Seat belt injury in pregnancy resulting in fetal death. A need for education?

Article Abstract:

Road traffic accidents can seriously damage a pregnant woman and her developing fetus. There have been several studies that have tried to determine whether wearing a seat belt protects or causes more harm to the mother and fetus. One study recommended that pregnant women should not wear lap belts, but should wear shoulder belts instead. However, other studies do not agree and recommend that pregnant women wear both lap and shoulder belts. Detachment or separation of the placenta is one of the most common causes of fetal death resulting from traffic accidents. This article describes the case reports of two 30-year-old pregnant women who were each front seat passengers in a car accident. The first case involved a woman at 36 weeks of pregnancy who was wearing a lap and shoulder belt at the time of the accident. Following impact, she had bruises on her chest and abdomen, several broken ribs, whiplash in her neck, and a cut on her leg. When no fetal heart sounds were detected, an ultrasound was performed to confirm fetal death. Following a short labor, the woman gave birth to a stillborn baby with no apparent abnormalities. The placenta was delivered in two separate pieces, indicating that it had ruptured during the accident. The second case involved a woman at 31 weeks of pregnancy who was also wearing a lap and shoulder belt at the time of the accident. The only visible injuries were bruises on her chest and abdomen. However, when ultrasound was performed, there was no fetal heart beat. Labor was induced and 12 hours later a stillborn male fetus was delivered. Examination of the placenta showed that it was plugged with blood clots. It is concluded that lap and shoulder belts should be worn by pregnant women, but the seat belt should be properly fitted to rest underneath and above the abdominal bulge to prevent fetal trauma. Proper instructions for seat belt usage should be given to all pregnant women as a part of their prenatal care. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Splenic rupture in utero following a road traffic accident. Case report

Article Abstract:

Road traffic accidents can be a serious threat to the health of a pregnant woman and the developing fetus. It has been estimated that up to 7 percent of all pregnant women may be involved in a road traffic accident resulting in blunt trauma to the abdominal area. In most of these cases, both the mother and fetus are unharmed. However, in a few cases the accidents cause serious injuries and even death. Several studies have tried to determine whether wearing a seat belt would harm or protect the mother and fetus. In one study, there was no difference in the incidence of fetal death regardless of whether the mother was wearing a lap seat belt or not. Another study reported that wearing a three point harness (over the shoulder) improved the rate of fetal survival. Detachment or tearing of the placenta is the most common cause of fetal death in traffic accidents. This is estimated to occur in 3.6 percent of traffic accidents involving pregnant women, and symptoms appear within 48 hours. This article describes the case report of a 27-year-old pregnant nurse who was involved in a car accident during her 36th week of pregnancy. She was driving 35 mph when she ran into the back of another car. The woman was not wearing a seat belt and on impact she was thrown forward into the steering wheel. Upon entry to the emergency room, she complained of upper abdominal pain. Ultrasound scanning was performed and showed a living fetus with a slow heart rate (bradycardia). A normal weight baby girl was delivered by cesarean section, but she was in poor condition. There was no damage to the placenta. Three hours after delivery, it became apparent that the baby had internal bleeding caused by a ruptured spleen. Surgery was performed to remove the spleen, but the baby died 24 hours later. This case study illustrates the importance of close and continuous monitoring of both mother and fetus after trauma injury. (Consumer Summary produced by Reliance Medical Information, Inc.)

Spleen

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'Nuns, virgins, and spinsters'. Rigoni-Stern and cervical cancer revisited

Article Abstract:

Cervical cancer is considered to be rare among nuns. The British Department of Health currently does not consider screening for cervical cancer necessary for nuns, virgins, or spinsters. However, various studies that have examined the incidence of cervical cancer among nuns do not confirm that this malignancy is particularly rare among nuns. Most studies have reported a large number of tumors of unspecified sites among nuns, and some of these may be cases of cervical cancer. Hence, the incidence of cervical cancer among nuns may actually be underreported. Cervical cancer is more common among women who have been married than among women who have never been married, and is most frequent among women aged 55 years and older. However, cancer of the uterus is more common among women with no previous pregnancy, such as nuns. Cervical cancer causes 74 deaths per million women annually, and ranks seventh in causes of death due to malignancy among women. The frequency of cervical cancer is similar to that of cancer of the bladder, esophagus, and uterus, and leukemias. Review of the literature indicates that the death rate due to cervical cancer among nuns is similar to that among other single women. The false belief that cervical cancer is rare among nuns could result in misdiagnosis and failure to provide appropriate treatment; reluctance to record the correct diagnosis due to disbelief or desire to protect the nun's reputation; and absence of routine screening for cervical cancer among nuns. The development of symptoms of cervical cancer, including irregular vaginal bleeding, bleeding between menstrual periods, and recurrent discharge from the vagina in a nun should suggest a need for a thorough pelvic examination. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Demographic aspects, Cervical cancer, Medical screening, Health screening, Nuns

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