The epidemiology of traumatic injury-related fetal mortality in Pennsylvania, 1995–1997: the role of motor vehicle crashes☆
Section snippets
Historical context
The effects of traumatic injury on pregnancy have been observed for millennia. While the oldest cases are lost in the fog of antiquity, known instances are referenced in the 15th century BCE Code of Hammurabi (Buchsbaum, 1976) and the Old Testament (Exodus 22:21).
In the medical literature of the late Nineteenth and mid-Twentieth centuries, the issue received increasingly detailed coverage, primarily in the forms of case reports and series. While the earliest of these papers described incidents
Modern scientific foundations
By the mid-1960s, within the trauma and obstetrics communities, the problems and challenges of pregnancy and automotive crashes were well recognized. Estimates of fetal mortality rates based on case series were increasingly reported (Elliott, 1966, Buchsbaum, 1968, Crosby and Costiloe, 1971). The first experimental (animal) studies investigating the forces and physiology of restrained pregnant women were initiated in 1968 (Crosby et al., 1968). Crosby was also the first to conduct a follow-up
Government statistics: fetal death registries and crash reporting systems
In contrast to the widespread awareness of the issue in the medical community, traumatic injury-related fetal mortality has received little attention from the public health vital statistics infrastructure or from modern traffic injury or crash data systems. In the former, coding conventions have limited examination of the cases to a grouping called ‘death due to maternal injury’. This subgroup is often combined into an even broader category of ‘maternal causes’. Thus, contributions of injuries
Methods
Fetal death certificates sent to the Pennsylvania State Health Department covering the years 1995–1997 were reviewed. Published reports indicated that there were 7131 fetal death certificates filed (among 442 705 live births) during this period. After internal review board approval and an approval for access to protected data from the state Health Department, arrangements were made to visit the Division of Vital Records for certificate review and data abstraction (without the use of identifiers
Results
Table 1 summarizes the major findings from this review. There was little difference between fetal gender (15 males, 12 females). The mean maternal age was 25 years, with the distribution skewed towards younger ages (Fig. 1). Seventy-seven percent of the mothers were white and 19% were black (blacks represented about 15% of all live births in Pennsylvania in 1995). Eleven of the deaths occurred in 1995, seven in 1996, and 13 in 1997. In three of the cases (10%), the fetal death certificate noted
Discussion
This study probably represents the largest reported population-based description of traumatic fetal injury-related deaths to date. By far, the leading cause of traumatic fetal injury death was motor vehicle crashes. Placental separation was the leading physiologic injury diagnosis. The rate of overall reported traumatic injury-related fetal death (≥16 weeks gestation) was 6.5/100 000 live births, slightly lower from the nine reported by Naey (which used a slightly different definition and drew
Recommendations
This study should be expanded to include examination of traumatic injury-related fetal deaths across the country to garner more numbers for analysis and better geographic representation. The author is currently engaged in such an effort and results from an analyses of birth certificates coded as 760.5 from states representing about 50% of the US population of women of childbearing age over a 3-year period (1995–1997) will be submitted for publication in the near future. About 240 fetal death
Acknowledgements
Partial funding for this project was supplied by the National Highway Traffic Safety Administration through a grant with the University of Pittsburgh Graduate School of Public Health Department of Biostatistics. I would like to thank my research assistant, Tony Fabio, for his help in data collection and abstraction and my colleagues at the Center for Injury Research and Control for their review and comments on manuscript drafts. This work was contingent upon the helpful cooperation of the
References (33)
- et al.
Fetal death in motor vehicle accidents
Annals of Emergency Medicine
(1987) Accidental injury complicating pregnancy
American Journal of Obstetrics and Gynecology
(1968)- et al.
Fetal death in a population of black women
American Journal of Preventive Medicine
(1995) Traumatic fetal deaths
Journal of Emergency Medicine
(1989)- et al.
Severe road traffic injuries in third trimester of pregnancy
Injury
(1984) Motor vehicle crashes, pregnancy loss and preterm labor
International Journal of Gynaecology and Obstetrics
(1997)- et al.
A prospective controlled study of outcome after trauma during pregnancy
American Journal of Obstetrics and Gynecology
(1990) - et al.
A study of intercurrent conditions observed during pregnancy
American Journal of Obstetrics and Gynecology
(1963) - et al.
Fetomaternal hemorrhage following trauma
American Journal of Obstetrics and Gynecology
(1985) - et al.
Traumatic fetal death resulting from fractured pelvis
American Journal of Obstetrics and Gynecology
(1953)
Lethal intrauterine fetal trauma
American Journal of Obstetrics and Gynecology
Report of two cases of intrauterine fracture, with remarks on this condition and references to 51 cases already reported by different writers
Transactions of the American Surgery Association
How serious is accidental injury during pregnancy?
Medical Times
Safety of lap-belt restraint for pregnant victims of automobile collisions [letter]
New England Journal of Medicine
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Trauma in Pregnancy
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2016, Accident Analysis and PreventionTrauma in pregnant patients
2015, Current Problems in SurgeryCitation Excerpt :Motor vehicle collisions were the leading trauma mechanism (82% of cases), followed by firearm injuries (6% of cases) and fall-related injuries (3% of cases). Traumatic injury–related fetal mortality was reported by the same author9 in a 2-year study, with data from only 1 state: 31 of 7131 (0.4%) fetal deaths were ascribed to trauma, whereas the fetal death rate was 6.5 per 100,000 live births. Motor vehicle collisions were the leading cause of injury (81%) and placental separation was the most common diagnosis (42%).
The tolerance of the human body to automobile collision impact - A systematic review of injury biomechanics research, 1990-2009
2015, Accident Analysis and PreventionCitation Excerpt :A limited number of studies investigated the failure tolerance of post-delivery, extra-fetal natal tissue (the chorioamnion (Pressman et al., 2002) and the fetal membrane (Oyen et al., 2004)). Motor vehicle collisions are the leading cause of traumatic fetal death (Weiss et al., 2001; Weiss, 2001). Despite this, there remains little information on the mechanisms or tolerances to injury among pregnant women.
Comparison of pregnant and non-pregnant occupant crash and injury characteristics based on national crash data
2015, Accident Analysis and PreventionPerinatal implications of motor vehicle accident trauma during pregnancy: Identifying populations at risk
2013, American Journal of Obstetrics and GynecologyCitation Excerpt :In the only study with a substantial proportion of pregnant African American trauma patients, restraint use by race was not reported.19 In a national study by Weiss,16 predictors of nonrestraint use were similar to those in nonpregnant women; race was not analyzed. If African American race is a factor for lack of nonrestraint use in pregnancy, it will require larger population studies to evaluate this association.
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An earlier version of this paper entitled ‘The epidemiology of traumatic injury-related fetal mortality in Pennsylvania: the role of motor vehicle crashes’ was presented at the meeting of the Association for the Advancement of Automotive Medicine. Barcelona, Spain, September, 1999.