Dina El Kady

Maternal and neonatal outcomes of assaults during pregnancy.

OBJECTIVE: To assess perinatal outcomes of women hospitalized for assault during pregnancy as a function of timing of delivery. METHODS: A retrospective population-based study analyzing maternal discharge records linked to birth/death certificates in California from 1991 to 1999 was performed. International Classifications of Disease, Ninth Clinical Modification (ICD-9-CM) codes were used to identify injury types and outcomes. External causation codes identified assaults as the mechanism of the injuries. Injury Severity Scores were assessed. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and multivariate logistic regression was used for analysis of outcomes. RESULTS: A total of 2,070 women were hospitalized during pregnancy after sustaining an assault. Assaulted women were younger, multiparous, and with delayed prenatal care compared with unassaulted controls. Women delivering at the assault hospitalization had high rates of prematurity: 24%, OR 2.4 (95% CI 1.8–3.3), maternal death: 0.71%, OR 19 (95% CI 2.7–144.7), fetal death: 9.3%, OR 8 (95% CI 4.6–14.3), uterine rupture: 0.71%, OR 46 (95% CI 6.5–337.8), and other adverse outcomes compared with unassaulted women. Women discharged after an assault, delivering at a subsequent hospitalization, had increased risks of abruption: 2%, OR 1.8 (95% CI 1.3–2.5), hemorrhage: 3.2%, OR 1.8 (95% CI 1.4–2.5), prematurity: 15%, OR 1.3 (95% CI 1.2–1.5), and low birth weight: 13.4%, OR 1.7 (95% CI 1.5–1.9) at delivery. CONCLUSION: Women sustaining an assault during pregnancy experience both immediate (uterine rupture, increased fetal and maternal mortality) and long-term sequelae (prematurity and low birth weight infants), which have significant negative effects on pregnancy outcome. LEVEL OF EVIDENCE: III

Maternal and neonatal outcomes after attempted suicide

OBJECTIVE: The purpose of this study was to describe identifiers and estimate maternal and neonatal outcomes in women who attempt suicide during pregnancy. METHODS: A linked Vital Statistics-Patient Discharge database of the State of California was used to identify cases of intentional injury during pregnancy. A retrospective analysis of maternal and neonatal outcomes in pregnant women who were admitted for attempted suicide is presented. RESULTS: There were 4,833,286 deliveries in California from 1991 to 1999. Of those deliveries, 2,132 were complicated by attempted suicide during pregnancy (0.4 per 1,000 pregnancies). The control population was composed of patients who did not attempt suicide. The group of women that attempted suicide during pregnancy had increases in premature labor, cesarean delivery, and need for blood transfusion. Analysis of neonatal outcomes revealed increases in respiratory distress syndrome and low birth weight infants. A subanalysis, including women who delivered at the hospitalization for attempted suicide, demonstrated increased premature delivery, respiratory distress syndrome, and neonatal and infant death. CONCLUSION: Attempted suicide is associated with significantly higher rates of maternal and perinatal morbidity, and in some cases, perinatal mortality. The best identifier for women at risk for attempting suicide is substance abuse. Care provider identification and prevention are of key importance in preventing these outcomes. LEVEL OF EVIDENCE: II-2