Trauma is the leading cause of pregnancy-associated maternal deaths in the United States. Motor vehicle crashes are the most frequent, followed by violence and assault. A study done in Maryland found that between 1993 and 1998, homicide was the leading cause of death among pregnant or recently pregnant women, but was only the fifth leading cause of death in non-pregnant women (Kilpatrick, 2013). For reasons not entirely clear, pregnancy is a risk-factor for domestic violence.
Factors associated with injury severity are predictive of poor fetal outcome. These factors include maternal low blood pressure, poor fetal heart tracings, direct injury to the uterus/fetus, maternal death, and a poor Injury Severity Score (ISS). The ISS score is an anatomical scoring system that correlates linearly with mortality, morbidity, hospital stay and other measures of severity (Surgical Critical Care.net, 2001). Click here to see a sample ISS score. Any type of trauma that results in these factors places a woman at risk for death and/or fetal loss. Women who sustain life-threatening trauma have a 40-50% chance of fetal loss, and fewer than 5% of women who sustain minor injuries experience fetal loss (Kilpatrick, 2013). Women who experience trauma in the first trimester, specifically abdominal trauma, do not usually experience pregnancy loss because of the protection of the uterus by the pelvis. As the uterus grows, this protection declines and outcomes are more difficult to predict.
In evaluating cases involving violent trauma and a pregnancy loss, it is important to evaluate not only all of the circumstances surrounding the case and the specific injury, but other factors that may be the cause of the fetal demise. Maternal medical history, pregnancy history and prenatal care are all important elements that could reveal conditions independent of the trauma that may have contributed or even be the cause of, the fetal loss. For example, preexisting conditions such as preeclampsia, pregnancy-induced hypertension, uncontrolled diabetes, and drug and alcohol use all pose a significant risk to the unborn baby, especially within the circumstance of little or no prenatal care.
Brown, H. (2009). Trauma in pregnancy. Obstetrics and Gynecology, 147-160.
Kilpatrick, S. J. (2013, August 1). Trauma in Pregnancy. Retrieved from UpToDate: http://www.uptodate.com/contents/trauma-in-pregnancy#H20
Surgical Critical Care.net. (2001). Injury Severity Scoring/AAST Organ Grading Scales. Orlando: Orlando Regional Medical Center.