Ümit Naci GÜNDOĞMUŞ, Ceyhun KÜÇÜK, Pınar BAKIR KÜÇÜK, Murat Nihat ARSLAN

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Travma sonrası gebelik sonlanmasının adli tıbbi yönü

AMAÇ: Gebe kadınlar gebe olmayan kadınlarla benzer travma riskine sahip olmakla birlikte uğradıkları travmanın hem klinik hem de adli tıbbi sonuçları olabilmektedir. Bu çalışmada adli tıp pratiğinde karşılaşılan sorunlardan biri olan travma sonra- sı gebelik sonlanmasının adli boyutunun değerlendirilmesinde dikkate alınacak hususların ortaya konması amaçlanmıştır. GEREÇLER: Çalışmada 2005-2012 tarihleri arasında travma sonra gebelik sonlanması iddiası ile Adli Tıp Kurumu Adli Tıp İkinci İhtisas Kurulu’na gönderilen vakaların adli dosyaların- da bulunan adli ve tıbbi belgelerde kayıtlı bulgulardan travma mağduru olduğu iddia edilen gebenin sosyodemografik özel- likleri, tıbbi geçmişi, failin yakınlığı, travmanın türü, lokalizas- yonu, travma ile semptom arasındaki süre, travma ile gebelik sonlanması arasındaki süre dikkate alınmıştır. Kurul sonucu ile bu sonuca gerekçe olarak gösterilen veriler değerlendirilmiştir. BULGULAR: Çalışmanın kapsadığı sekiz yıllık dönemde 158 olguya mütalaa düzenlenmiş olup olguların %60’ının 19-30 yaş aralığında olduğu görüldü. İddia olunan travma sonrası en sık gebelik sonlanmasının birinci trimesterde meydana geldiği an- cak istatistiksel olarak anlamlı olacak şekilde birinci trimester gebelik sonlanmalarında nedensellik bağı kurulmadığı görül- müştür. Gebelik sonlanmasına neden olduğu iddia edilen trav- malar arasında en sık abdominopelvik travma, karşılaşılan en sık semptomun da vajinal kanama olduğu belirlenmiştir. SONUÇ: Bu çalışma sonucunda travma ile gebelik sonlan- ması arasındaki nedensellik bağı değerlendirilirken en sık baş- vurulan ve araştırılan kriterlerin gebenin yaşı, gebelik dönemi, travma türü, lokalizasyonu, semptomların ortaya çıkış süresi olduğu, bunlardan gebelik dönemi ve semptomların ortaya çıkış zamanının daha belirleyici olduğu tespit edilmiştir.

Forensic aspects of pregnancy termination after trauma

INTRODUCTION: Pregnant women have a similar risk of trauma as non-pregnant women, but their trauma can have both clinical and forensic medical consequences. In this study, the aim of this study was to reveal the issues to be taken into consideration in evaluating the forensic aspects of pregnancy termination after trauma, which is one of the problems encoun- tered in forensic medical practice. METHODS: In this study, cases referred to the 2nd Speciali- zation Board of the Council of Forensic Medicine unit between 2005 and 2012 with the claim of termination of pregnancy after trauma were evaluated. Among the findings recorded in foren- sic and medical documents, the sociodemographic characteris- tics of the pregnant victims, their medical history information, the relational degrees of the perpetrators, the types and locali- zations of the trauma, the time between trauma and symptoms, and the time between trauma and pregnancy termination were evaluated. The results of the Board and the data shown as justi- fication for these results were evaluated. RESULTS: During the eight-year period covered by the study, 158 cases were considered, and 60% of those were of women between the ages of 19 and 30. It was observed that the most frequent pregnancy termination after trauma occurred in the first trimester, but causality was not established in first trimes- ter pregnancy terminations. Among the traumas claimed to cause pregnancy termination, it was determined that the most common was abdominopelvic trauma, and the most common symptom was vaginal hemorrhage. CONCLUSION: The most frequently used and investigated criteria when evaluating the causality between trauma and pregnancy termination were the age of the pregnant woman, the gestational period, the type and localization of the trauma, and the onset of symptoms. The most determinant criteria were the gestational period and the time of onset of symptoms.
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  • 1. Trauma during pregnancy. ACOG Technical Bulletin Number 161--November 1991. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 1993 Feb;40(2):165-70.
  • 2. Kuczkowski K. Trauma during pregnancy: a situation pregnant with danger. Acta Anæsthesiologica Belgica 2005;56(1):13-8.
  • 3. Sakamoto J, Michels C, Eisfelder B, Joshi N. Trauma in preg- nancy. Emergency Medicine Clinics 2019;37(2):317-38.
  • 4. La Rosa M, Loaiza S, Zambrano MA, Escobar MF. Trauma in pregnancy. Clinical Obstetrics and Gynecology 2020;63(2):447-54.
  • 5. Shah AJ, Kilcline BA. Trauma in pregnancy. Emergency Medi- cine Clinics 2003;21(3):615-29.
  • 6. Soysal Z, Eke M, Çağdır S. Gebelik, doğum ve lohusalıkta anne ölümleri. In: Soysal Z, editor. Adli Obstetrik Jinekoloji. İstanbul: Publication of Council of Forensic Medicine; 2003. p. 323-76.
  • 7. Knight B. Forensic Pathology London Arnold Press; 2015.
  • 8. Soysal Z, Eke M. Gebelik ile ilgili adli tıp sorunları. In: Soysal Z, Çakalır C, editors. Adli Tıp II Cilt [in Turkish]. İstanbul: Cerrahpaşa Tıp Fakültesi Yayınları; 1999. p. 875-973
  • 9. Krywko DM, Toy FK, Mahan ME, Kiel J. Pregnancy Trauma. Treasure Island (FL): StatPearls Publishing; 2021.
  • 10. El Kady D. Perinatal outcomes of traumatic injuries during pregnancy. Clinical obstetrics and gynecology 2007;50(3):582-91.
  • 11. Ali J, Yeo A, Gana TJ, McLellan BA. Predictors of fetal mortal- ity in pregnant trauma patients. Journal of Trauma and Acute Care Surgery 1997;42(5):782-5.
  • 12. Curet MJ, Schermer CR, Demarest GB, Bieneik III EJ, Curet LB. Predictors of outcome in trauma during pregnancy: identi- fication of patients who can be monitored for less than 6 hours. Journal of Trauma and Acute Care Surgery 2000;49(1):18-25.
  • 13. Pearlman M. Motor vehicle crashes, pregnancy loss and preterm labor. International Journal of Gynecology & Obstetrics 1997;57(2):127-32.
  • 14. Mirza FG, Devine PC, Gaddipati S. Trauma in pregnancy: a systematic approach. American journal of perinatology 2010;27(07):579-86.
  • 15. Keeling JW. Fetal and Perinatal Death. In: Busuttil A, Keel- ing J, editors. Paediatric Forensic Medicine and Pathology: CRC press; 2008. p. 180-95.
  • 16. Connolly AM, Katz VL, Bash KL, McMahon MJ, Hansen WF. Trauma and Pregnancy. Am J Perinatol 1997;14(06):331-6.
  • 17. Weiss HB, Songer TJ, Fabio A. Fetal deaths related to mater- nal injury. JAMA 2001;286(15):1863-8.
  • 18. Fort AT, Harlin RS. Pregnancy outcome after noncatastrophic maternal trauma during pregnancy. Obstetrics and Gynecology 1970;35(6):912-5.
  • 19. Runnebaum IB, Holcberg G, Katz M. Pregnancy outcome af- ter repeated blunt abdominal trauma. European Journal of Ob- stetrics & Gynecology and Reproductive Biology 1998;80(1):85-6.
  • 20. Oxford CM, Ludmir J. Trauma in pregnancy. Clinical Obstet- rics and Gynecology 2009;52(4):611-29.
  • 21. Cunningam FG, Leveno KJ, L BS. Maternal and Fetal Anato- my and Physiology. Williams Obstetrics Translation Eds Ceylan Y, Yıldırım G Gedikbaşı A2010. p. 11-107.
  • 22. Ikossi DG, Lazar AA, Morabito D, Fildes J, Knudson MM. Pro- file of mothers at risk: an analysis of injury and pregnancy loss in 1,195 trauma patients. Journal of the American College of Sur- geons 2005;200(1):49-56.
  • 23. Corsi PR, Rasslan S, de Oliveira LB, Kronfly FS, Marinho VP. Trauma in pregnant women: analysis of maternal and fetal mor- tality. Injury 1999;30(4):239-43.
  • 24. Dannenberg AL, Carter DM, Lawson HW, Ashton DM, Dorf- man SF, Graham EH. Homicide and other injuries as causes of maternal death in New York City, 1987 through 1991. American Journal of Obstetrics and Gynecology 1995;172(5):1557-64.
  • 25. Soysal Z, Kolusayın O. Evaluation of the lesions of the fe- male genital organs and conditions involving fetus due to assault and battery during pregnancy in forensic medicine. J For Med 1985;1(2):201-9.
  • 26. Taşpınar A, Bolsoy N, Kaya F, Şirin A, Şirin G. Physical vio- lence and affecting factors during pregnancy in Çanakkale. Aile ve Toplum Dergisi 2008;4(13):63-76.
  • 27. Taşpınar A, Bolsoy N, Şirin A. Are Pregnant Women Experi- encing Physical Violence? Manisa Sample. Adli Psikiyatri Dergisi 2005;2(2):41-7.
  • 28. Giray H, Keskinoğlu P, Sönmez Y, Meseri R, Karakuş NE, Yücetin N, Günay T. Domestic violence and associations during pregnancy. STED/Sürekli Tıp Eğitimi Dergisi 2005;14(10):217-20.
  • 29. Petersen R, Gazmararian JA, Spitz AM, Rowley DL, Good- win MM, Saltzman LE, Marks JS. Violence and adverse preg- nancy outcomes: a review of the literature and directions for future research. American Journal of Preventive Medicine 1997;13(5):366-73.
  • 30. Satin AJ, Hemsell DL, Stone Jr IC, Theriot S, Wendel Jr GD. Sexual assault in pregnancy. Obstetrics and Gynecology 1991;77(5):710-4.
  • 31. Pearlman M, Tintinalli J. Evaluation and treatment of the gravida and fetus following trauma during pregnancy. Obstetrics and Gynecology Clinics of North America 1991;18(2):371-81.
  • 32. Rogers FB, Rozycki GS, Osler TM, Shackford SR, Jalbert J, Kirton O, Scalea T, Morris J, Ross S, Cipolle M. A multi-institu- tional study of factors associated with fetal death in injured preg-
  • nant patients. Archives of Surgery 1999;134(11):1274-7. 33. Di Maio DJ, Dİ Maio VJM. Forensic Pathology. Boca Raton: CRC press; 1993.
  • 34. Rasmussen S, Irgens L, Dalaker K. A history of placental dys- function and risk of placental abruption. Paediatric and Perinatal Epidemiology 1999;13(1):9-21.
  • 35. Moise Jr K, Belfort M. Damage control during pregnancy. Surgical Oncology Clinics of North America 1997;77:839-45.
  • 36. Hedin LW, Janson PO. Domestic violence during pregnancy: The prevalence of physical injuries, substance use, abortions and miscarriages. Acta obstetricia et gynecologica Scandinavica 2000;79(8):625-30.
  • 37. Kalousek DK, Neave C. Pathology of abortion: The embryo and the previable fetus. Potter’s Pathology of the Fetus and İnfant St Louis: Mosby 1997:106
  • 38. Gracia CR, Sammel MD, Chittams J, Hummel AC, Shaunik A, Barnhart KT. Risk factors for spontaneous abortion in early symptomatic first-trimester pregnancies. Obstetrics & Gynecol- ogy 2005;106(5 Part 1):993-9.
  • 39. de La Rochebrochard E, Thonneau P. Paternal age and ma- ternal age are risk factors for miscarriage; results of a multicen- tre European study. Human Reproduction 2002;17(6):1649-56.
  • 40. El Kady D, Gilbert WM, Anderson J, Danielsen B, Towner D, Smith LH. Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population. American Journal of Obstetrics and Gynecology 2004;190(6):1661-8.
  • 41. Schiff MA, Holt VL. Pregnancy outcomes following hospital- ization for motor vehicle crashes in Washington State from 1989 to 2001. American Journal of Epidemiology 2005;161(6):503-10.
  • 42. Pernoll ML. Obstetrics & Gynecology. 10 ed: McGraw-Hill Professional; 2001.
  • 43. Hasan R, Baird DD, Herring AH, Olshan AF, Funk MLJ, Hart- mann KE. Patterns and predictors of vaginal bleeding in the first trimester of pregnancy. Annals of Epidemiology 2010;20(7):524- 31.
  • 44. American College of Obstetricians and Gynecologists. Criti- cal care in pregnancy. Practice Bulletin No:100. February 2009.
Adli Tıp Dergisi-Cover
  • ISSN: 1018-5275
  • Yayın Aralığı: 3
  • Başlangıç: 1985
  • Yayıncı: BAYT Yayıncılık
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