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A large proportion of women who are injured during pregnancy are the
victims of assaults that drastically increase their risk of poor
outcomes, including a 41-fold increase in the risk of uterine rupture
before labor and an 18-fold increase in the risk of maternal death.
“Intentional injuries and assaults during pregnancy result in
significant maternal and fetal morbidity and mortality. Women with
internal injuries have the worst outcomes, but even those with
superficial injuries are at higher risk of adverse outcomes, including
maternal death,” Dr. Dina El Kady said in a poster session at the annual
meeting of the Society for Maternal-Fetal Medicine.
Dr. El Kady of the University of California, Davis, performed a
retrospective analysis of all deliveries in California in 1991-1999.
Out of the more than 4 million deliveries, 14,110 women were
hospitalized for sustaining an injury during pregnancy. Of this group,
4,122 (29%) reported an intentional injury or assault.
Women who were assaulted were more likely to be young (aged 20 years
or younger), black, and have less than a high school degree than were
the unassaulted women. They were also more likely to be multiparous and
had a higher rate of late or no prenatal care. Almost 80% of them were
on Medi-Cal, California’s public health coverage program.
The types of assaults they reported were unarmed fight or brawl
(47%), “other” (23%), firearm (13%), stabbing (10%), and abuse (7%). The
proportion of actual abuse was probably higher, Dr. El Kady said,
because many women in abusive relationships do not truthfully report the
causes of their injuries. Women sustained a variety of injury types
secondary to assault: superficial injury, contusion, or crushing injury
(20%); fractures (18%); open wounds (17%); internal injuries to the
thorax, abdomen, and pelvis (8.5%); and cranial injuries (4%).
The injuries of 491 of the women were severe enough to lead to
delivery. The rest of the women were discharged without delivering. (See
box.)
“The women who were treated and discharged undelivered still had a
higher risk for poor outcomes – including low birth weight, abruption,
and preterm labor and delivery – perhaps because they were returning to
a violent or dangerous environment,” Dr. El Kady said. “These women
should be more closely monitored during the remainder of their
pregnancies.”
She said her analysis doesn’t begin to describe the true scope of the
problem of violence against pregnant women. “These are only the women we
know about,” she said. “Most commonly, these women do not report their
injuries or seek any prenatal care, so we really have no idea how many
more pregnant women out there are really suffering these kinds of
injuries.” |
