Risk factors for foetal loss in injured pregnant patients: an analysis of 105 patients managed at a major trauma centre in South Africa

Abstract

Background: Pregnant patients in trauma present a unique challenge for clinicians to manage both foetal and maternal well-being, requiring specialised resuscitation algorithms. This study reviews the outcome of pregnant trauma patients in a major trauma centre in South Africa and the risk factors associated with foetal loss.

Methods: This is a retrospective analysis of all pregnant patients admitted to the Pietermaritzburg Metropolitan Trauma Service (PMTS) from January 2012 to December 2023. Patient data abstracted included mechanism of injury, physiological parameters, injury severity score (ISS), gestational age, diagnostic and surgical procedures performed, complications, and maternal and foetal mortality. Univariate logistic regression analysis was used.

Results: During the study period, a total of 124 female pregnant patients were admitted, and 105 were analysed after excluding 19 patients with missing data. The mean age of the patients in the study was 26 years, with an average gestation age of 18 weeks. Blunt trauma accounted for majority of the injuries (62%). Foetal death occurred in 16% of cases. Risk factors associated with foetal death were high shock index (OR 38.0, 95% CI: 0.8–1793.0), high ISS (OR 1.2, 95% CI: 1.1–1.3), and the need for laparotomy (OR 6.9, CI: 1.4–34.1).

Conclusion: Risk factors for foetal loss include injury severity, shock on admission and the need for laparotomy. Identifying these risk factors might improve management of foetal and maternal health.