Major trauma in pregnant women: maternal/fetal outcome.

One regional trauma center's experience with a large number of seriously injured pregnant women was reviewed to identify factors affecting maternal and fetal outcome after injury. Of 318 pregnant women who suffered trauma from January 1984 through December 1988, 25 (8%) were severely injured and would have required hospital admission even in the absence of pregnancy. Physical examination, except for the inappropriate absence of fetal heart tones, was a poor predictor of fetal status. Sonography proved to be the most accurate modality for acutely assessing fetal status. There was one (4%) maternal death, consistent with predicted mortality (TRISS methodology). Four pregnancies were lost and one neonate died because of injuries sustained, not because of surgery or anesthesia. There was significant difference between the ISS (average, 9) and CTS (average, 16) of women with surviving pregnancies or successful deliveries and the ISS (average, 30) and CTS (average, 12) of women who lost pregnancies or witnessed neonatal death. Fetal outcome relates to direct fetal injury and to the acute hemodynamic insult associated with maternal trauma. Maternal evaluation and treatment should occur in a stepwise and organized fashion following the general principles of trauma care (ATLS guidelines) in conjunction with perinatal specialists. Uterine ultrasonography should be an integral component of the initial evaluation. With expedient resuscitation, evaluation, and intervention, maternal and fetal survival can be expected.