The aim of the study was to evaluate the following: (1) pregnancy outcome after blunt abdominal
trauma and (2) factors that may predict
preterm birth and adverse peripartum outcomes.
STUDY DESIGN: All women who had noncatastrophic abdominal
trauma and came to the labor and delivery suite July 1994-August 1997 were prospectively evaluated and admitted for continuous uterine and fetal monitoring. A complete blood cell count, coagulation profile, and Kleihauer-Betke
stain were performed. Ultrasonographic examination was performed to rule out
hematoma.
Tocolytic agents were administrated in cases with persistent contractions. Pregnancy outcomes and risk factors were compared between those with
preterm birth before 37 weeks' gestation and those who were delivered after 37 weeks' gestation.
RESULTS: Delivery information was available for 85 women with blunt abdominal
trauma from motor vehicle accident (28), falls (27), and direct assault (30, which included 17 cases of domestic abuse). Four women, 3 of whom were exposed to domestic abuse, were hospitalized twice. Thirteen patients had
preterm birth and 72 patients were delivered at term. In all cases the results of Kleihauer-Betke stains, maternal vital signs, blood cell count, coagulation profile, and placental ultrasonographic examinations were normal. The differences between the 2 groups with respect to gestational age at the time of
trauma, length of
hospital stay, subjective reports of
abdominal pain, objective findings of abdominal tenderness, patterns of uterine contractions, interval between
trauma and delivery, and Apgar scores were not statistically significant. However, the
preterm birth group received
magnesium sulfate tocolysis more frequently (31% vs 7%) and had a significantly greater rate of peripartum complications, such as
rupture of membranes and
abruptio placentae, than the group of patients who delivered at term (46.2% vs 12.5%, P <.05). Women with domestic abuse had increased uterine contractions at the time of abdominal
trauma (52.9% vs 19.1%, P =.01) but did not require increased use of
tocolysis. Women with domestic abuse had more peripartum complications (41.8% vs 11.8%, P <.01).
CONCLUSIONS: Women with noncatastrophic blunt abdominal
trauma in pregnancy tend to have favorable neonatal outcomes. Findings or reports of abdominal tenderness and uterine contractions are not predictive of
preterm birth.
Preterm birth was associated with increased peripartum complications. However, domestic abuse was associated with repeated
trauma in the index pregnancy and increased peripartum complications.