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Artigos Originais • Rev. Col. Bras. Cir. 26 (2) • Abr 1999 • https://doi.org/10.1590/S0100-69911999000200003   copiar

Trauma na gestante: análise da mortalidade materna e fetal

Trauma in pregnancy: analysis of maternal and fetal mortality

Resumos

Foram analisadas retrospectivamente 26 pacientes gestantes traumatizadas, num período de nove anos. A média de idade foi 23,7 anos (16-42). A idade gestacional variou de dez a quarenta semanas (média 21,5 semanas); a maioria (46,1%) no segundo trimestre. O mecanismo predominante (65,3%) foi o trauma abdominal fechado por acidente automobilístico (atropelamento ou colisão). Na admissão, oito (30,7%) pacientes apresentavam alterações hemodinâmicas. Seis doentes (23,0%) apresentavam sangramento vaginal e, destas, quatro estavam hemodinamicamente normais. Analisamos a mortalidade materna, a mortalidade fetal e suas causas. Comparamos também a mediana dos valores do RTS e TRISS entre os grupos, sobrevida materno-fetal, sobrevida materna e óbito materno-fetal. Todas as gestantes admitidas com sangramento vaginal apresentaram óbito fetal. A mortalidade materna foi de 11,5%, por choque hemorrágico. A mortalidade fetal foi de 30,7%, sendo que 37,5% destes óbitos foram provocados pela morte materna. A principal causa de mortalidade fetal foi o descolamento de placenta (50,0%). Os índices de trauma, RTS e TRISS, foram significativamente menor (p=0,0025 e p<0,0001) no grupo óbito materno-fetal, porém esses índices não apresentaram valor prognóstico na mortalidade fetal.

Trauma; Gestação; Índices de Trauma; Mortalidade

Twenty-six traumatized pregnant patients were retrospectively analyzed over a nine year period. The average age was 23.7 years (16-42). Gestational age was 10-40 weeks (average 21.5 weeks), the majority (46.1%) being in the second trimester. The predominant mechanism (65.3%) was blunt abdominal trauma by automobile accident (collision or running over). During admission, eight (30.7%) patients showed hemodynamic alterations. Six patients (23.0%) showed vaginal bleeding and of these, four were hemodynamically normal. Median values of RTS and TRISS were also compared among the following groups: maternal-letal survival, maternal survival and maternal-fetal death. All pregnant women admitted with vaginal bleeding showed fetal death. Maternal mortality was caused by hemorrhagic shock in 11.5% of the cases. Fetal mortality occurred in 30.7% of the cases, and 37.5% of these were caused by maternal death. The main cause of the letal death (50.0%) was abruptio placentae. RTS and TRISS were significantly lower (p=0.0025 and p<0.0001) in the maternal-letal death group, but these scores presented no prognostic value for letal mortality.

Trauma; Pregnancy; Trauma Score; Mortality

ARTIGO ORIGINAL

Trauma na gestante: análise da mortalidade materna e fetal

Trauma in pregnancy: analysis of maternal and fetal mortality

Paulo Roberto Corsi, TCBC-SPI; Samir Rasslan, TCBC-SPII; Liliana Bechelli de OliveiraIII; Flavia Souza KronflyIV; Veruska Pereira MarinhoIV

IProfessor Assistente

IIProfessor Titular. Diretor do Serviço de Emergência

IIIAcadêmica

IVMédica Residente

Endereço para correspondência Endereço para correspondência: Dr. Paulo Roberto Corsi Rua Joaquim Antunes, 577 / 132 05415-011-SãoPaulo-SP

RESUMO

Foram analisadas retrospectivamente 26 pacientes gestantes traumatizadas, num período de nove anos. A média de idade foi 23,7 anos (16-42). A idade gestacional variou de dez a quarenta semanas (média 21,5 semanas); a maioria (46,1%) no segundo trimestre. O mecanismo predominante (65,3%) foi o trauma abdominal fechado por acidente automobilístico (atropelamento ou colisão). Na admissão, oito (30,7%) pacientes apresentavam alterações hemodinâmicas. Seis doentes (23,0%) apresentavam sangramento vaginal e, destas, quatro estavam hemodinamicamente normais. Analisamos a mortalidade materna, a mortalidade fetal e suas causas. Comparamos também a mediana dos valores do RTS e TRISS entre os grupos, sobrevida materno-fetal, sobrevida materna e óbito materno-fetal. Todas as gestantes admitidas com sangramento vaginal apresentaram óbito fetal. A mortalidade materna foi de 11,5%, por choque hemorrágico. A mortalidade fetal foi de 30,7%, sendo que 37,5% destes óbitos foram provocados pela morte materna. A principal causa de mortalidade fetal foi o descolamento de placenta (50,0%). Os índices de trauma, RTS e TRISS, foram significativamente menor (p=0,0025 e p<0,0001) no grupo óbito materno-fetal, porém esses índices não apresentaram valor prognóstico na mortalidade fetal.

Unitermos: Trauma; Gestação; Índices de Trauma; Mortalidade.

ABSTRACT

Twenty-six traumatized pregnant patients were retrospectively analyzed over a nine year period. The average age was 23.7 years (16-42). Gestational age was 10-40 weeks (average 21.5 weeks), the majority (46.1%) being in the second trimester. The predominant mechanism (65.3%) was blunt abdominal trauma by automobile accident (collision or running over). During admission, eight (30.7%) patients showed hemodynamic alterations. Six patients (23.0%) showed vaginal bleeding and of these, four were hemodynamically normal. Median values of RTS and TRISS were also compared among the following groups: maternal-letal survival, maternal survival and maternal-fetal death. All pregnant women admitted with vaginal bleeding showed fetal death. Maternal mortality was caused by hemorrhagic shock in 11.5% of the cases. Fetal mortality occurred in 30.7% of the cases, and 37.5% of these were caused by maternal death. The main cause of the letal death (50.0%) was abruptio placentae. RTS and TRISS were significantly lower (p=0.0025 and p<0.0001) in the maternal-letal death group, but these scores presented no prognostic value for letal mortality.

Key words: Trauma; Pregnancy; Trauma Score; Mortality.

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REFERÊNCIAS

1) Peckham C, King R - A study of intercurrent conditions observed during pregnancy. Am J Obster Gynecol 1963;87:609-24.

2) Pearlman MD - Motor vehicle crashes, pregnancy loss and preterm labor. Int J Gynecol abster 1997;57:127-32.

3) Baker DP - Traumatismo na paciente grávida. Clin Cir Am Norte 1982; 62:313-29.

4) M;cAnena OJ, Moore EE, Marx JA - Avaliação inicial do paciente com traumatismo abdominal contuso. Clin Cir Am Norte 1990;70: 509-31.

5) American College of Surgeons: "Trauma in Pregnancy". In Advanced Trauma Life Support Instructor Manual. USA 1993 - Chap.II: 283-92.

6) Moise Jr KJ, Belfort MA - Emergência controlada para a paciente obstétrica. Clin Cir Am Norte 1997;77:839-45.

7) Lavin Jr JP, Polsky SS - Abdominal trauma during pregnancy. Clin Perinatol 1983;10:423-38.

8) Ali J, Yeo A, Gana TJ, et al- Predictors of fetal mortality in pregnant trauma patients. J Trauma 1997;42:782-5.

9) Champion HR, Sacco WJ, Capes WS, et al- A revision of the Trauma Score. J Trauma 1989;29:623-9.

10) Capes WS, Champion HR, Sacco WJ et al- The Injury Severity Score revisited. J Trauma 1988;28:69-75.

11) Boyd CR, Tolson MA, Capes WS - Evaluation trauma care: The TRISS Method. J Trauma 1987;27:370-8.

12) Connolly AM, Katz VL, McMahon MJ et al- Trauma and pregnancy. Am J Perinatol 1997;14:331-6.

13) Morkovin V - "Trauma in pregnancy". In Farrel, R.G. (ed.): OB/GYN Emergencies: The first 60 minutes. Rockville - USA - Aspen Publications, 1986,6:pp.71-86.

14) Goodwin TM, Breen MT - Pregnancy outcome and feto maternal hemorrhage after non catastrophic trauma. Am J Obster Gynecol 1990;162:665-71.

15) Pearlman MD, Tintinalli JE, Lorenz RP - A prospective controlled study of outcome after trauma during pregnancy. Am J Obster GynecoI1990;162:1.502-10.

16) Rothenberger D, Quattlebaum FW, Perry Jr JF, et al - Blunt maternal trauma: a review of 103 cases. J Trauma 1978;18:173-9.

17) Pearlman MD, Tintinalli JE, Lorenz RP - Blunt trauma during pregnancy. N Engl J Med 1990;323:1.609-13.

18) Lukaski HC, Siders WA, Nielsen EJ, et al - Total body water in pregnancy: assessment by using bioelectrical impedance. Am J Clin Nutr 1994;59:578-85.

19) Esposito TI, Gens DR, Smith LG, et al- Trauma during pregnancy: A review of 79 cases. Arch Surg 1991;126:1.073-8.

20) Kissinger DP, Rozycki GS, Morris Jr IA, et al- Trauma in pregnancy, predicting pregnancy outcome. Arch Surg 1991;126:1.079-86.

21) Maciel CI, Leite MSB - Traumatismo fetal intra-útero sem comprometimento materno (relato de um caso) Rev Goiana Med 1983; 29:179-81.

22) A.C.a.G. - Technical bulletin number 161: Trauma during pregnancy. Int J Gynecol Obstet 1993;40:165-70.

23) Elias M - Rupture of the uterus by external violence. Lancet 1950;2: 253-4.

24) Lifschultz BD, Donoghue ER - Fetal death following maternal trauma: Two case reports and survey of the literature. J For Sci 1991; 36: 1.740-4.

25) Crosby WM, Costiloe IP - Safety of lap-belt restraint for pregnant victims of automobile collisions. N Engl J Med 1971;284:632-6.

26) Timberlake GA, McSSwain NE - Trauma in pregnancy: a 10-year perspective. Am Surg 1978;55:151-3.

27) Drost TF, Rosemurgy AS, Sherrnan HF, et al- Major trauma in pregnant women: maternal/fetal outcome. J Trauma 1990;30:574-8.

28) Hoff WS, D' Amelio LF, TinkoffGH, et al- Maternal predictors of fetal demise in trauma during pregnancy. Surg Gynecol Obstet 1991; 172:175-80.

29) Helton AS, McFarlane I, Anderson ET - Battered and pregnant: A prevalence study. Am. J. Public Health 1987;77:1.337-9.

30) Poole GV, Martin Ir IN, Perry Ir KG, et al- Trauma in pregnancy: the role of interpersonal violence. Am J Obstet Gynecol 1996;174: 1.873-7.

31) Crosby WM, SnyderRG, Snow CC, et al - Impact injuries in pregnancy. Experimental studies. Am J Obstet Gynecol 1968;101:100-10.

32) Biester EM, Tomich PG, Esposito TI, et al - Trauma in pregnancy: Normal Revised Trauma Score in relation to other markers of maternofetal status - A preliminary study. Am J Obstet Gynecol 1997;176: 1.206-12.

Recebido em 29/6/98

Aceito para publicação em 1/10/98

Trabalho realizado no Serviço de Emergência do Departamento de Cirurgia da Faculdade de Ciências Médicas da Santa Casa de São Paulo.

  • 1) Peckham C, King R - A study of intercurrent conditions observed during pregnancy. Am J Obster Gynecol 1963;87:609-24.
  • 2) Pearlman MD - Motor vehicle crashes, pregnancy loss and preterm labor. Int J Gynecol abster 1997;57:127-32.
  • 3) Baker DP - Traumatismo na paciente grávida. Clin Cir Am Norte 1982; 62:313-29.
  • 4) M;cAnena OJ, Moore EE, Marx JA - Avaliaçăo inicial do paciente com traumatismo abdominal contuso. Clin Cir Am Norte 1990;70: 509-31.
  • 5) American College of Surgeons: "Trauma in Pregnancy". In Advanced Trauma Life Support Instructor Manual. USA 1993 - Chap.II: 283-92.
  • 6) Moise Jr KJ, Belfort MA - Emergęncia controlada para a paciente obstétrica. Clin Cir Am Norte 1997;77:839-45.
  • 7) Lavin Jr JP, Polsky SS - Abdominal trauma during pregnancy. Clin Perinatol 1983;10:423-38.
  • 8) Ali J, Yeo A, Gana TJ, et al- Predictors of fetal mortality in pregnant trauma patients. J Trauma 1997;42:782-5.
  • 9) Champion HR, Sacco WJ, Capes WS, et al- A revision of the Trauma Score. J Trauma 1989;29:623-9.
  • 10) Capes WS, Champion HR, Sacco WJ et al- The Injury Severity Score revisited. J Trauma 1988;28:69-75.
  • 11) Boyd CR, Tolson MA, Capes WS - Evaluation trauma care: The TRISS Method. J Trauma 1987;27:370-8.
  • 12) Connolly AM, Katz VL, McMahon MJ et al- Trauma and pregnancy. Am J Perinatol 1997;14:331-6.
  • 13) Morkovin V - "Trauma in pregnancy". In Farrel, R.G. (ed.): OB/GYN Emergencies: The first 60 minutes. Rockville - USA - Aspen Publications, 1986,6:pp.71-86.
  • 14) Goodwin TM, Breen MT - Pregnancy outcome and feto maternal hemorrhage after non catastrophic trauma. Am J Obster Gynecol 1990;162:665-71.
  • 15) Pearlman MD, Tintinalli JE, Lorenz RP - A prospective controlled study of outcome after trauma during pregnancy. Am J Obster GynecoI1990;162:1.502-10.
  • 16) Rothenberger D, Quattlebaum FW, Perry Jr JF, et al - Blunt maternal trauma: a review of 103 cases. J Trauma 1978;18:173-9.
  • 17) Pearlman MD, Tintinalli JE, Lorenz RP - Blunt trauma during pregnancy. N Engl J Med 1990;323:1.609-13.
  • 18) Lukaski HC, Siders WA, Nielsen EJ, et al - Total body water in pregnancy: assessment by using bioelectrical impedance. Am J Clin Nutr 1994;59:578-85.
  • 19) Esposito TI, Gens DR, Smith LG, et al- Trauma during pregnancy: A review of 79 cases. Arch Surg 1991;126:1.073-8.
  • 20) Kissinger DP, Rozycki GS, Morris Jr IA, et al- Trauma in pregnancy, predicting pregnancy outcome. Arch Surg 1991;126:1.079-86.
  • 21) Maciel CI, Leite MSB - Traumatismo fetal intra-útero sem comprometimento materno (relato de um caso) Rev Goiana Med 1983; 29:179-81.
  • 22
    ) A.C.a.G. - Technical bulletin number 161: Trauma during pregnancy. Int J Gynecol Obstet 1993;40:165-70.
  • 23) Elias M - Rupture of the uterus by  external violence. Lancet 1950;2: 253-4.
  • 24) Lifschultz BD, Donoghue ER - Fetal death following maternal trauma: Two case reports and survey of the literature. J For Sci 1991; 36: 1.740-4.
  • 25) Crosby WM, Costiloe IP - Safety of lap-belt restraint for pregnant victims of automobile collisions. N Engl J Med 1971;284:632-6.
  • 26) Timberlake GA, McSSwain NE - Trauma in pregnancy: a 10-year perspective. Am Surg 1978;55:151-3.
  • 27) Drost TF, Rosemurgy AS, Sherrnan HF, et al- Major trauma in pregnant women: maternal/fetal outcome. J Trauma 1990;30:574-8.
  • 28) Hoff WS, D' Amelio LF, TinkoffGH, et al- Maternal predictors of fetal demise in trauma during pregnancy. Surg Gynecol Obstet 1991; 172:175-80.
  • 29) Helton AS, McFarlane I, Anderson ET - Battered and pregnant: A prevalence study. Am. J. Public Health 1987;77:1.337-9.
  • 30) Poole GV, Martin Ir IN, Perry Ir KG, et al- Trauma in pregnancy: the role of interpersonal violence. Am J Obstet Gynecol 1996;174: 1.873-7.
  • 31) Crosby WM, SnyderRG, Snow CC, et al - Impact injuries in pregnancy. Experimental studies. Am J Obstet Gynecol 1968;101:100-10.
  • 32) Biester EM, Tomich PG, Esposito TI, et al - Trauma in pregnancy: Normal Revised Trauma Score in relation to other markers of maternofetal status - A preliminary study. Am J Obstet Gynecol 1997;176: 1.206-12.

  • Endereço para correspondência:

    Dr. Paulo Roberto Corsi
    Rua Joaquim Antunes, 577 / 132
    05415-011-SãoPaulo-SP

    • Datas de Publicação

    • Publicação nesta coleção
      09 Fev 2010
    • Data do Fascículo
      Abr 1999

    Histórico

    • Aceito
      10 Jan 1998
    • Recebido
      29 Jun 1998
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