ABSTRACT
PREGNANCY CONSIDERATIONS Causes of trauma in pregnancy differ from nonpregnant trauma in that more are attributed to motor vehicles and fewer to other causes. Pregnancy is generally protective in relation to suicide. Compared to women of the same age who are not pregnant, pregnant women are younger, have lower ISS and lower mortality (1% vs. 4%), have shorter length of stay, and lower rates of alcohol and drug use; however, 12% had been drinking and 20% had been using drugs. A crash rate of 13/1000 person-years was calculated for pregnant women aged 15 to 39 (7), which is half the rate for nonpregnant women in this age group (26/1000) (7). Rate of seat-belt use is higher among pregnant patients than the comparison group (66% vs. 50%). Rate of interpersonal violence is similar among pregnant and nonpregnant women (12% vs. 10%). In 11% of pregnancy trauma cases (18), the pregnancy status is unknown at admission to the receiving trauma team, and in two-thirds of those the pregnancy was newly diagnosed by serum hCG screening-that is, the status had possibly not been known by the patient either. Of those pregnancies unknown to the trauma team at admission but presumably known to the patient (although she did not or could not communicate the status to the team), fetal mortality is >75%, including both spontaneous and elective abortion. Incidental pregnancies that were news to the trauma team although not to the patient carry a 25% probability of fetal mortality (18). One-third of the nonsurvivors in the newly diagnosed group were voluntary abortions, in which the women reported they were fearful of nonspecific damage because of either injury or radiation. It must be cautioned, however, that the stated rationale for elective abortion is not always true.
