Obstetric trauma admissions in a Level-1 trauma centre in South Africa: A 5-year retrospective review

Abstract

Background. The severity of injury and associated management determine maternal and fetal outcomes in pregnant trauma patients.

Objective. To describe the characteristics, mechanisms of injury, clinical interventions and maternal and fetal outcomes of obstetric trauma admissions at our institution.

Methods. This was a retrospective record review of pregnant trauma patients admitted to Chris Hani Baragwanath Academic Hospital over a 5-year period (N=800). Patient records from several departments were reviewed, including the intensive care unit (ICU). Data were collected on sociodemographics, mechanism of injury, clinical interventions, and maternal and fetal outcomes.

Results. The median maternal age and gestational age were 31.00 years and 26.00 weeks, respectively. Most patients were black African (n= 713; 89.1%) and the majority (70.3%; n=562) were single. More than half (n=484; 60.5%) were unemployed. Assault was the most frequent cause of trauma (n=330; 41.3%), followed by falls (n=265; 33.1%) and motor vehicle accidents (n=204; 25.5%). Almost a fifth of the patients (n=141; 18.0%) reported recent alcohol consumption. Four patients (0.5%) were admitted to ICU, of whom one died. Ten fetal deaths were recorded, of which three were delivered by patients admitted to ICU. Eleven neonates were delivered before 37 weeks.

Conclusion. Our results show that pregnant patients who are single and unemployed were at increased risk of obstetric trauma. Assaults, falls and motor vehicle accidents were the most common causes of maternal trauma in our sample. Implementing strategies to detect and prevent intimate partner violence and improve road safety may contribute to reduced maternal and fetal mortality.