternal and neonatal outcomes is low following blunt abdominal trauma. Extended monitoring of asymptomatic patients including laboratory tests and coagulation profiles were not predictive of preterm labor or secondary adverse perinatal outcomes.

Level of Evidence

Therapeutic/Care management, Level III.

Keywords:

• Abdominal trauma
• pregnancy
• preterm labor
• perinatal complications

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Mehraban SH. Study design data collection, final approval. LAGODKA S: Study design, data collection, manuscript writing, critical revision, final approval. KYDD J: Literature search, study design, data collection, manuscript writing, critical revision, final approval. Mehraban S: Study design, data collection, final approval. CHENDRASEKHAR A: Study design, data collection, final approval. CABBAD M: Study design, manuscript writing, critical revision, final approval. LAKHI N: Study design, data analysis, data interpretation, Manuscript writing, critical revision, final approval.