Significance of motor vehicle crashes and pelvic injury on fetal mortality: A five-year institutional review

Background: Motor vehicle crashes (MVC) are the leading cause of maternal injury during pregnancy. It is estimated that 1,300 to 13,000 fetal deaths/yr result from maternal MVC. Methods: Pregnant women with injuries were identified by ICD-9 codes containing pregnancy and injury from hospital medical records and Trauma/ED registries. Records were reviewed for demographic data, fetal gestational age, mechanism of injury, injuries sustained, Glasgow Coma Score, loss of consciousness (LOC), Injury Severity Score (ISS), and maternal and fetal outcome. Fisher's exact test, t test, and logistic regression analysis were performed to analyze statistical analysis. Results: From 2001 to 2005, 29,066 pregnant patients were seen at our institution. Five thousand two hundred forty-four of these patients visited the ED, and 294 of them reported injuries. One hundred forty-eight (50.3%) patients were involved in MVC. The average maternal age was 23.8 years. The mean gestational age was 20 weeks. The majority of patients were drivers (n=97, 70%) versus passengers (n=42, 30%), and 66% were restrained versus 34% unrestrained. There were no maternal deaths; however, seven mothers (4.7%) had poor fetal outcome (six fetal deaths and one hydrops fetalis). Increased maternal age, LOC, high ISS, and pelvic injury were risk factors for poor fetal outcome. Logistic regression revealed LOC and pelvic injury to be independent risk factors. Conclusions: Increased maternal age, LOC, and maternal pelvic fractures sustained during MVC contribute toward high ISS and significantly impacts fetal outcome. Despite fetal gestational age, aggressive radiographic pursuit of pelvic fractures may be warranted.