Fetomaternal Outcomes in Pregnancy with Burn Injury: A Study Conducted in a tertiary care centre in Bangladesh

Author(s): Shafinaz Mehzabin, Afroza Kutubi, Fatema Wahid, Sumona Parvin, Mohammad Mahbub Elahi, Sharmin Hussain

Background:

Pregnancy-associated burn injury poses high maternal and fetal risk, the prognosis of which is gestational age at injury and burn severity dependent. Outcome data are limited in the low-resource settings where NICU access and multidisciplinary care are unavailable.

Methods:

Prospectively designed observational study conducted at Sheikh Hasina National Institute of Burn and Plastic Surgery over 16 months (December 2019–March 2021) in 54 pregnant women admitted with thermal burns. The inclusion criterion was TBSA >15% or <15% with inhalation injury. TBSA was approximated using Lund and Browder's chart. Fluid resuscitation followed a modified Parkland formula. Multidisciplinary care consisted of wound management, obstetric interventions by gestational age, and neonatal assessment. Antenatal corticosteroids and tocolytics were used as appropriate. Maternal-fetal risk assessment determined the timing and mode of delivery. Neonatal follow-up was impaired by a deficiency of sufficient NICU availability.

Results:

Maternal outcomes were highly correlated with TBSA and gestational trimester. Greater TBSA was linked with greater maternal morbidity and mortality (p<0.001). Fetal outcomes were poorer with larger TBSA, younger gestational age, and in the presence of inhalation injury. Spontaneous abortion and premature delivery were common in second-trimester patients, but viable third-trimester fetuses did well when early termination was selectively performed.

Conclusion:

Pregnancy burns with higher TBSA or at earlier gestation have serious maternal and fetal consequences. Multidisciplinary, early intervention, individualized obstetric care, and improved neonatal care are the determinants of optimizing outcomes in the developing world.