Mittal Pratima, Kripa Shankar, Ara Anjum, Tiwari Vinay Kumar
1Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India.
2Department of Burns and Plastic Surgery, VMMC and Safdarjung Hospital, New Delhi, India.
J Obstet Gynaecol India. 2018 Aug;68(4):270-275. doi: 10.1007/s13224-017-1021-4. Epub 2017 Jun 15.
Burns in pregnancy can be a potentially life-threatening condition for both mother and baby. Human physiology is altered during pregnancy and burns add further stress leading to diminished maternal reserves. Very few studies have been reported for management of such patients.
This was a prospective based study carried out in Department of Burns and Plastic Surgery in collaboration with Department of Obstetrics and Gynaecology and Department of Pediatrics for a period of 20 months from December 2011 to July 2013. Pregnant women with thermal injuries more than 15% TBSA were included in the study. Patients with coexisting obstetrics complications and burns other than thermal were excluded.
Out of 3397 female patients of burns admitted, 1382 patients were in reproductive groups, 1116 were married and 67 were pregnant; these were enrolled. Maternal and fetal outcome is inversely linked with the TBSA of the mother ( < 0.001). In TBSA group 15-30%, there was no maternal and fetal mortality, but in TBSA >30-50% maternal mortality was 44%, and in 50-70% maternal mortality was 83% and no mother survived in >70%. In TBSA 30-50%, fetal mortality was 72%. Only one baby survived in 50-70% TBSA group and one in >70% TBSA group after intensive care in NICU for prematurity. Fetal survival was also dependent on gestational age, and there are better outcomes in late trimesters.
Maternal and fetal outcome are directly related to TBSA of mother, and best care can be offered to such patients with a multidisciplinary team-based approach.
孕期烧伤对母婴来说都可能是危及生命的情况。孕期人体生理机能会发生改变,而烧伤会进一步加重压力,导致母体储备减少。关于此类患者的治疗,报道的研究极少。
这是一项前瞻性研究,于2011年12月至2013年7月期间在烧伤与整形外科与妇产科及儿科合作开展,为期20个月。纳入烧伤总面积超过15%的孕妇。排除合并产科并发症及非热力烧伤的患者。
在3397例入院的女性烧伤患者中,1382例处于生育年龄段,1116例已婚,67例怀孕;这些患者被纳入研究。母婴结局与母亲的烧伤总面积呈负相关(<0.001)。在烧伤总面积为15%-30%的组中,无母婴死亡,但在烧伤总面积>30%-50%时,母亲死亡率为44%,在50%-70%时,母亲死亡率为83%,而在>70%时无母亲存活。在烧伤总面积为30%-50%时,胎儿死亡率为72%。在烧伤总面积为50%-70%的组中,经新生儿重症监护病房(NICU)针对早产的重症监护后,仅1例婴儿存活,在>70%烧伤总面积组中有1例存活。胎儿存活也取决于孕周,孕晚期结局更好。
母婴结局与母亲的烧伤总面积直接相关,通过多学科团队协作的方法可为这类患者提供最佳治疗。