Thermal injury in pregnancy: predicting maternal and fetal outcome

ABSTRACT

This study was undertaken to assess the parameters that may predict maternal and foetal outcome in 49 thermally injured pregnant women in a Plastic surgery unit in tertiary referral center in the last five years. There were 33 maternal deaths and 34 fetal deaths. In general, pregnancy as such does not influence maternal outcome after thermal injury. In first and second trimester best chance for foetal survival is to ensure maternal survival and in the last trimester fetal survival depends upon fetal maturity. Maternal survival is less likely if the burn wound exceeds 50% total body surface area. Thermal injury does increase the risk of spontaneous abortion and premature labour. Early obstetric intervention is indicated in patients with fatal burn and complications.

KEYWORDS

Pregnacy - Thermal injury - Outcome

• 1 Mulla N, Albuquerqui MD, Mex N. Labour following severe thermal burns. Am J Obstet Gynecol 1958; 76: 1338-41
• 2 Matthews RN. Obstetric implications of burns in pregnancy. Br J Obstet Gynaecol 1982; 89: 603-9
• 3 Schmitz J. Pregnant patients with burns. Am J Obstet Gynecol 1971; 110: 57
• 4 Stage HA. Severe burns in the pregnant patients. Obstet Gynecol 1973; 42: 259--62
• 33 Stilwell JH. A major burn in early pregnancy with maternal survival and pregnancy progressing to term. Br J Plast Surg 1982; 35: 33--5
• 6 Rayburn W, Smith B, Feller I, Varner M, Cruikshank D. Major burns during pregnancy:Effects on foetal well-being. Obstet Gynecol 1984; 63: 392-5
• 43 Taylor JW, Plunkett GD, McManus WF, Pruitt BA. Thermal injury during pregnancy. Obstet Gynecol 1976; 47: 434-8
• 8 Guo SS, Greenspoon JS, Kahn AM. Management of burn injuries during pregnancy. Burns 2001; 27: 394-7
• 9 Bartle EJ, Sun JH, Wang XW. Burns in pregnancy. J. Burn Care Rehabil 1988; 9: 485-7
• 10 Cheah SH, Sivanesaratnam V. Burns in pregnancy-maternal and foetal prognosis. Aust. N. Z. J. Obstet. Gynaecol 1989; 29: 143-5
• 11 Akhtar MA, Mulawkar PM, Kulkarni HR. Burns in pregnancy:Effect on maternal and foetal outcomes. Burns 1994; 20: 351-5
• 12 Amy BW, McManus WF, Goodwin CW, Mason A, Pruitt BA. Thermal injury in the pregnant patient. Surg Gynecol Obstet 1985; 161: 209-12
• 13 Rode H, Millar AJ, Cywes S, Bloch CE, Boes EG, Theron E, van der Merwe AE, de Kock M. Thermal injury in pregnancy-the neglected tragedy. S Afr Med J 1990; 77: 346-8
• 14 Deitch EA, Rightmire DA, Clothier J, Blass N. Management of burns in pregnant women. Surg. Gynecol Obstet 1985; 161: 1-4
• 15 Benedetti TJ. Maternal complications of parenteral beta sympathomimetic therapy for premature labor. Am J Obstet Gynaecol 1983; 145: 1-6
• 16 Barden TP. Premature labour. In : Bolognese RT, Schwarz RH, Schneider J. editors Perinatal medicine, Management of high-risk fetus and neonate. 2nd. edn Baltimore:Williams and Wilkins, co; 1982: p.240-303
• 17 Herndon DN, Abston S, Stein MD. Increased thromboxane B2 levels in the plasma of burned and septic burned patients. Surg Gynaecol Obstet 1984; 159: 210-3
• 18 Ullmann Y, Blumenfeld Z, Hakim M, Mahoul I, Sujov P, Peled IJ. Urgent delivery, the treatment of choice in term pregnant women with extended burn injury. Burns 1997; 23: 157-9
• 19 Napoli B, DArpa N, Masellis M, Graziano R. Burns in pregnancy Annals of Burns and Fire Disasters. vol XIII. n° 1 2000
• 20 Gronert GA, Theye RA. Pathophysiology of hyperkalemia induced by succinylcholin. Anesthesiology 1975; 43: 89-99
• 21 Mabrouk AR, El-Feky AEH. Burns during pregnancy: A gloomy outcome. Burns 1997; 23: 596-60
• 22 Prasanna M, Singh K. Early burn wound excision in ′major′ burns with ′pregnancy′:a preliminary report. Burns 1996; 3: 234-37
• 23 Kitzmiller WJ, Neale HW, Warden GD, Smith D. The effect of full-thickness abdominal wall burns sustained during childhood on subsequent childbearing ability. Ann Plast Surg 1998; 40: 111-3
• 24 McCauley RL, Stenberg BA, Phillips LG, Blackwell SJ, Robson MC. Long-term assessment of the effects of circumferential truncal burns in pediatric patients on subsequent pregnancies. J Burn Care Rehabil 1991; 12: 51-3
• 25 El-Gallal ARS, Yousef SM. burns in pregnancy:a ten-year review of admitted patients Annals of Burns and Fire Disasters. vol. XV. -n. 3 2002