Elevated Admission White Blood Cell Count in Pregnant Trauma Patients: An Indicator of Ongoing Placental Abruption

Shah, Shuchi; Miller, Preston R.; Meredith, J. Wayne; Chang, Michael C.
July 2002
American Surgeon;Jul2002, Vol. 68 Issue 7, p644
Academic Journal
Placental abruption (PA) is a common cause of fetal demise in pregnant trauma patients. Diagnosis of PA may be difficult, and multiple diagnostic clues are currently used including uterine/ abdominal pain and tenderness, bleeding, maternal hemodynamic instability, and evidence of PA by ultrasonography or other fetal monitoring. Although diagnosis may be problematic fetal and maternal survival are dependent on early diagnosis and intervention. The purpose of this study is to determine predictive factors present at admission associated with PA in trauma victims. Records of all pregnant trauma patients admitted to Wake Forest University Baptist Medical Center over a 5-year period were reviewed for injury characteristics and outcome. Inclusion criteria included a confirmed pregnancy and fetal disposition. Specific admission parameters evaluated included temperature, heart rate, systolic blood pressure, partial pressure of CO[sub 2] in arterial blood, total white blood cell count (WBC) and differential, hematocrit, base deficit, and lactic acid. PA is defined as a spontaneous abortion in the first trimester or abruptio placenta in the second or third trimester. Between April 1, 1996 and October 30, 2000, 30 patients met study criteria. Six of 30 patients were found to have PA (20%). Of the studied parameters WBC was significantly elevated in PA patients (27 ± 4.6 vs 17 ± 7.8 WBC x 10[sup 3]/mm[sup 3]; P = 0.005) as was band count (10 ± 6.6% vs 4 ± 6.1%; P = 0.03). Hematocrit was lower in the PA group (27 ± 4.3% vs 32 ± 5.4%; P = 0.04). Within this group of variables which differed on univariate analysis, WBC was the best discriminator between patients with and without PA (sensitivity 100%, specificity 79%, negative predictive value 100%, and positive predictive value 54%). In pregnant trauma patients WBC >20,000/mm[sup 3] on admission should raise suspicion of the possibility of PA, and close monitoring is warranted....


Related Articles

  • Abdominal trauma in the pregnant patient. Hill, D. Ashley; Lense, Jorge J. // American Family Physician;3/1/1996, Vol. 53 Issue 4, p1269 

    Presents guidelines in the management of abdominal trauma in pregnant women. Mechanism of injury; Penetrating trauma; Minor trauma; Major trauma; Rh-negative patients; Tetanus vaccination; Burns.

  • Preventing injuries to your abdomen during pregnancy.  // American Family Physician;3/1/1996, Vol. 53 Issue 4, p1275 

    Presents answers to queries concerning the prevention of injuries and trauma to the abdomen in pregnant women. Includes queries on pregnant women in car accidents; Query on abdominal traumas; Query on the instances that require medical intervention.

  • First-trimester vaginal bleeding. Wheeler, Marsha // Contemporary OB/GYN;Jul2007, Vol. 52 Issue 7, p70 

    The article stresses the importance of diagnosing vaginal bleeding. The author says that vaginal bleeding in the first trimester will either lead to normal pregnancy or pregnancy loss. There are 6 ways to evaluate a patient who presents with vaginal bleeding, one of which is by obtaining a...

  • Disparities in Intimate Partner Violence Prenatal Counseling: Setting a Baseline for the Implementation of the Guidelines for Women's Preventive Services. Ta Park, Van M.; Hayes, Donald K.; Humphreys, Janice // Hawaii Journal of Medicine & Public Health;May2014, Vol. 73 Issue 5, p137 

    Prenatal health care counseling is associated with positive health outcomes for mothers and infants. Moreover, pregnant women are considered a vulnerable population at risk of being victims of intimate partner violence. Pregnancy provides a unique opportunity to identify and refer women...

  • Electronic fetal monitoring: On second thought, not an advance.  // HealthFacts;Dec95, Vol. 20 Issue 199, p3 

    Focuses on electronic fetal monitoring (EFM). Initial purpose of EFM; Risks presented by EFM.

  • The end of fetal monitoring? Stedman, Nancy // Redbook;Jun96, Vol. 187 Issue 2, p52 

    Reports that 99.8 percent of signs of potentially brain-damaging fetal distress detected by electronic monitoring of babies' heartbeat during labor are false alarms according to a study.

  • The practice of urging mothers in high-risk pregnancies...  // Consumers' Research Magazine;Sep93, Vol. 76 Issue 9, p40 

    Comments on an article in the `Journal of the American Medical Association,' on the use of home uterine activity monitoring (HUAM). How the device works; Cost considerations; More.

  • What to look for in a baby monitor. Young, Stephanie // Glamour;Mar96, Vol. 94 Issue 3, p73 

    Provides tips for selecting a baby monitor. Frequency of the baby monitor; Battery budget; Distance covered by the monitor; Size.

  • Fetal monitoring: The risks of a high-tech birth. Blecher, Michele Bitoun // Parenting;Dec96/Jan97, Vol. 10 Issue 10, p229 

    Focuses on the risks of using electronic fetal monitoring (EFM). Threats to fetus; Effects to pregnant women; Effectiveness of EFM.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics