Computed tomography (CT) has been validated to identify and classify placental abruption following blunt trauma. The purpose of this study was to demonstrate improvement in fetal survival when delivery occurs by protocol at the first sign of class III fetal heart rate tracing (FHT) in pregnant trauma patients with a viable fetus on arrival and CT evidence of ≤ 50% placental perfusion secondary to placental abruption.
This is a retrospective review of pregnant trauma patients ≥ 26 weeks gestation who underwent abdominopelvic CT as part of their initial evaluation. Charts were reviewed for CT interpretation of placental pathology with classification of placental abruption based upon enhancement (Grade 1, >50% perfusion; Grade 2, 25-50% perfusion; Grade 3, <25% perfusion) as well as need for delivery and fetal outcomes.
Forty-one patients met inclusion criteria. CT revealed evidence of placental abruption in 6 patients (15%): Grade 1, 1 patient, Grade 2, 1 patient, and Grade 3, 4 patients. Gestational age ranged from 26 to 39 weeks. All patients with ≥ Grade 2 placental abruption developed concerning fetal heart tracings and underwent delivery emergently at first sign. Abruption was confirmed intraoperatively in all cases. Each birth was viable and Apgar Scores at 10 minutes were >7 in 80 % of infants, all of whom were ultimately discharged home. The remaining infant was transferred to an outside facility.
Delivery at first sign of non-assuring FHTs in pregnant trauma patients (third trimester) with ≥ Grade 2 placental abruption can lead to improved fetal outcome.
III Therapeutic/care management.
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