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Pregnancy linked to higher risk of death from traumatic injury, Penn study finds

May 05, 2017

SAN DIEGO -- Studies have found that one in six pregnant women have been abused by a partner - beaten, stabbed, shot, or even murdered. New research shows the risks to these women may be especially profound: Pregnant women are twice as likely to be a victim of an assault-related trauma (including suicide) - and die from their injuries - than an accident-related trauma like car accidents or falls, compared to women who are not pregnant, according to a new study from researchers in the Perelman School of Medicine at the University of Pennsylvania. The findings come from a Pennsylvania statewide analysis of hospital trauma cases occurring over a decade, and will be presented Sunday at the American Congress of Obstetricians & Gynecologists' (ACOG) Annual Clinical and Scientific Meeting in San Diego (poster 36G).

"Trauma from assaults or accidents complicates 1 in 12 pregnancies and is the leading non-obstetric cause of death among pregnant women. Not only is it associated with complications for the baby, but management of traumatic injuries in pregnant patients has its unique challenges, given the physiologic changes of pregnancy and restrictions doctors may face when treating pregnant patients," said the study's lead author Neha Deshpande, MD, a clinical resident of Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania. "Despite the severity of the issue, little is known about how trauma actually impacts pregnant women since accidental and incidental causes of death are excluded in many statewide and national maternal mortality reviews. The striking results of our study suggest that widespread screening for violence and trauma during pregnancy may provide an opportunity to identify women at risk for death during pregnancy."

Previous research on the topic has shown that violence is common in pregnancy - even in relationships where previously there were no incidents - but the new study is the first large statewide analysis highlighting the effect of violent trauma on maternal mortality. For their analysis, the researchers used data from the Pennsylvania Trauma Outcomes Study database, a comprehensive and validated registry which includes records of admissions to all accredited trauma centers in the state. The analysis focused on admissions from 2005 through 2015, and included nearly 45,000 cases of trauma among victims who were defined as women of childbearing age (14-49).

The researchers found that pregnant trauma victims, on average, suffered less severe injuries than their non-pregnant counterparts. However, despite less severe injuries, pregnant women were nearly twice as likely to be dead when they arrived at the hospital, or die in the hospital. In particular, assault-related trauma was about three times more deadly than accident-related trauma. In addition, after suffering a violent assault, pregnant women were 4.4 times more likely to be transferred to another facility for obstetric services and support.

"Since the typical definition of maternal deaths includes only those directly caused or impacted by pregnancy, it does not include accidental or incidental causes of death, making it difficult to accurately gauge the burden of trauma-related deaths on maternal mortality," said senior author Corrina M. Oxford, an assistant professor of Clinical Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania. "However, evidence presented in our study suggests this is a pervasive issue that requires further attention to ensure these women, and their babies, are being properly cared for."

Results also showed that nearly 1 in 5 pregnant women reported a psychiatric illness or arrived at the hospital following a suicide attempt. Minority and uninsured women were also significantly more likely to experience assault. The authors say the findings point to an opportunity for intervention to safeguard pregnant women, and they recommend universal screening of pregnant women at obstetric clinics for assault and mental illness, similar to screenings for postpartum depression.
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The research was recently awarded the prestigious 2017 S. Leon Israel Award from the Obstetrical Society of Philadelphia.

Co-authors on the study Randi Smith from Traumatology and Critical Care at Penn Medicine, and Lauren Kucirka from Johns Hopkins University School of Medicine.

Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $6.7 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2016 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2016, Penn Medicine provided $393 million to benefit our community.

University of Pennsylvania School of Medicine

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