创伤孕妇胎儿分娩的预测因素：一项多中心研究。
Predictors of fetal delivery in pregnant trauma patients: A multicenter study.
作者信息
Santos Jeffrey W, Grigorian Areg, Lucas Alexa N, Fierro Nicole, Dhillon Navpreet K, Ley Eric J, Smith Jennifer, Burruss Sigrid, Dahan Alden, Johnson Arianne, Ganske William, Biffl Walter L, Bayat Dunya, Castelo Matthew, Wintz Diane, Schaffer Kathryn B, Zheng Dennis J, Tillou Areti, Coimbra Raul, Tuli Rahul, Santorelli Jarrett E, Emigh Brent, Schellenberg Morgan, Inaba Kenji, Duncan Thomas K, Diaz Graal, Tay-Lasso Erika, Zezoff Danielle C, Nahmias Jeffry
机构信息
From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, (J.W.S., A.G., A.N.L., E.T.-L., D.C.Z., J.N.), University of California, Irvine, Orange; Department of Surgery (N.F., N.K.D., E.J.L.), Cedars-Sinai Medical Center, Los Angeles; Division of Trauma and Critical Care (J.S.), Harbor-UCLA Hospital, Torrance; Department of Trauma, Acute Care Surgery, Surgical Critical Care (S.B.), Loma Linda Medical Center, Loma Linda; Riverside School of Medicine (A.D.), University of California, Riverside; Cottage Health Research Institute (A.J., W.G.), Santa Barbara Cottage Hospital, Santa Barbara; Trauma and Acute Care Surgery, Scripps Memorial Hospital (W.L.B., D.B., M.C.), La Jolla; Department of Surgery (D.W., K.B.S.), Sharp Memorial Hospital, San Diego; Department of Surgery (D.J.Z., A.T.), UCLA David Geffen School of Medicine, Los Angeles; Department of Surgery, Comparative Effectiveness and Clinical Outcomes Research Center-CECORC (R.C., R.T.), Riverside University Health System Medical Center, Moreno Valley; Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery (J.E.S.), University of California San Diego School of Medicine, San Diego; Division of Acute Care Surgery (B.E., M.S., K.I.), LAC+USC Medical Center, University of Southern California, Los Angeles; and Department of Trauma (T.K.D., G.D.), Ventura County Medical Center, Ventura, California.
出版信息
J Trauma Acute Care Surg. 2024 Jan 1;96(1):109-115. doi: 10.1097/TA.0000000000003964. Epub 2023 Aug 15.
BACKGROUND
Pregnant trauma patients (PTPs) undergo observation and fetal monitoring following trauma due to possible fetal delivery (FD) or adverse outcome. There is a paucity of data on PTP outcomes, especially related to risk factors for FD. We aimed to identify predictors of posttraumatic FD in potentially viable pregnancies.
METHODS
All PTPs (≥18 years) with ≥24-weeks gestational age were included in this multicenter retrospective study at 12 Level-I and II trauma centers between 2016 and 2021. Pregnant trauma patients who underwent FD ((+) FD) were compared to those who did not deliver ((-) FD) during the index hospitalization. Univariate analyses and multivariable logistic regression were performed to identify predictors of FD.
RESULTS
Of 591 PTPs, 63 (10.7%) underwent FD, with 4 (6.3%) maternal deaths. The (+) FD group was similar in maternal age (27 vs. 28 years, p = 0.310) but had older gestational age (37 vs. 30 weeks, p < 0.001) and higher mean injury severity score (7.0 vs. 1.5, p < 0.001) compared with the (-) FD group. The (+) FD group had higher rates of vaginal bleeding (6.3% vs. 1.1%, p = 0.002), uterine contractions (46% vs. 23.5%, p < 0.001), and abnormal fetal heart tracing (54.7% vs. 14.6%, p < 0.001). On multivariate analysis, independent predictors for (+) FD included abdominal injury (odds ratio [OR], 4.07; confidence interval [CI], 1.11-15.02; p = 0.035), gestational age (OR, 1.68 per week ≥24 weeks; CI, 1.44-1.95; p < 0.001), abnormal FHT (OR, 12.72; CI, 5.19-31.17; p < 0.001), and premature rupture of membranes (OR, 35.97; CI, 7.28-177.74; p < 0.001).
CONCLUSION
The FD rate was approximately 10% for PTPs with viable fetal gestational age. Independent risk factors for (+) FD included maternal and fetal factors, many of which are available on initial trauma bay evaluation. These risk factors may help predict FD in the trauma setting and shape future guidelines regarding the recommended observation of PTPs.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
背景
创伤后的妊娠创伤患者（PTP）需接受观察和胎儿监测，因为可能会出现胎儿分娩（FD）或不良结局。关于PTP结局的数据匮乏，尤其是与FD危险因素相关的数据。我们旨在确定潜在可存活妊娠中创伤后FD的预测因素。
方法
本多中心回顾性研究纳入了2016年至2021年间在12个一级和二级创伤中心的所有年龄≥18岁、孕周≥24周的PTP。将在本次住院期间接受FD（（+）FD）的妊娠创伤患者与未分娩（（-）FD）的患者进行比较。进行单因素分析和多变量逻辑回归以确定FD的预测因素。
结果
在591例PTP中，63例（10.7%）接受了FD，其中4例（6.3%）产妇死亡。（+）FD组产妇年龄与（-）FD组相似（27岁对28岁，p = 0.310），但孕周更大（37周对30周，p < 0.001），平均损伤严重程度评分更高（7.0对1.5，p < 0.001）。（+）FD组阴道出血发生率更高（6.3%对1.1%，p = 0.002）、子宫收缩发生率更高（46%对23.5%，p < 0.001）、胎儿心率异常发生率更高（54.7%对14.6%，p < 0.001）。多变量分析显示，（+）FD的独立预测因素包括腹部损伤（比值比[OR]，4.07；置信区间[CI]，1.11 - 15.02；p = 0.035）、孕周（≥24周每周OR，1.68；CI，1.44 - 1.95；p < 0.001）、胎儿心率异常（OR，12.72；CI，5.19 - 31.17；p < 0.001）和胎膜早破（OR，35.97；CI，7.28 - 177.74；p < 0.001）。
结论
具有可存活胎儿孕周的PTP的FD率约为10%。（+）FD的独立危险因素包括母体和胎儿因素，其中许多在初次创伤评估时即可获得。这些危险因素可能有助于预测创伤情况下的FD，并形成未来关于PTP推荐观察的指南。
证据水平
治疗/护理管理；三级。
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