Trauma During Pregnancy: Predictors of Readmission and Maternal-Fetal Outcomes.

INTRODUCTION

Trauma is the leading nonobstetrical cause of mortality in pregnant women and a major cause of fetal demise. Among pregnant trauma patients, there is a paucity of data on factors associated with unplanned readmissions. We examined the predictors of 90-day readmission in pregnant women admitted for traumatic injuries and evaluated the associated maternal-fetal complications.

METHODS

The Nationwide Readmissions Database (2016-2019) was reviewed for all adult trauma admissions. Pregnant state at index admission was determined by International Classification of Diseases-10 codes for gestational age. The primary outcome was 90-d readmission rate. A multivariable logistic regression model was used to identify predictors of readmissions in this patient population.

RESULTS

Of the 5653 pregnant trauma admissions, 254 (4.5%) had at least one unplanned readmission within 90 d of discharge. Readmitted patients were younger, in their first or second trimester, on Medicaid, belonged to a lower-income quartile, suffered more severe injuries, and had a greater number of comorbid conditions, including substance use disorder and pregestational diabetes. The most common nonobstetric cause of 90-d readmission was psychiatric conditions. Readmitted patients were less likely to have experienced fetal death at index admission (0.1% versus 2.6%, P = 0.029) but more likely to have developed genitourinary complications during index admission (15.4% versus 5.9%, P < 0.001). Preterm delivery, chorioamnionitis, and intrauterine growth restriction were significantly increased in readmitted patients. Uninsured status, multiple comorbidities, and history of a cesarean section were independent predictors of readmission.

CONCLUSIONS

In pregnant patients admitted for traumatic injuries, readmission was associated with poor maternal-fetal outcomes. The risk of readmission was significantly higher in younger patients, those with multiple comorbidities, and those who were uninsured. Interventions targeting these risk factors should be implemented to alleviate the burden of the initial trauma.