Akhtar M A, Mulawkar P M, Kulkarni H R
Clinical Epidemiology Unit, Government Medical College and Hospital, Nagpur, India.
Burns. 1994 Aug;20(4):351-5. doi: 10.1016/0305-4179(94)90066-3.
Burn injury during pregnancy is known to have adverse effects on fetal and maternal survival. Any hope of reducing the high mortality lies in identifying the risk factors responsible for the poor maternal and fetal outcome. A prospective study cohort of 50 pregnant burned patients, a comparison cohort of 50 uncomplicated singleton pregnancies and another comparison cohort of 50 non-pregnant burned females were followed up for fetal and maternal survival or death at the Government Medical College & Hospital, Nagpur, India. The effect of maternal factors on the maternal and fetal survival were assessed. Most of the patients (64 per cent) were severely burned, i.e. > 60 per cent TBSA with 100 per cent fetal and maternal mortality. There was 50 per cent maternal and fetal loss in the 40-59 per cent TBSA group. A fetal loss of 11.1 per cent was noted in the 20-39 per cent TBSA group with no maternal loss. Survival analyses using the Kaplan-Meier survival analysis and the Cox Proportional Hazards model showed that TBSA burned was the only factor found to be statistically significantly (P < 0.0001) responsible for the adverse fetal and maternal outcome. Pregnancy did not alter the maternal survival. Adequate shock management and early excision with grafting could reduce the mortality figures. Prevention of injury during pregnancy still appears to be the best option.
孕期烧伤已知会对胎儿和母亲的存活产生不利影响。降低高死亡率的任何希望都在于确定导致母婴不良结局的风险因素。在印度那格浦尔政府医学院及医院，对50名怀孕烧伤患者的前瞻性研究队列、50名单胎无并发症妊娠的对照队列以及50名非怀孕烧伤女性的另一对照队列进行随访，观察胎儿和母亲的存活或死亡情况。评估了母亲因素对母婴存活的影响。大多数患者（64%）烧伤严重，即烧伤总面积>60%，胎儿和母亲死亡率达100%。在烧伤总面积为40 - 59%的组中，母婴损失率为50%。在烧伤总面积为20 - 39%的组中，胎儿损失率为11.1%，无母亲死亡。使用Kaplan - Meier生存分析和Cox比例风险模型进行的生存分析表明，烧伤总面积是唯一被发现对胎儿和母亲不良结局有统计学显著影响（P < 0.0001）的因素。怀孕并未改变母亲的存活率。充分的休克处理和早期切痂植皮可降低死亡率。预防孕期受伤似乎仍是最佳选择。
