Pak L L, Reece E A, Chan L
Department Of Obstetrics, Gynecology, and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA 19140, USA.
Am J Obstet Gynecol. 1998 Nov;179(5):1140-4. doi: 10.1016/s0002-9378(98)70121-8.
The aim of the study was to evaluate the following: (1) pregnancy outcome after blunt abdominal trauma and (2) factors that may predict preterm birth and adverse peripartum outcomes.
All women who had noncatastrophic abdominal trauma and came to the labor and delivery suite July 1994-August 1997 were prospectively evaluated and admitted for continuous uterine and fetal monitoring. A complete blood cell count, coagulation profile, and Kleihauer-Betke stain were performed. Ultrasonographic examination was performed to rule out hematoma. Tocolytic agents were administrated in cases with persistent contractions. Pregnancy outcomes and risk factors were compared between those with preterm birth before 37 weeks' gestation and those who were delivered after 37 weeks' gestation.
Delivery information was available for 85 women with blunt abdominal trauma from motor vehicle accident (28), falls (27), and direct assault (30, which included 17 cases of domestic abuse). Four women, 3 of whom were exposed to domestic abuse, were hospitalized twice. Thirteen patients had preterm birth and 72 patients were delivered at term. In all cases the results of Kleihauer-Betke stains, maternal vital signs, blood cell count, coagulation profile, and placental ultrasonographic examinations were normal. The differences between the 2 groups with respect to gestational age at the time of trauma, length of hospital stay, subjective reports of abdominal pain, objective findings of abdominal tenderness, patterns of uterine contractions, interval between trauma and delivery, and Apgar scores were not statistically significant. However, the preterm birth group received magnesium sulfate tocolysis more frequently (31% vs 7%) and had a significantly greater rate of peripartum complications, such as rupture of membranes and abruptio placentae, than the group of patients who delivered at term (46.2% vs 12.5%, P <.05). Women with domestic abuse had increased uterine contractions at the time of abdominal trauma (52.9% vs 19.1%, P =.01) but did not require increased use of tocolysis. Women with domestic abuse had more peripartum complications (41.8% vs 11.8%, P <.01).
Women with noncatastrophic blunt abdominal trauma in pregnancy tend to have favorable neonatal outcomes. Findings or reports of abdominal tenderness and uterine contractions are not predictive of preterm birth. Preterm birth was associated with increased peripartum complications. However, domestic abuse was associated with repeated trauma in the index pregnancy and increased peripartum complications.
本研究旨在评估以下内容：（1）钝性腹部创伤后的妊娠结局；（2）可能预测早产及围产期不良结局的因素。
对1994年7月至1997年8月期间因非灾难性腹部创伤前来分娩室的所有女性进行前瞻性评估，并收入院进行持续的子宫及胎儿监测。进行全血细胞计数、凝血指标检查及改良Kleihauer-Betke试验。行超声检查以排除血肿。对有持续性宫缩的病例使用宫缩抑制剂。比较妊娠37周前早产的女性与妊娠37周后分娩的女性的妊娠结局及危险因素。
获取了85例因钝性腹部创伤入院的女性的分娩信息，创伤原因包括机动车事故（28例）、跌倒（27例）及直接袭击（30例，其中包括17例家庭暴力）。4名女性曾两次住院，其中3名遭受家庭暴力。13例患者早产，72例患者足月分娩。所有病例的改良Kleihauer-Betke试验结果、产妇生命体征、血细胞计数、凝血指标及胎盘超声检查均正常。两组在创伤时的孕周、住院时间、腹痛主观报告、腹部压痛客观发现、子宫收缩模式、创伤至分娩的间隔时间及阿氏评分方面的差异无统计学意义。然而，早产组硫酸镁宫缩抑制治疗的使用频率更高（31%对7%），且围产期并发症发生率显著高于足月分娩组，如胎膜破裂和胎盘早剥（46.2%对12.5%，P<.05）。遭受家庭暴力的女性在腹部创伤时子宫收缩增加（52.9%对19.1%，P=.01），但宫缩抑制剂的使用未增加。遭受家庭暴力的女性围产期并发症更多（41.8%对11.8%，P<.01）。
妊娠期非灾难性钝性腹部创伤的女性往往有良好的新生儿结局。腹部压痛及子宫收缩的发现或报告不能预测早产。早产与围产期并发症增加相关。然而，家庭暴力与本次妊娠的反复创伤及围产期并发症增加相关。
