L. Hart1,3, C. Meyer1,2,3, A. Santos1,3, R. Smith1,2,3, C. Castater3,4, J. Sciarretta1,3, M. Platner1,3, J. Ellis1,3, J. Nguyen3,4 1Emory University School Of Medicine, Atlanta, GA, USA 2Rollins School of Public Health, Emory University, Atlanta, GA, USA 3Grady Health System, Atlanta, GA, USA 4Morehouse School of Medicine, Trauma Surgery, Atlanta, GA, USA
Introduction: Trauma is the leading cause of non-obstetric mortality in pregnant females. There are currently no consensus guidelines for the optimal surgical management of pregnant females with emergent operative indications. Therefore, the purpose of this study was to compare surgical interventions and outcomes among pregnant female trauma patients with emergent operative indications.
Methods: A retrospective cohort review was conducted at an ACS-verified Level I trauma center from 2016-2022 and included all pregnant female trauma patients. For those requiring emergent abdominal surgery, outcomes were compared between patients who had a midline laparotomy versus Pfannenstiel incision.
Results: A total of 147 pregnant female trauma patients were identified. Of those, 30 required emergent operative intervention and met inclusion criteria, with 12 patients in the midline laparotomy arm and 18 in the Pfannenstiel incision arm. Patients were similar in average age, heart rate, presenting GCS, present fetal heart tones, rate of pre-operative imaging, indication for emergent operation, ICU length of stay, and hospital length of stay. Patients who ultimately required a laparotomy tended to be hypotensive on presentation with lower SBP (100 vs 121 p=0.006), higher ISS (28 vs 17 p=0.005), and earlier gestational age (27 vs 34 weeks p=0.02). One patient initially received a Pfannenstiel incision which was subsequently converted to a laparotomy. The mortality rate for the laparotomy arm was 27% (n=3) versus 0% in the Pfannenstiel incision arm (p = 0.04).
Conclusion: This study demonstrates that Pfannenstiel incision is acceptable for the operative management of fetal distress in the absence of other signs of concomitant intra-abdominal maternal injury following trauma in pregnant women. Further, patients with severe maternal polytrauma or hypotension required vertical midline laparotomy incision and were associated with higher risk of mortality.
