目的:孕妇外伤后,为高危患者提供及时和适当的管理对孕妇和胎儿都至关重要。这项研究旨在确定预测创伤后不良妊娠结局的危险因素。
方法:进行了一项回顾性队列研究,包括317例经历创伤的孕妇。收集的数据包括一般人口统计,损伤机制和不良妊娠结局。根据是否存在与创伤相关的不良妊娠结局,将患者分为两个亚组。进行单变量和多变量逻辑回归以估计临床变量与不良妊娠结局之间的关联。
结果:共有41例(12.93%)患者在创伤后的最初24小时内出现不良妊娠结局。这项研究显示年龄>35岁(OR=14.995,95%CI:5.024-44.755,P<0.001),妊娠晚期创伤(OR=3.878,95%CI:1.343-11.204,P=0.012),腹痛(OR=3.032,95%CI:1.221-7.527,P=0.017),阴道出血(OR=3.226,95%CI:1.093-9.523,P=0.034),创伤超声检查(FAST)阳性(OR=8.496,95%CI:2.825-25.555,P<0.001),9≤损伤严重度评分(ISS)<16(OR=3.039,95%CI:1.046~8.835,P=0.041)和ISS≥16(OR=5.553,95%CI:1.387~22.225,P=0.015)增加了创伤后不良妊娠结局的概率。产妇年龄,分娩时的胎龄,阴道出血和FAST结果阳性是异常分娩的危险因素.
结论:高龄产妇,妊娠晚期,积极的FAST结果应提醒多学科创伤团队密切监测患者,以防止不良妊娠结局.
OBJECTIVE: After traumatic injury in pregnant women, providing timely and appropriate management for high-risk patients is crucial for both pregnant women and fetuses. This study aimed to identify risk factors that predict adverse pregnancy outcomes after traumatic injury.
METHODS: A retrospective cohort study including 317 pregnant patients who experienced trauma was conducted. The collected data included general demographics, injury mechanisms and adverse pregnancy outcomes. Patients were divided into two subgroups based on the absence or presence of trauma-related adverse pregnancy outcomes. Univariate and multivariate logistic regressions were conducted to estimate the associations between clinical variables and adverse pregnancy outcomes.
RESULTS: A total of 41 (12.93%) patients experienced adverse pregnancy outcomes within the first 24 h post-trauma. This study revealed that age >35 years (OR=14.995, 95% CI: 5.024-44.755, P<0.001), third trimester trauma (OR=3.878, 95% CI: 1.343-11.204, P=0.012), abdominal pain (OR=3.032, 95% CI: 1.221-7.527, P=0.017), vaginal bleeding (OR=3.226, 95% CI: 1.093-9.523, P=0.034), positive scan in focused assessment with sonography for trauma (FAST) positive (OR=8.496, 95% CI: 2.825-25.555, P<0.001), 9≤ injury severity score (ISS) <16 (OR=3.039, 95% CI: 1.046-8.835, P=0.041) and ISS≥16 (OR=5.553, 95% CI: 1.387-22.225, P=0.015) increased the probability of posttraumatic adverse pregnancy outcomes. Maternal age, gestational age at delivery, vaginal bleeding and positive FAST results were risk factors for abnormal delivery.
CONCLUSIONS: Advanced maternal age, third trimester, and positive FAST results should alert multidisciplinary trauma teams to closely monitor patients to prevent adverse pregnancy outcomes.