孕产妇损伤与不良围产结局的关联：回顾性队列研究
该回顾性队列研究基于2018-2024年58,897例分娩数据，发现3.1%发生孕产妇损伤；损伤与剖宫产（HR 1.09）和胎盘早剥（HR 2.74）风险升高相关，尤其坠落伤、交通伤及孕中期、严重、腹部损伤；未发现与严重孕产妇并发症或死产相关。
要点
- 孕产妇损伤增加剖宫产和胎盘早剥风险，尤其孕中期、严重及腹部损伤。
- 坠落伤与剖宫产风险升高相关（HR 1.21），交通伤与胎盘早剥风险升高相关（HR 3.33）。
- 损伤未与严重孕产妇并发症或死产风险升高相关。
核心结论
- 孕产妇损伤与剖宫产和胎盘早剥风险升高相关，尤其孕中期、严重及腹部损伤。
研究设计与样本
- 回顾性队列研究，使用2018-2024年Atrium Health Wake Forest Baptist健康系统电子健康记录，共58,897例分娩。
主要发现
- 1801例（3.1%）发生孕产妇损伤；剖宫产、严重孕产妇并发症、死产和胎盘早剥发生率分别为35%、4.6%、0.2%和0.3%。
- 损伤与剖宫产风险升高相关（HR 1.09，95%CI 1.01-1.18），坠落伤风险更高（HR 1.21，95%CI 1.04-1.41）。
- 损伤与胎盘早剥风险升高相关（HR 2.74，95%CI 1.50-4.99），交通伤风险更高（HR 3.33，95%CI 1.46-7.61）。
- 严重损伤与剖宫产风险升高相关（HR 1.53，95%CI 1.29-1.81），非严重损伤无显著关联（HR 1.01，95%CI 0.92-1.11）。
- 损伤与严重孕产妇并发症或死产无显著关联。
临床怎么用
- 对孕中期、严重或腹部损伤的孕妇应加强监测，关注剖宫产和胎盘早剥风险。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: Maternal injury affects 6% to 8% of pregnancies and is associated with perinatal complications. Some outcomes remain understudied, with limited evidence on variation of associations by injury characteristics. OBJECTIVE: To estimate associations between maternal injury and adverse perinatal outcomes. STUDY DESIGN: We conducted a retrospective cohort study using electronic health record data at the Atrium Health Wake Forest Baptist health system (2018-2024 births). We identified maternal injury using validated ICD-10-CM diagnostic codes and stratified injury by mechanism (transport accident, fall, other unintentional, intentional), trimester, location (abdominal, nonabdominal), and severity (severe: Abbreviated Injury Scale≥2). Time-varying Cox proportional hazards models estimated associations between injury and severe maternal morbidity (SMM), stillbirth, cesarean delivery, and placental abruption, identified using ICD-10-CM codes. RESULTS: Among 58,897 deliveries, 1801 (3.1%) experienced maternal injury. SMM, stillbirth, cesarean delivery, and placental abruption occurred in 4.6%, 0.2%, 35%, and 0.3% of deliveries, respectively. Injury was associated with increased risk of cesarean delivery (hazard ratio [HR] 1.09, 95% CI 1.01-1.18), especially from falls (HR 1.21, CI 1.04-1.41), and placental abruption (HR 2.74, CI 1.50-4.99), especially from transport accidents (HR 3.33, CI 1.46-7.61). Second trimester, severe, and abdominal injury increased risk of both outcomes (eg, severe injury and cesarean risk: HR 1.53, CI 1.29-1.81 v. nonsevere: HR 1.01, CI 0.92-1.11). Maternal injury was not associated with SMM or stillbirth. CONCLUSIONS: Maternal injury was associated with increased risk of cesarean delivery and placental abruption, particularly for second trimester, severe, and abdominal injury. These findings may inform postinjury clinical care management, focusing on pregnancies most at risk.
引用
- Musty A, Jensen ET, Stamilio D, et al. Associations between maternal injury and adverse perinatal outcomes: evidence from a retrospective cohort study. Am J Obstet Gynecol MFM. 2026. PMID: 41999886. doi:10.1016/j.ajogmf.2026.101967
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。