Caracterización del trauma en embarazadas en un hospital de tercer nivel en Bogotá, Colombia

Calderón Salazar, Carlos Julio

doi:https://doi.org/10.48713/10336_38033

Ítem

Embargo

Caracterización del trauma en embarazadas en un hospital de tercer nivel en Bogotá, Colombia

https://repository.urosario.edu.co/handle/10336/38033
https://doi.org/10.48713/10336_38033

Autores

Calderón Salazar, Carlos Julio

Archivos

PDF

Fecha

2023-01-15

Directores

Ríos, Angela

Jiménez, María Fernanda

Padilla, Cristina

Gonzalez, Alvaro

Angel Barrios, Jorge Armando

García López, Andrea Elena

Editor

Universidad del Rosario

Buscar en:

Métricas alternativas

Resumen

Introducción: Las gestantes tienen una mayor probabilidad de sufrir un trauma violento en comparación con las no embarazadas. También tienen un 66% más de riesgo de muerte derivado del trauma en comparación con esta misma población. De esta manera, la injuria en pacientes embarazadas presenta un reto al involucrar dos pacientes que deben ser tratados en simultáneo, y que puede tener un gran impacto en la morbimortalidad materno-perinatal. Materiales y métodos: Estudio observacional descriptivo de corte transversal, en el cual se revisaron las historias clínicas de manera retrospectiva de las mujeres embarazadas atendidas por el servicio de cirugía general entre enero de 2018 y mayo de 2021. Se desarrolló un análisis univariado y bivariado de las características relevantes. Resultados: Se identificaron un total de 34 pacientes gestantes con trauma penetrante o contundente, de un total de 15.343 embarazadas atendidas en el periodo de estudio. La edad gestacional promedio fue 20,5 (DS: 9,1) semanas. 8,8% eran pacientes emigrantes; todas venezolanas. La totalidad de las pacientes recibieron algún tipo de lesión en el abdomen, el puntaje del Injury Severity Score (ISS) en promedio fue de 6 puntos; con un máximo de 75 puntos y un mínimo de 2 puntos. La prevalencia del trauma en población gestante en la Subred Integrada de Servicios de Salud Suroccidente E.S.E Unidad Occidente de Kennedy es de 2 por cada 1000 pacientes atendidas, con una mortalidad del 3 pacientes por cada 100. Palabras clave: Accidentes; Embarazo; Heridas; Índices de gravedad del trauma; Traumatismo múltiple; Violencia doméstica.

Abstract

Introduction: Trauma is the leading cause of non-obstetric death in pregnant women, affecting 6-8% of all pregnancies, and remains a major cause of fetal demise. The care of an injured pregnant woman represents a challenge for even experienced healthcare personnel, since it involves the simultaneous management of two patients at risk: a pregnant woman and her fetus. Globally, the most frequent causes of unintentional trauma in pregnancy are motor vehicle accidents (48%) and falls (25%), while common intentional causes include intimate partner violence (IVP) (17%) and suicide. In Colombia, the prevalence of interpersonal violence in pregnant women is 8.1%. It has also been reported that a pregnancy is 1.4 times more likely terminate when violence is present. There are few studies in Latin America and the Caribbean on the characterization of traumatic injuries during pregnancy, particularly when it comes to those caused by interpersonal violence. Purpose: To describe the epidemiology and outcomes of pregnant patients who suffered blunt or penetrating trauma and were admitted to Hospital de Kennedy, a Level I trauma center, between 2018 and 2021. Materials and methods: We performed a cross-sectional descriptive observational study between January 2018 and May 2021, in which all medical records of pregnant patients treated by the general surgery team were retrospectively reviewed. Patients who left against medical advice, had a psychological pregnancy, or in whom the pregnancy status could not be confirmed, were excluded. The risk of interpersonal violence was established during assessment by the gynecologist or social worker. Univariate descriptive analysis was carried out by means of measures of central tendency and corresponding dispersion according to the distribution of the variables. For the bivariate analysis, hypothesis tests were performed on two or several samples (Chi-square, Fisher's exact test, Wilcoxon's sum of rankings, ANOVA) depending on the nature of the variables compared. Results: A total of 34 injured pregnant patients were identified from 15,343 pregnant women treated at the hospital during the study period. The mean age of the patients was 23.44 (SD= 6.13) years, and the mean gestational age was 20.51 weeks (SD: 9.1). 8.8% were migrant patients; all from Venezuela. Most of the patients had governmental health coverage (82.35%, n= 28). was Anatomic areas most often injured were the abdomen or pelvis, followed by the extremities, then the head and neck. Thirty–three patients sustained a blunt injury (97.06%), while only one case (2.94%) was victim of a gunshot wound. This last case represents the only maternal mortality and stillbirth within this cohort. Domestic violence was responsible for most of the cases (88.23%, n= 30), followed by motor vehicle accidents (11.76%, n=3). Most of the patients experienced a single injury (85.29%, n=29). The median Injury Severity Score (ISS) of patients at the emergency department was 6 (IQR=2, 75). The median hospital length of stay was 1 day (IQR=1, 2). The prevalence of trauma in the pregnant population at Hospital de Kennedy is 2 per 1000 pregnant patients treated and the mortality of the pregnant patients included in the cohort was 3 patients per 100. See Table 1. Sociodemographic, clinical characteristics, and outcomes of patients with trauma during pregnancy.Conclusion: Despite trauma in pregnant women being uncommon within this cohort, interpersonal violence predominates in the majority of cases. Blunt trauma was the most frequent mechanism encountered. This study provides useful information about the management of the injured pregnant patient and opportunities for the development of injury prevention measures.