For the woman who is D-negative, administration ofanti-D immunoglobulin should be considered. his may be omitted if a test for fetal bleeding is negative. Even with anti-D immunoglobulin, alloimmunization may still develop if the fetalmaternal hemorrhage exceeds 15 mL of fetal cells (Chap. 15, p.r306).
For the pregnant trauma patient, confirmation of current tetanus immunization status is pertinent. When indicated, a dose oftetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) is preferred for its neonatal pertussis immunity beneits (Chap. 9, p. 171).
Fetal* Maternal...
FIGURE 47-1 2 Maternal and fetal mortality rates by burn severity in nearly 400 women. (Data from Akhtar, 1994; Amy, 1985; Mabrouk, 1977; Maghsoudi, 2006; Parikh, 2015; Rayburn, 1984; Rode, 1990.)
Treatment ofthe burned gravida is similar to that for nonpregnant patients (Mendez-Figueroa, 2016). With treatment, it is generally agreed that pregnancy does not alter maternal outcome from thermal injury compared with that of nonpregnant women ofsimilar age. As perhaps expected, maternal and fetal survival parallels the percentage of burned surface area (Parikh, 2015). Karimi and colleagues (2009) reported higher mortality rates for both with suicidal attempts and with inhalational injuries. The composite mortality rate for nearly 400 women from seven studies increased in a linear fashion as the percent of burned body surface area increased 47-12). For 20-, 40-, and 60-percent burns, the maternal mortality rates were approximately 4, 30, and 93 percent, respectively. he corresponding fetal mortality rates were 20, 48, and 96 percent, respectively. With severe burns, the woman usually enters labor spontaneously within a few days to a week and often delivers a stillborn. Contributory factors are hypovolemia, pulmonary injury, septicemia, and the intensely catabolic state (Radosevich, 2013).
Following serious abdominal burns, skin contractures that develop may be painful during a subsequent pregnancy and may even require surgical decompression and split-skin autografts (Mitsukawa, 2015; Radosevich, 2013). Loss or distortion of nipples may cause problems in breastfeeding. Mitsukawa and associates (2015) reported that contracture release was indicated with scars spanning more thanr>75 percent of the total abdominal area. Alternatively, normal abdominal tissue expansion due to pregnancy appears to be an excellent source for obtaining skin grafts postpartum to correct scar deformities at other body sites (Del Frari, 2004).
Earlier case reports suggested a high fetal mortality rate with electric shock (Fatovich, 1993). In a prospective cohort study, however, Einarson and coworkers (1997) showed similar perinatal outcomes in 31 injured women compared with those of noninjured controls. They concluded that traditional 110volt North American electrical current likely is less dangerous than the 220-volt currents available in Europe. A woman with been related to a mild electrical shock at 22 weeks was described (Sozen, 2004). Another woman with brain death from cardiac arrest was reported (Sparic, 2014). Thermal burns with electro cution may be extensive.
The pathophysiological efects of lightning injuries can be devastating. Garda Gutierrez and coworkers (2005) reviewed a 50-percent stillbirth rate.