Kissinger et al evaluated risk factors affecting fetal loss after trauma to a pregnant woman. These can help identify high risk situations. The authors are from Washington (DC) Hospital Center, Vanderbilt University and San Francisco General Hospital.


Risk factors for fetal loss:

(1) high Injury Severity Scale (ISS)

(2) low Glasgow Coma Score (GCS)

(3) direct uteroplacental injury, especially with penetrating injury, premature rupture of membranes or abruptio placentae

(4) maternal shock on admission (systolic blood pressure < 90 mm Hg and heart rate >=100 beats per minute)

(5) maternal pelvic fracture

(6) maternal hypoxia on admission (PaO2 < 70 mm Hg on room air)


Risk correlation with Injury Severity Scale:

(1) The mean ISS for a viable fetus was 6.2 and for a nonviable fetus was 21.6

(2) No injury with an ISS > 30 resulted in a viable fetus.

(3) Using an ISS >= 4 had a negative predictive value of 0.968 and a sensitivity of 0.929, but a poor specificity at 0.380.

(4) Using an ISS >= 9 had a negative predictive value of 0.966 and a sensitivity of 0.857, with a specificity at 0.709. Two nonviable pregnancies occurred with an ISS < 9.


Risk correlation with the Glasgow Coma Score:

(1) The mean GCS for a viable fetus was 14.5 and for a nonviable fetus was 12.

(2) Using a cutoff of <= 9 had a negative predictive value of 0.89 and specificity of 0.97 but sensitivity of 0.31.

(3) Using a cutoff of <= 12 had a similar negative predictive value.

(4) Severe head injury (GCS 3 or 4) was associated with both fetal and maternal deaths.


Additional factors which may contribute to fetal death:

(1) concurrent use of cocaine or other drugs (page 1083)

(2) failure to perform cardiotocographic monitoring of the fetus

(3) fetal gestational age, with third trimester infants more viable if delivered


All mothers should have a Kleihauer-Betke test to detect fetomaternal hemorrhage. An Rh-negative mother who has undergone trauma should receive Rhogam, with the total dose determined by the extent of any fetomaternal hemorrhage.


To read more or access our algorithms and calculators, please log in or register.