Trauma in pregnancy at a major trauma centre in South Africa
Background. Trauma in pregnancy poses a unique challenge to clinicians. Literature on this topic is limited in South Africa (SA).
Objectives. To review our institution’s experience with the management of trauma in pregnancy in a developing-world setting.
Methods. This study was based at Grey’s Hospital, Pietermaritzburg, SA. All pregnant patients who were admitted to our institution following trauma between December 2012 and December 2018 were identified from the Hybrid Electronic Medical Registry (HEMR).
Results. During the 6-year study period, 2 990 female patients were admitted by the Pietermaritzburg Metropolitan Trauma Service (PMTS), of whom 89 were pregnant. The mean age of these patients was 25.64 (range 17 - 43) years. The mechanism of injury was road traffic crash (RTC) in 39, stab wounds (SW) in 19, assault other than SW or gunshot wounds (GSW) in 19, GSW in 8, snake bite in 5, impalement in 1, dog bite in 1, hanging in 1, sexual assault in 1 and a single case of a patient being hit by a falling object. A subset of patients sustained >1 mechanism of injury. Thirty patients were managed operatively. The mean time of gestation was 19.16 (5 - 36) weeks. Three patients died, and there were 16 fetal deaths (including 3 lost after the mother’s death). Forty-five fetuses were recorded as surviving at discharge, while 25 fetal outcomes were not specifically recorded. There were 2 threatened miscarriages and/or patients with vaginal bleeding, 1 positive pregnancy test with no recorded outcome and no premature births as a result of trauma.
Conclusions. Trauma in pregnancy is relatively uncommon and mostly due to a RTC or deliberately inflicted trauma. Fetal outcome is largely dependent on the severity of the maternal injury, with injuries requiring laparotomy leading to a high fetal mortality rate.
S E Moffatt, Department of Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
B Goldberg, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
V Y Kong, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
J-P Da Costa, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
M T D Smith, Department of Surgery, University of KwaZulu-Natal, Pietermaritzburg, South Africa
J L Bruce, Department of Surgery, Grey’s Hospital, Pietermaritzburg, South Africa
G L Laing, Department of Surgery, Grey’s Hospital, Pietermaritzburg, South Africa
D L Clarke, Department of Surgery, University of KwaZulu-Natal, Pietermaritzburg; and Department of Surgery, Grey’s Hospital, Pietermaritzburg, South Africa
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Date published: 2020-07-07
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