Results
During the study period, FCM test was obtained in 1296 pregnant women
(Figure 1). Of these, 273 tests
were performed for non- trauma indications and were excluded. Of the
1023 remaining, 387 (38%) were collected due to MVA, 367 (36%) due to
fall, 353 (35%) had direct abdominal injury, and 14 (1%) had other
mechanisms of trauma. (Some women had more than one mechanism of trauma
recorded).
In 914 (89.3%) women who were evaluated due to a trauma incident during
pregnancy some FMH was detected. In
119 (11.6%) women FCM test was
considered positive (≥0.03/≥30 ml) with median result of 0.03
[0.03-0.04] and in 904
(88.4%) women FCM test was negative ((≤0.03/≤30 ml) with median result
of 0.01 [0.01-0.02].
Table 1 presents the demographic and obstetric characteristics
of the study groups. The gestational age at trauma did not differ
between the groups. Also, no differences were noted in the
gravidity/parity order or the number of previous miscarriages/cesarean
deliveries. Accordingly, the rates of fertility treatments, multifetal
gestation, and hypertensive or diabetic disorders of pregnancy were
comparable between the groups.
The clinicopathological characteristics of the trauma event and short
term maternal and neonatal outcomes, stratified by FCM negative or
positive results, are presented in Table 2. Trauma mechanism
did not differ between the groups. In addition, no differences were
noted in the ISS and the maternal symptoms, including vaginal bleeding,
uterine contractions, decreased fetal movements, rupture of the
membranes, clinical or sonographic signs of placental abruption, or
fetal death. However, the rate of trauma injury necessitating assessment
by non-obstetric specialty was statistically higher in the positive FCM
group (49.6% vs 40.5%, p=0.06). Nevertheless, the type of
hospitalization, rate of non-obstetrical surgery, and the rate of
delivery during hospitalization were also similar between the groups.
However, length of stay (days) was statistically longer in the positive
FCM group (1.4±1.8 vs 1.1±1.6, p=0.03).
Delivery information was available for 650/1023 (63.5%) women. The
demographic and obstetric characteristics and the positive FCM rates of
women who deliver in our medical center were mostly similar to those who
did not deliver in our center. However, women who delivered in our
medical center had higher rates of vaginal bleeding and uterine
contractions at admission (supplementary table 1) .
Maternal and neonatal delivery outcomes stratified by FCM results is
shown in Table 3. Of the women with available delivery
information, 84 women (70.6%) had positive FCM results and 566 (62.6%)
had negative FCM (p=0.09). No cases of fetal death were noted during
trauma admission in both groups. The other maternal and neonatal
delivery outcomes, including the composite adverse outcomes, were
similar in both groups.
In order to evaluate the
independent association between positive FCM and composite adverse
outcome we fitted a multivariate model. We included all variables found
to be significantly associated with composite adverse outcome in the
univariate analysis (not presented): vaginal bleeding at admission,
uterine contractions at admission, multifetal gestation, and
hospitalization. The multivariate model revealed (in order of risk
magnitude) that vaginal bleeding at admission, multifetal gestation and
hospitalization were independently associated with the composite adverse
outcome. However, the association between positive FCM and composite
adverse maternal and neonatal outcome was not significant (adjusted OR
0.42, 95% CI 0.16-1.11, p=0.08), Table 4 .
Comment: