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Blunt Abdominal Trauma during Pregnancy in Nigeria: Causes, Obstetric Complications and Pregnancy Outcome

Umoh MS, Japhet E, Udoukpong EA, Oku OE and Ekanem EI

Background: Trauma is a major cause of morbidity and mortality worldwide. It is among the commonest reason for admission to Accident and Emergency (A&E) Department of the University of Calabar Teaching Hospital (UCTH) Calabar, Nigeria. The pregnant woman is highly vulnerable to trauma with possible injuries to mother and foetus. Such usually evokes great concern. Reports on blunt abdominal trauma during pregnancy in Nigeria are scanty, probably due to the scarcity of trained emergency physicians and trauma surgeons. Aim: This 3 year prospective study aimed at establishing the common causes, obstetric complications and pregnancy outcome in blunt abdominal trauma during pregnancy in the south-south geopolitical zone of Nigeria. Methodology: This was 3 year (March 1 20011 to Feb.28, 2013) the records of all trauma cases admitted into the A and E department of the UCTH, Calabar were prospectively collected. Demographic data, mechanism of trauma, injury severity, management, obstetric complications and pregnancy outcome for pregnant women with blunt abdominal trauma were extracted onto a proforma designed for the study. Pregnancy outcome was regarded as successful if it was carried to term or delivered of live baby with no consequent ill effects traceable to the trauma. The results are presented and discussed. Results: A total of 12488 patients were admitted to the A&E department during the study period. Trauma accounted for 42.0% (5245 patients), of which 0.38% (20) were pregnant women with blunt abdominal trauma. The women were aged 17-40 years. The gestational ages ranged from 8-38 weeks. Thirty-five (65.0%) and 7 (35.0) were booked and unbooked cases respectively. They were 4, 11, and 5 in the 1st, 2nd and 3rd trimester respectively. The mechanism of injury included assaults, road traffic accidents, and falls. Assaults constituted 11 (55.0%), road traffic accidents 7 (35.0%) and domestic falls 2 (10.0%). Fifteen (75.0%) had injury severity score (ISS) <9. The RTA victims had associated injuries, which included bruises, superficial lacerations, one closed left humeral fracture and a red eye. Most patients presented within 6 h and 1>72 hours from time of trauma. Management approach was multidisciplinary. All patients were monitored for at least 24 h before discharged. The main obstetric complications were premature uterine contractions, vaginal bleeding, foetal distress preterm delivery and 1 intrauterine death (IUD). One patient had emergency Caesarean section due to severe foetal distress. The IUD was recorded in a patient at 34 weeks gestation discharged after 24 hours of monitoring with no discernible risk to mother and foetus. Two patients were lost to followup and 17 (85.0%) had successful pregnancy outcome. There was no maternal death. Conclusions: Assault was the most common mechanism of trauma. The excellent outcome notwithstanding our A&E department requires upgrading to possess modern facilities for foeto-maternal monitoring and trained emergency physicians are needed to improve the emergency services especially to the most vulnerable patients like the pregnant women with trauma.