Severity of the injury in pregnancy and impact on the baby

An injury sustained on the pregnant abdomen could lead to fetal demise simply because of its severity. This may be in the form of direct trauma to the fetus itself, or perforation of the womb, with resultant severe internal bleeding.

It could also lacerate the placenta (afterbirth). All these make the fetal prognosis quite poor.

Baby protecting mother

This is a tragic but true role-reversal.

In advanced pregnancy, trauma sustained directly on the abdomen, when very severe, may kill the baby but leave the mother relatively safe. This is simply because the pregnant uterus offers an effective physical shield against injury to the major blood vessels and other vital organs in the abdomen.

Even though there were hundreds of recorded gun-shot wounds to the abdomen of pregnant women throughout the twentieth century and into this century, the last recorded maternal death in that century directly attributable (solely) to that injury was in 1912! Ofcourse that was before Iraq... There are more advantages (some undesirable) to being pregnant than you ever imagined...

Importance of gestational age in pregnancy trauma

Direct trauma to the abdomen below 12 weeks of gestation is unlikely to directly affect the pregnancy, because the uterus is still entirely in the pelvic cavity up to that stage.

Trauma sustained in the early second trimester up to about twenty-four weeks may lead to miscarriage; or if it is 24 weeks or beyond, it can cause preterm labour, depending on severity of the injury. The eventual consequence is pregnancy loss because most severely premature babies are lost, even if born alive.

Penetrating trauma sustained in the latter phase of pregnancy (third trimester) has a 40-70% chance of leading to fetal loss.

Indirect trauma leading to preterm labour has a less adverse outcome.

Psychological "fallout" from trauma as a factor in the likely pregnancy outcome.

Researchers have repeatedly observed that there is no consistent relationship between the severity of the physical injury and fetal outcome in trauma during pregnancy. This is particularly observed when trauma was a result of inter-personal violence usually involving a partner.

It has been observed that in some cases where the maternal injury severity score was zero (i.e. virtually no physical injury), the woman went on to lose the pregnancy. It is believed that the weight of mental and psychological distress resulting from the assault leads to this outcome. This is why it is important to ensure that all victims of assault are given not only the medical treatment for the physical injury (if there), but proper psychological support as well.

Continues next page