CONSEQUENCES OF SEVERE UTERINE CONTUSION IN PREGNANT WOMEN

Objective. To make a comprehensive analysis of the pattern and nature of different damages among pregnant women with severe injury. Subjects and methods. In the past 11 years, the authors have followed up 158 pregnant women; the study enrolled only patients with severe injury who were admitted to the head center of Tashkent and its regional branches. The severest injuries characterized as polytrauma were noted in 18 (11.4%) pregnant women who had been admitted after traffic accidents (TA) and catatrauma and their mortality rate was 55.6% (10 of the 18 women died). Overall maternal death rate was 13.3% (21 of the 158 women were dead). The pregnant women’s age ranged from 18 to 35 years. The victims comprised 59 (37.3%) primigravidas and 99 (62.6%) secundiparas. The gestational age of the victims ranged from 8 to 40 weeks. Results. Damages to the locomotor apparatus and extragenital internal organs were present in 93 (58.9%) and 86 (54.4%) pregnant women, respectively. Mixed shock developed in 125 (79.1%) pregnant women. Eighty-six pregnant women with TA and catatrauma were found to have upper and lower limb fractures in 86(100.0%) cases, neurotrauma in 78 (90.7%), splenic rupture in 24 (27.9%), extensive retroperitoneal hematoma in 19 (22.1%), pelvic fracture in 18 (20.9%), rupture of the kidney in 16 (18.6%) and that of the liver in 11 (12.8%), pneumo-and hemothorax in 8 (9.3%), costal fractures in 6 (7.0%), lung ruptures in 6 (7.0%), spinal fracture in 2 (2.3%), urinary bladder rupture in 2 (2.3%), urethral detachment in 2 (2.3%), and leg detachment in 1 (1.2%) victim. At the same time, the volume of total blood loss in the victims was below 1000 ml in 9 (10.5%) pregnant women, from 1200 to 2000ml in 31 (36.0%), from 2200 ml or more in 46 (53.5%). Damages to the uterine-placental unit in 137 victims (those with burn injury being excluded) included uterine atony and areflexia in 25 (18.2%) pregnant women, premature detachment of the normally located placenta in 25 (18.2%), and incomplete uterine rupture in 1 (0.7%) case. Conclusion. The performed studies allowed us to formulate new propositions that characterize severe contusion of the pregnant uterus and to recommend a number of clinical guidelines at the stages of hospitalization.

pregnant women, polytrauma, maternal death rates