Large retrospective analysis: prenatal assaults linked to high risks of maternal, fetal morbidity.(Obstetrics)

NEW ORLEANS -- 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 relation ships do not truth-fully report the causes of their injuries.

Women sustained a variety of injury types secondary to assault superficial injury, contusion, or crushing ...