Epidemiology

It has been consistently estimated that significant trauma complicates 6 to 7 percent of all pregnancies.2 Trauma during pregnancy is associated with an increased risk of preterm labor, placental abruption, fetal-maternal hemorrhage, and pregnancy loss. Maternal trauma-related mortality rate does not appear to be different from that of nonpregnant women.45

The most common cause of blunt abdominal trauma is motor vehicle crash, accounting for up to 70 percent of acute injuries. This is followed by falls and direct assault in decreasing order of frequency.126 The incidence of falls appears to increase with advancement of pregnancies, presumably due to alterations in maternal balance and coordination. Minor abdominal trauma may yet result in fetal demise. Up to 5 percent of patients with minor trauma may experience abruption. The role of domestic violence during pregnancy is of significant concern, with one large series describing more than 31 percent of trauma in pregnant women as intentional injuries and as many as 88 percent of those cases implicating the husband or boyfriend as perpetrator. 7 Whether this represents a change in epidemiology or reporting, the need for vigilance by emergency physicians for domestic or intimate violence during pregnancy is clear.

Penetrating injuries are less common than blunt trauma during pregnancy. Gunshot wounds are the most common form of penetrating trauma. Some of these injuries may be self-inflicted and represent attempts to terminate pregnancies.6 Fetal mortality rates in penetrating injuries are as high as 70 percent. While the rate of maternal visceral injuries is 19 to 38 percent, there remains a 60 to 90 percent chance of fetal injury. This is presumably due to the protective effect of the gravid uterus on maternal viscera.

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