Burns During Pregnancy: Implications For Maternal-Perinatal Providers And Guidelines For Practice

Importance When a major burn is suffered during pregnancy, the obstetric provider is challenged to respond on an evidence basis because personal experience usually is lacking. Currently, there is a paucity of publications to inform the obstetrician, guide practice, and impact early critical decision making.Objective The aims of this study were to summarize the available information on early management of burns during pregnancy and to identify components of best practices for optimal outcome.Evidence Acquisition The PubMed database was searched for relevant titles and abstracts involving pregnant patients suffering from second-/third-degree burns. Among these studies, the bibliographies were investigated for further relevant literature. A total of 114 studies were identified during the initial search, and only studies published in English and French were included for a total of 42. Variable data were available for 1141 patients, with complete data for 139 cases. Mediation and regression analysis were used for available data. Insufficient data were available to undertake a systematic review.Results Total body surface area of burns (TBSAB) was positively associated with maternal death, and the odds of maternal mortality increase by 1.08 per percentage increase of TBSAB (P < 0.001). Fetal survival depends on maternal survival (P 0.001). Maternal survival declines incrementally when TBSAB exceeds 55%, and inhalation injury further exacerbates maternal-perinatal risk.Conclusions Emergent assessment of the pregnant burn victim includes determination of gestational age, extent of TBSAB, presence of inhalation injury, and continuous fetal monitoring. If gestational age is 24 weeks or longer and TBSAB exceeds 55%, urgent cesarean delivery appears desirable for the mother and baby.Relevance A specific analysis of maternal-perinatal outcome based on TBSAB and gestational age is relevant to obstetric and emergency providers who provide care to pregnant burn patients.Target Audience Obstetricians and gynecologists, family physicians.Learning Objectives After completing this activity, the learner will be better able to: summarize the English literature relative to the impact of significant second/third degree burns on the pregnant patient and her fetus; relate gestational age and the measurement of total body surface of burn to the likelihood of subsequent maternal and perinatal survival following a significant burn; and provide an evidence basis for rapidly assessing maternal and perinatal risk to the burned pregnant patient and making management decisions for immediate or later delivery.