Hospitalization of injured pregnant women - is it justified? A decade of data

Hospitalization of injured pregnant women - is it justified? A decade of data | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Hospitalization of injured pregnant women - is it justified? A decade of data Sharon Goldman, Morel Ragoler, Adi Givon, Irina Radomislensky, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4976030/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Nov, 2025 Read the published version in Israel Journal of Health Policy Research → Version 1 posted 5 You are reading this latest preprint version Abstract Background Pregnant women commonly sustain injuries following traffic collisions, falls, and intentional incidents such as domestic violence. Injuries sustained by pregnant women can lead to placental abruption, pelvic fracture, preterm delivery as well as maternal and fetal mortality. The aim of this study was to compare injury and hospitalization characteristics among hospitalized pregnant and nonpregnant women. For pregnant women, gestational age was analyzed according to injury severity and hospitalization characteristics. Methods The Israel National Trauma Registry was the data source for this retrospective study. Demographic, injury and hospitalization characteristics were collected and analyzed for pregnant and nonpregnant women hospitalized between Jan 1, 2012 and December 31, 2021. Among pregnant females, gestational age was identified. Categorical variables were compared using the Chi-square Test and Fisher's Exact Test. Results A total of 33,377 women, aged 18–45 years, were hospitalized due to trauma-related injury; 14,606 (43.8%) were pregnant, and 18,771 (56.2%) were not pregnant. Among the pregnant women, 91.7% had an Injury Severity Score (ISS) of 1, and 75.9% were hospitalized for a single day. In comparison, 31% of the nonpregnant women had an ISS of 1 (X 2 = 12,371.26, df = 1, P < 0.0001), and 32% were hospitalized for one day. Traffic accidents contributed to 51.8% of hospitalizations among pregnant women, compared with 42.8% among nonpregnant women. While falls were more prevalent among pregnant women, a greater proportion of nonpregnant women were hospitalized with intentional injuries. Among pregnant women, injuries during the third trimester are most common. However, those hospitalized during the first trimester suffered from more severe injuries than injuries during the second and third trimesters did. Compared with nonpregnant women, pregnant women are more likely to sustain minor injuries, have shorter hospitalization stays, have fewer surgical interventions and have fewer admissions to intensive care units (ICUs). Conclusions This study provides important data for medical personnel and policymakers regarding trauma-related injuries among pregnant women. The results highlight the need to construct effective prevention and treatment protocols and criteria for hospitalizing injured women during pregnancy. A multidisciplinary team of experts, including neonatal and obgyn physicians should design criteria for hospital observation and discharge in an effort to prevent any adverse events while also avoiding unnecessary hospitalization. hospitalization pregnant women trauma-related injuries gestational age traffic collisions falls Figures Figure 1 Figure 2 Background Trauma-related injuries during pregnancy have tremendous consequences for maternal and fetal well-being.(1–3) Injury outcomes among pregnant women include placental abruption, pelvic fracture, preterm delivery and high mortality rates among both the woman and fetus.(3–5) Pregnant women commonly sustain injuries following traffic collisions, falls, and intentional incidents such as domestic violence.(2,6,7) Traffic collisions are the most frequent and fatal for both the woman and the fetus, as reported in a 2019 literature review, with 13.7% and 10.7% mortality rates among pregnant women and fetuses, respectively.(2–4,8) Furthermore, one out of four pregnant women falls during pregnancy, often due to increased weight and a shift in the center of gravity, leading to bodily imbalance.(8) The management of injured pregnant women poses serious medical challenges.(4,9) The physiological changes that occur during pregnancy may influence the manner of treatment; hence, a multidisciplinary team, including obstetric experts and a team manager, is needed. (2,3,9,10)The risk of significant fetal injuries and even mortality among injured pregnant women emphasizes the importance of treatment protocols and policies.(3) Since pregnancy cannot be determined by the naked eye, the Advanced Trauma Life Support (ATLS) guidelines recommend that a pregnancy test be performed for all fertile-aged women being treated following a trauma-related incident.(2,10) The initial treatment of injured women should be consistent with trauma casualty care protocols, regardless of pregnancy status. (2,8,10) These guidelines include gathering information about trauma-related incidents, gravid uterus displacement to one side, vital sign assessment and stabilization of the pregnant woman (e.g., maternal hemodynamic stability)(3,4,8,10) via ABCDE (airway, breathing, circulation, disability, and exposure) actions. (3,4,6,8,10) Fetal monitoring should be performed immediately after establishing maternal stability. (6,10) The ATLS guidelines also recommend gathering information regarding physical assessments and obstetric history, including gestational age, fetal maturity, and date of delivery.(2,4) Since fetal injuries may not be apparent immediately following trauma, a minimum of 4–6 hours of monitoring is recommended.(1,6) The main concern following trauma is placental abruption, which can occur even 24 hours and longer after the incident.(3,4,8) Placental abruption may ultimately result in premature birth, fetal death, and other complications.(3) The severity of maternal injuries has a direct impact on the duration of fetal monitoring.(4) For instance, women with minor maternal injuries such as minor bruising, minor lacerations or an ISS of zero, require four hours of monitoring. 1,4 In contrast, those with more severe injuries, such as positive Kleihauer–Betke (KB) tests, vaginal bleeding, or uterine contractions, necessitate at least 24 hours of fetal monitoring.(3,6) Gestational age also affects the duration of fetal monitoring.(10) For instance, a viable fetus (i.e., at least 22 weeks gestation) must be monitored for longer than the minimum monitoring duration and may even last for 48 hours.(1,6,8) Efficient and effective treatment protocols for trauma during pregnancy should be constructed and embedded in relevant medical care facilities. These evidence-based protocols should rely on analyses of large quantities of data originating from numerous medical centers. Methods Aims This study aimed to analyze and describe the demographic, injury, and hospitalization characteristics of pregnant and nonpregnant women hospitalized due to a trauma-related injury in an effort to establish operational protocols for hospitalized pregnant women. In addition, the injury characteristics of the pregnant women were examined with respect to gestational age. Study design The Israel National Trauma Registry (INTR) was the data source for this retrospective study. The INTR includes comprehensive data on hospitalized trauma patients from 21 hospitals, of which six are level I trauma centers (TCs) and 14 are level II TCs. Trained trauma registrars recorded data from each trauma center under the guidance of a trauma director. Data quality checks were conducted before data analysis. The data are anonymous. All hospitalized trauma patients classified with an ICD-9-CM diagnosis code 800–989.9 who were admitted to the Department of Emergency Medicine (ER) and hospitalized, died in the ER, or were transferred to another hospital were included in the database. The INTR does not include casualties who died onsite or en route to the hospital, admissions 72 hours or more after the incident, poisonings, suffocations, or drownings. This study was approved by the Sheba Medical Center Institutional Review Board (IRB) (SMC 5138–18). For the purposes of this study, the data obtained from the INTR included pregnant (cases) and nonpregnant (control) women hospitalized following a trauma-related incident between January 1, 2012, and December 31, 2021. All women aged 18–45 years were included in this study. A negligible percentage of pregnant women under the age of 18 (0.32%) and older than 45 years (0.22%) were also considered during this process. Data regarding gestational age at the time of trauma-related incidents were also included in this study. Injured pregnant women and medical staff reported pregnancy status and related information. Age, ethnicity, length of stay, injury severity, and injured body region were analyzed in relation to gestational age. The variables extracted from the INTR included: Demographic information Age and ethnicity (Jew/non-Jew). Mechanism of injury traffic crash (private vehicle, pedestrian, bus, bicycle, motorcycle, and other), fall (from height, same level, and stairs), burns, intentional (violence, suicide, terror/war), and other unintentional injuries. (Suicide due to strangulation and poisoning is not included in the INTR). Seat position for two- and four-wheel vehicles (driver, front seat, rear seat). Type of injury blunt, penetrating. Injury Severity The Injury Severity Score (ISS), is the sum of the squares of the single highest AIS score for each of the three most severely injured body regions. Injured body region head/neck, torso, extremities; pelvic fractures. Hospital resource utilization : Length of stay (LOS), admission to intensive care units (ICUs), and surgical intervention. Evacuation Method private vehicles and emergency medical services (EMS). Gestational age (The length of time that a fetus grows inside the mother’s uterus, in weeks. The gestational age was divided into trimesters. Statistical analysis Categorical variables were compared using the chi-square test or Fisher's exact test depending on the sample size of the groups. A t- test was used to investigate the normally distributed age among the investigated groups. The median age is presented as the interquartile range (IQR). All the statistical analyses were performed using S.A.S. software; version 9.4 (SAS Institute, Cary, NC, USA). All comparisons were considered statistically significant at P < 0.05. Results Characteristics of the study population A total of 33,377 women aged 18–45 years, were hospitalized between 2012 and 2021 due to trauma-related injuries. Among them, 14,606 (43.8%) were pregnant at the time of hospitalization and 18,771 (56.2%) were not pregnant. ( Fig. 1 ) Among pregnant women, only 8,801 (60.3%) reported gestational age. Among the 14,606 pregnant women, 5,712 (39.1%) were injured during the third trimester, 2,816 (19.3%) during the second trimester, and 273 (1.9%) during the first trimester; for the remaining 5,805 (39.7%), the gestational age was unknown. ( Fig. 1 ) Compared with their nonpregnant counterparts, pregnant women were younger, with a median age of 29.0 (IQR 25.0,33.0) years (nonpregnant median age = 30.0; IQR 23.0, 38.0) (t = 19.07, df = 32,095, P < 0.0001). While non-Jews accounted for 24% of pregnant women, they accounted for 32.8% of nonpregnant women. (X2 = 311.60, df = 1, P < 0.0001) (Table 1 ). Table 1 Demographic and injury characteristics among hospitalized pregnant and nonpregnant women, 2012–2021 Pregnant women n (%) Nonpregnant women n (%) P-value Total 14,606 18,771 Age Median (IQR 25,75) 29.0 (25.0,33.0) 30.0 (23.0, 38.0) < .0001 Mean (SD) 29.3 (± 5.3) 30.8 (± 8.5) Ethnicity n (%) 1 < .0001 Jews 11,071 (76.1) 12,425 (67.2) Non-Jews 3,483 (23.9) 6,064 (32.8) Injury Mechanism < .0001 Traffic 7,563 (51.8) 8,039 (42.8) Falls 5,888 (40.3) 5,811 (31.0) Intentional 328 (2.3) 1,217 (6.5) Other unintentional 2 807 (5.6) 3,704 (19.7) Traffic, of which : 7,563 8,039 < .0001 Private vehicle 6,818 (90.2) 4,506 (56.1) Pedestrian 243 (3.2) 1,312 (16.3) Bus 188 (2.5) 143 (1.8) Bicycle 17 (0.2) 397 (4.9) Motorcycle 16 (0.2) 551 (6.9) Others/unknown 281 (3.7) 1,130 (14.1) Falls , of which : 5,888 5,811 < .0001 Fall on same level 4,252 (72.2) 3,468 (59.7) Fall on stairs 1,199 (20.4) 1,096 (18.9) Fall from height 337 (5.7) 1,116 (19.1) Other fall 100 (1.7) 131 (2.3) Intentional, of which : 328 1,217 < .0001 Violence 296 (90.2) 713 (58.6) Suicide attempts 11 (3.4) 381 (31.3) Terror / warfare 21 (6.4) 123 (10.1) Injured body region 3 Head and Neck 1,001 (6.9) 5,743 (30.6) < .0001 Torso 11,250 (77.0) 6,087 (32.4) < .0001 Spine/back 192 (1.3) 2,139 (11.4) < .0001 Extremities 2,031 (13.9) 11,491 (61.22) < .0001 Method of transportation < .0001 Private vehicle 11,194 (76.6) 9,213 (49.1) Emergency medical services 3,412 (23.4) 9,558 (80.9) P < 0.0001 1 Unknown ethnicity, n = 334 2 Other unintentional includes burns, other and unknown unintentional injuries 3 Casualties can sustain injuries to more than one body region. Injury mechanism Traffic collisions (51.8% vs. 42.8%) and falls (40.3% vs. 31.0%) were the leading causes of hospitalization among pregnant and nonpregnant women, respectively (X2 = 1,948.39, df = 5, P < 0.0001) (Table 1 ). Over half of the pregnant women were hospitalized because of traffic-related injuries, of which 90.2% (n = 6,818) were injured in a private vehicle (X2 = 2,781.08, df = 6, P < 0.0001) and 67% (n = 5,069) were drivers (X2 = 970.16, df = 4, P < 0.0001). In comparison, 56.1% of nonpregnant women hospitalized with traffic-related injuries were injured in private vehicles. Nonpregnant women were more likely than pregnant women to be injured as pedestrians; pedestrian injuries accounted for 3.2% and 16.3% of traffic-related hospitalizations for pregnant and nonpregnant women, respectively. (Table 1 ) Seat position was identified, and 67% of pregnant women and 52.4% of nonpregnant women were driving the vehicle during the traffic collision. (data not shown). Falls accounted for 40% (n = 5,888) of hospitalizations among the pregnant women. Of these, 72.2% (n = 4,52) were same level falls, 5.7% (n = 337) from height, and 20.4% (n = 1,199) on stairs. In comparison, falls accounted for only 31% of hospitalizations among nonpregnant women, of which 59.7% were on the same level, 19.2% were from a higher level and 18.9% were on stairs (X2 = 505.56, df = 3, P < 0.0001) (Table 1 ). Intentional injuries were more common in nonpregnant women (6.5%, n = 1,217) than in pregnant women (2.3%, n = 328) (Table 1 ). Among hospitalizations due to intentional injuries, violence accounted for 90.2% and 58.6% of injuries in pregnant and nonpregnant women, respectively. Eleven pregnant women were hospitalized for attempted suicide. In comparison, among nonpregnant women, 31.3% (n = 381) of the intentional injuries were suicide attempts. (X2 = 123.02, df = 2, P < 0.0001). (Table 1 ) Pregnant women were more likely to be transported to the hospital by private car (76.6%), whereas nonpregnant women were more likely to be transported by EMS (50.9%) (X2 = 2,625.82, df = 1, P < 0.0001). (Table 1 ) Hospital resource utilization A substantial number of pregnant women (75.9%) were hospitalized for a single day, as opposed to nonpregnant women (32.0%) (X 2 = 7,020.16, df = 2, P < 0.0001). (Table 2 ) Nonpregnant women were much more likely to be admitted to the ICU (0.35% and 5.9% for pregnant and nonpregnant casualties, respectively) (X 2 = 749.26, df = 1, P < 0.0001) and to undergo surgical interventions (2.3% and 37.6% for pregnant and nonpregnant casualties, respectively) (X 2 = 5,913.29, df = 1, P < 0.0001) (Table 3 ). Table 2 Hospitalization and injury severity characteristics among hospitalized pregnant and non-pregnant women, 2012–2021 Injury Severity Characteristics ALL hospitalized women Hospitalized women classified with ISS ≥ 2 Pregnant women n (%) (N = 14,606) Non-pregnant women n (%) (N = 18,771) Pregnant women n (%) (N = 1,217) Nonpregnant women n (%) (N = 12,928) LOS (days) 1 11,081 (75.9) 5,999 (32.0) 597 (49.1) 3,046 (23.6) 2 2,051 (14.0) 3,767 (20.0) 184 (15.1) 2,448 (18.9) 3+ 1,474 (10.1) 9,005 (48.0) 436 (35.8) 7,434 (57.5) ISS 1 N/A 2 N/A 2 1 13,385 (91.7) 5,802 (31.0%) ≥ 2 1,217 (8.3) 12,928 (69.0) ICU (days) ≥ 1 51 (0.4) 1,100 (5.9) 45 (3.7) 1,052 (8.1) Surgical intervention Underwent surgery 342 (2.3) 7,054 (37.6) 276 (22.7) 6,275 (48.5) Mortality 3(0.02) 115 (0.6) 3(0.3) 115 (0.9) P < 0.0001 Abbreviations: Injury Severity Score – ISS; Length of Stay – LOS; Intensive Care Unit - ICU 1 Unknown ISS n = 45 2 N/A = variable not relevant for this group Table 3 Injury and hospitalization characteristics among the pregnant women by gestational age 2012–2021 First trimester n (%) (n = 273) Second trimester n (%) (n = 2,816) Third trimester n (%) (n = 5,712) Unknown gestational age n (%) (n = 5,805) Mechanism of injury Traffic 148 (54.2%) 1,568 (55.7%) 2,661 (46.6%) 3,186 (54.9%) Falls 76 (27.8%) 1,002 (35.6%) 2,646 (46.3%) 2,164 (37.3%) Intentional 25 (9.2%) 95 (3.4%) 81 (1.4%) 127 (2.2%) Other/unknown 24 (8.8%) 151 (5.4%) 324 (5.7%) 328 (5.7%) LOS (days) 1 146 (53.5%) 2,166 (76.9%) 4,357 (76.3%) 4,412 (76.0%) 2+ 127 (46.5%) 650 (23.1%) 1,355 (23.7%) 1,393 (24.0%) ISS 1 1 174 (64.0%) 2,551 (90.6%) 5,230 (91.6%) 5,430 (93.6%) 2+ 98 (36.0%) 265 (9.4%) 481 (8.4%) 373 (6.4%) Injured body region 2 Head and Neck 77 (28.2%) 246 (8.7%) 330 (5.8%) 348 (6.0%) Torso 176 (64.5%) 2,293 (81.4%) 4,433 (77.6%) 4,348 (74.9%) Extremities 101 (37.0%) 442 (15.7%) 881 (15.4%) 607 (10.5%) P < 0.0001 Abbreviations: Injury Severity Score – ISS; Length of Stay – LOS 1 Missing data for ISS: first trimester n = 1, third trimester n = 1, unknown gestational age n = 2. 2 A casualty may be injured in more than one body region Injury severity A sizable number of hospitalized pregnant women had an ISS of 1 (91.7%, n = 13,385). In comparison, only 31% (5,802) of the nonpregnant women had an ISS of 1. (X2 = 12,371.26, df = 1, P < 0.0001) (Table 2 ). Hospitalization and injury characteristics were analyzed separately for women with an ISS ≥ 2, which revealed similar results regarding LOS (X2 = 383.34, df = 2, P < 0.0001), ICU admission (X2 = 30.65, df = 1, P < 0.0001), and surgical intervention (X2 = 299.14, df = 1, P < 0.0001) as found in the entire sample. (Table 2 ) Among pregnant women, the torso accounted for the majority of injuries (77.0%), whereas among nonpregnant women, the extremities were the major injured body regions (61.2%). Only 13.9% of pregnant women sustained injuries to their extremities (X2 = 7,629.38, df = 1, P < 0.0001). Among pregnant women, 1,001 (6.9%) sustained head and neck injuries, whereas 5,743 (30.6%) of nonpregnant women experienced head and neck injuries (X2 = 2,871.79, df = 1, P < 0.0001) (Table 1 ). Furthermore, among pregnant women, blunt injuries accounted for 99.3% (14,504) of all injuries. In-hospital mortality was rare, three pregnant women (0.02%) and 115 (0.6%) nonpregnant women died. After excluding patients with an ISS of 1, 57% of the pregnant women sustained injuries to the torso, whereas 29% of the control group sustained such injuries (X2 = 378.32, df = 1, P < 0.0001). Injuries to the head and neck were found in 20.3% of pregnant women and 29.1% of nonpregnant women (X2 = 42.52, df = 1, P < 0.0001). No differences were found between the cases and controls regarding injuries to the extremities (p = 0.79) (data not shown). Among casualties with ISS ≥ 2, falls accounted for 54.7% (n = 666) of hospitalizations among pregnant women and 37.2% (n = 4,809) among nonpregnant women. Traffic collisions led to hospitalizations among 36.6% (n = 445) and 43.2% (n = 5,586) of pregnant and nonpregnant women with ISS ≥ 2, respectively (X2 = 171.81, df = 5, P < 0.0001) (Fig. 2 ). Gestational age Among pregnant women, only 8,801 (60.3%) reported gestational age. Among the 14,606 pregnant women, 5,712 (39.1%) were injured during the third trimester, 2,816 (19.3%) during the second trimester, and 273 (1.9%) during the first trimester; for the remaining 5,805 (39.7%) casualties, the gestational age was unknown. More than half of the pregnant women hospitalized during the first (54.2%) and second (55.7%) trimesters were involved in traffic collisions. Among women hospitalized during the third trimester, 46.6% were due to traffic collisions and 46.3% were fall injuries. Intentional injuries were more prominent among women in their first (9.2%) trimester than in their second (3.4%) and third (1.4%) trimesters (X2 = 236.48, df = 9, P < 0.0001). (Table 3 ) A greater percentage of women were hospitalized for more than one day during their first trimester (46.5%) than during the second (23.1%) and third (23.7%) trimesters (X2 = 77.01, df = 3, P < 0.0001).(Table 3 ) A greater proportion of women with an ISS ≥ 2 were hospitalized during the first trimester (36.0%) than during the second (9.4%) and third trimesters (8.4%) (X2 = 305.02, df = 3, P < 0.0001). (Table 3 ) Furthermore, women injured during the second (81.4%) and third (77.6%) trimesters sustained a greater number of injuries to the torso than those during the first trimester (64.5%) (X2 = 71.06, df = 3, P < 0.0001). The latter group had a greater percentage of head and neck injuries (28.2%) and extremities injuries (37.0%) than during the second and third trimesters (head/neck: X2 = 227.66, df = 3, P < 0.0001; extremities: X2 = 197.81, df = 3, P < 0.0001). (Table 3 ) Discussion Data from the INTR provide a vast amount of information regarding trauma-related hospitalizations. For the purpose of this study, the data focused on pregnant and nonpregnant women aged 18–45 years who were hospitalized over a ten-year period. Pregnant women were more likely than nonpregnant women to sustain minor injuries, whereas nonpregnant women were more likely to have longer hospital stays and undergo surgery. This study also revealed that most hospitalized pregnant women were injured during the third trimester, followed by the second trimester (for casualties with known gestational age). However, women in the first trimester sustained more severe injuries and were hospitalized for longer periods. In this study, the majority of pregnant women sustained minor injuries and were hospitalized for only one day. A possible explanation, as suggested by Azar et al., is that pregnant women are more likely to seek medical care following a traumatic event than nonpregnant women are (15). In addition, concerns for the fetus may lead to hospitalization of pregnant women sustaining minor injuries.(14,15) Low injury severity among hospitalized pregnant women has also been documented in previous studies.(7,9,14–18) This can be emphasized by the relatively few medical interventions (e.g., surgery and blood transfusion) reported for pregnant women.(7,9,15) Between 2012–2021, traffic collisions were the leading cause of hospitalizations among women aged 18–45, the majority of whom were drivers in private cars. A large body of evidence supports the findings of this study, confirming that traffic-related events are the leading cause of injury among pregnant women.(7,9,11–14) However, the percentages of pregnant women injured in traffic collisions were inconsistent with those reported in previous studies. In the present study, 51.8% of the pregnant women were hospitalized due to a traffic collision, while other countries reported varying results, such as 55.5% in the UK, 58.1% in the USA, 64.4% in Japan, 74.7% in Qatar, and 82.5% in Australia.(7,13,9,12,11) Most (~ 90%) pregnant women hospitalized due to traffic-related injuries were injured while in a private vehicle, and the majority of all vehicle occupants were drivers. These findings and the proximity of the abdomen to the steering wheel may explain the high frequency of torso injuries among pregnant women. These findings are supported by previous studies, which concluded that 88.6%-90% of pregnant women are injured in private vehicles.(14,15) Furthermore, an Israeli study reported that between 2006 and 2013, 67% of hospitalized pregnant women involved in motor vehicle accidents were drivers.(14) A study in the U.S. reported that 54% of pregnant women involved in traffic accidents were drivers and that thoracic and abdominal injuries were the most common injuries among these women.(15) During a fifteen-year period, 24.8% and 14.6% of pregnant Japanese women sustained chest and abdominal injuries, respectively.(9) Differences in the investigated body regions may partially explain the differences between the studies. In comparison to other research, in the current study a greater percentage of pregnant women were hospitalized following a fall related injury. Falls led to hospitalizations among ~ 40% of the pregnant women investigated in this study, whereas 9.5%-16.7% were reported in other studies.(7,11,12) Differences in the study design and population characteristics may explain the variations in trauma-related hospitalizations among pregnant women. For example, the current study included all pregnant women hospitalized due to an injury, whereas Sato et al. focused on younger females with severe trauma (ISS > 12).(11) The various studies also differed by study period. Similar to the current study, Deshpande et al. focused on a ten-year period, in contrast to the two- and twelve-year periods reported in other studies.(11,12) A short LOS for hospitalized pregnant women has also been previously documented.(9,14–17) For example, in Australia, 78% of pregnant women were hospitalized for one day, and only 12% of pregnant and 28% of nonpregnant women involved in traffic collisions were hospitalized for six days or more.(16) In contrast to the findings of this study, no differences between pregnant and nonpregnant women involved in traffic accidents were found regarding LOS, mortality, ICU, or surgery reported in a single level I trauma center in the USA.(18) The relatively small percentage (2.3%) of surgical interventions among pregnant women found in the currentr study was inconsistent with the 12.1% reported in a single level I trauma center study conducted in the USA.(17) These two previous studies obtained information from a single trauma center, unlike the data described in this study, which were collected from numerous trauma centers. The outcomes of the current study revealed that most hospitalized women of known gestational age were injured during the third trimester. Supporting evidence has been documented in previous studies, in which most pregnant women were more likely to be injured during the third trimester.(5,12) For example, one study reported that approximately 70% of injured pregnant women in Israel (between 2000 and 2008) were injured during the third trimester.(5) A slightly smaller percentage (47.7%) was documented in Qatar between2013–2015.(12) As shown in this study, most pregnant women hospitalized following a fall were injured during the second and third trimesters. Body weight and the center of gravity change during these trimesters and provide possible explanations.(4) Indeed, women in the third trimester show reduced postural stability and hence are more susceptible to falls.(2) Fetal monitoring is often derived from concerns regarding placental abruption, which may occur after trauma-related injury.(6,19) However, the monitoring duration varies and should be determined for each case. While some minor injuries are not associated with adverse pregnancy outcomes, severe trauma may lead to placental abruption, or as well as fatal fetal and maternal injuries.(6,18) Thus, the importance to differentiate between vital and unjustified hospitalizations. Unwarranted hospitalizations place a burden on the pregnant woman, the family and the health system. The hospital is usually a hectic environment and can cause unnecessary anxiety especially for the pregnant woman. In addition, hospitalization can be a financial hardship on the individual and family level due to missed work days and child care. On the institutional and national level, it is known that hospitalization is costly, which often includes unnecessary testing. Finally, hospitals are often the source of exposure to viruses and infections. Pregnant women are at high risk and thus unnecessary exposure should be limited. Limitations The major limitation of this study is that the INTR includes limited obstetric information and data on fetal health and outcomes. Fetal injuries and outcomes due to the trauma-related injuries were unknown and thus not discussed in this study. In addition, the INTR includes only hospitalized patients; thus, casualties discharged from the emergency room (without hospitalization) were not included. Since this research was specific to hospitalized patients, the study was not inhibited. Policy implications and recommendations When an injured pregnant women arrives at the hospital emergency department, careful attention is needed for both maternal and fetal health. This study highlights the need for effective observational and treatment protocols regarding the care for injured pregnant women. While traumatic injuries are the leading cause of nonobstetric maternal death, the majority of hospitalized pregnant women suffer from minor injuries. While minor injuries are not usually associated with adverse pregnancy outcomes, some injuries can lead to fatal fetal injuries, (6,18) thus, the importance of protocols and observation for both the fetus and the mother. Protocols and guidelines should be developed or revised to include outpatient care and monitoring in an effort to prevent unnecessary hospitalizations. The guidelines should be based on maternal injury severity and the gestational age of the fetus.(8,10) It is important to identify the gestational age of the fetus in order to make educated decisions for monitoring the fetus. The risk for fetal loss occurs during the first two trimesters while the risk for fetal distress, premature delivery or fetal death occurs during the third trimester. Type of testing and monitoring differs depending on the gestational week. Evidence of fetal compromise usually becomes apparent within the first 4–6 hours of electronic monitoring, thus, pregnant women with minor injuries should be monitored for six hours.(20,21) Monitoring also reflects the concerns regarding placental abruption, which may occur following a trauma-related injury.(6,18) Following hospital monitoring, if no adverse events are identified the pregnant patient should be discharged for further monitoring at the community level, rather than hospitalization. For example, in this study, a large percentage of the hospitalized women suffered from minor injuries with an ISS = 1. According to the recommended protocols, many of these hospitalized women could have been monitored in the ED for six hours and then discharged, and if needed, further observation at the local clinic. While patients with an ISS of one should usually be discharged for non-hospitalization observation, patients with ISS greater than 8 should remain in the hospital for fetal and maternal observation and monitoring. In these cases the medical staff should check for shock, evidence of contractions, uterine tenderness and vaginal bleeding. Criteria for discharging the injured pregnant woman should include: Stable maternal vital signs (normal blood pressure, pulse, and respiratory rate); Absence of vaginal bleeding or abdominal pain; Normal fetal heart rate and absence of fetal distress on monitoring; No signs of uterine contractions or preterm labor; Negative findings on any necessary imaging (e.g., ultrasound to check for placental integrity) and No need for further medical interventions (21). Women with Rh-negative should continue to be monitored.(1) In order to design relevant guidelines, a multidisciplinary panel of experts, including neonatal specialists and obgyn physicians, should design the criteria for hospitalization and discharge of pregnant injured women in an effort to prevent any adverse events while also avoiding unwarranted hospitalization. The protocols should focus not only on the institutional level, but also be directed to community health specialists. Conclusion Pregnant women are more likely than nonpregnant women to be hospitalized after sustaining minor injuries. The findings from this study raise several questions regarding the justification for hospitalizing pregnant women with minor injuries. Advantageous observation and treatment protocols for the pregnant trauma patient and her fetus should be reviewed and updated in an effort to limit unnecessary hospitalizations while properly caring for fetal and maternal health. Policy makers, neonatal and obgyn experts should work together to optimize trauma care for pregnant women and their fetuses. Abbreviations ATLS Advanced Trauma Life Support EMS Emergency medical services ER Department of emergency medicine ICU Intensive care unit INTR Israel National Trauma Registry IQR Interquartile range IRB Institutional Review Board ISS Injury Severity Score LOS Length of stay SMC Sheba Medical Center TC Trauma center Declarations Ethical approval and consent to participate- This study was conducted at the National Center for Trauma and Emergency Medicine Research, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel. Since no identifying information was available to the researchers, there was no need in receiving any type of informed consent. In addition, this study received approval from the Sheba Medical Center Institutional Review Board (IRB) (SMC 5138–18). All methods were performed in accordance with the ethical standards as laid down in the Declaration of Helsinki and its later amendments or comparable ethical standards. Consent for publication – Not applicable Availability of data and materials – The datasets analyzed during the current study are available from the corresponding author on reasonable request. Conflict of interest- The authors report no conflicts of interest. Funding source- None. Author contributions : EK and MR conceived the study and study design. AG and IR oversaw the methodology and data analysis. MR and SG drafted the manuscript. ITG collected data. All authors contributed substantially to the manuscript review, editing and revision. The Israeli Trauma Group is a study group composed of trauma units of all hospitals belonging to the Israel Trauma Registry, tasked with producing the data for the registry. Acknowledgements - Israel Trauma Group (ITG) includes: H. Bahouth, M. Bala, A. Bar, A. Braslavsky, D. Czeiger, D. Fadeev, A. L. Goldstein, I. Grevtsev, G. Hirschhorn, I. Jeroukhimov, A. Kedar, Y. Klein, A. Korin, B. Levit , I. Schrier, A. D. Schwarz, W. Shomar, D. Soffer, M. Weiss, O. Yaslowitz, I. Zoarets. References Liggett MR, Amro A, Son M, Schwulst S. Management of the Pregnant Trauma Patient: A Systematic Literature Review. Journal of Surgical Research. 2023 May;285:187–96. Lucia A, Dantoni SE. Trauma Management of the Pregnant Patient. Crit Care Clin. 2016 Jan;32(1):109–17. Greco PS, Day LJ, Pearlman MD. Guidance for Evaluation and Management of Blunt Abdominal Trauma in Pregnancy. Obstetrics & Gynecology. 2019 Dec 4;134(6):1343–57. Petrone P, Jiménez-Morillas P, Axelrad A, Marini CP. Traumatic injuries to the pregnant patient: a critical literature review. European Journal of Trauma and Emergency Surgery. 2019 Jun 15;45(3):383–92. Melamed N, Aviram A, Silver M, Peled Y, Wiznitzer A, Glezerman M, et al. Pregnancy course and outcome following blunt trauma. The Journal of Maternal-Fetal & Neonatal Medicine. 2012 Sep;25(9):1612–7. Murphy NJ QJD. Trauma in pregnancy: assessment, management, and prevention. Am Fam Physician. 2014;90:717–22. Deshpande NA, Kucirka LM, Smith RN, Oxford CM. Pregnant trauma victims experience nearly 2-fold higher mortality compared to their nonpregnant counterparts. Am J Obstet Gynecol. 2017 Nov;217(5):590.e1-590.e9. Mendez-Figueroa H, Dahlke JD, Vrees RA, Rouse DJ. Trauma in pregnancy: an updated systematic review. Am J Obstet Gynecol. 2013 Jul;209(1):1–10. Makino Y, Kiguchi T, Kato H, Inada S. Epidemiology and outcomes of pregnant trauma patients in Japan: a nationwide descriptive study. European Journal of Trauma and Emergency Surgery. 2023 Jun 17;49(3):1287–93. American College of Surgeons. Committee on Trauma. ATLS, Advanced Trauma Life Support for Doctors: Student Course Manual. In: ATLS, Advanced Trauma Life Support for Doctors: Student Course Manual. 9th ed. 2012. Sato N, Cameron P, Thomson BN, Read D, McLellan S, Woodward A, et al. Epidemiology of pregnant patients with major trauma in Victoria. Emergency Medicine Australasia. 2022 Feb 23;34(1):24–8. Al-Thani H, El-Menyar A, Sathian B, Mekkodathil A, Thomas S, Mollazehi M, et al. Blunt traumatic injury during pregnancy: a descriptive analysis from a level 1 trauma center. European Journal of Trauma and Emergency Surgery. 2019 Jun 27;45(3):393–401. Battaloglu E, McDonnell D, Chu J, Lecky F, Porter SK. Epidemiology and outcomes of pregnancy and obstetric complications in trauma in the United Kingdom. Injury. 2016 Jan;47(1):184–7. Miller N, Biron-Shental T, Peleg K, Fishman A, Olsha O, Givon A, et al. Are pregnant women safer in motor vehicle accidents? J Perinat Med. 2016 Jan 1;44(3). Azar T, Longo C, Oddy L, Abenhaim HA. Motor vehicle collision‐related accidents in pregnancy. Journal of Obstetrics and Gynaecology Research. 2015 Sep 14;41(9):1370–6. Vivian‐Taylor J, Roberts C, Chen J, Ford J. Motor vehicle accidents during pregnancy: a population‐based study. BJOG. 2012 Mar 10;119(4):499–503. Maxwell BG, Greenlaw A, Smith WJ, Barbosa RR, Ropp KM, Lundeberg MR. Pregnant trauma patients may be at increased risk of mortality compared to nonpregnant women of reproductive age: trends and outcomes over 10 years at a level I trauma center. Women’s Health. 2020 Jan 24;16:174550652093302. Owattanapanich N, Lewis MR, Benjamin ER, Wong MD, Demetriades D. Motor vehicle crashes in pregnancy: Maternal and fetal outcomes. Journal of Trauma and Acute Care Surgery. 2021 May;90(5):861–5. Cahill AG, Bastek JA, Stamilio DM, Odibo AO, Stevens E, Macones GA. Minor trauma in pregnancy—is the evaluation unwarranted? Am J Obstet Gynecol. 2008 Feb;198(2):208.e1-208.e5. Pearlman MD, Tintanalli JF, Lorenz RP. A prospective controlled study of outcome after trauma during pregnancy. AM JObstet Gynecol. 1990;162:1502–10. Jain V, Chari R, Maslovitz S, Farine D, Bujold E, Gagnon R, et al. Guidelines for the Management of a Pregnant Trauma Patient. Journal of Obstetrics and Gynaecology Canada. 2015 Jun;37(6):553–71. Cite Share Download PDF Status: Published Journal Publication published 12 Nov, 2025 Read the published version in Israel Journal of Health Policy Research → Version 1 posted Reviewers agreed at journal 02 Nov, 2024 Reviewers invited by journal 31 Oct, 2024 Editor assigned by journal 30 Oct, 2024 First submitted to journal 30 Oct, 2024 Editorial decision: Major revision 02 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4976030","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":372556951,"identity":"de81720b-2543-4fe1-a3b2-de7c014088ae","order_by":0,"name":"Sharon Goldman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYDACCQiVIM/MfPABkMHDR7QWw3a2ZAOQFjaitTCc5zEDswlqkZ/d/OzDxx21eYzNDGaVX3PsZNgYmB8+uoFHi8GdY8YzZ545XszOzJB2W3ZbMtBhbMbGOfi0SCQYM/O2HUtsbGY4dltyGzNQCw+bND4t8jPSP4O1NBxmbCuW3FZPWAvDjRyQLTVALcxsjB+3HSasxeBGTjHjzLYDxYbNbMzSjNuO87AxE/AL0GGbGT621eXJ85//+PHntmp7fvbmh4/xOgwCDoNJZh4wSVg5CNSBScYfxKkeBaNgFIyCEQYAkGFF1JMgx6wAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-4163-5331","institution":"Gertner Institute for Health Policy and Epidemiology","correspondingAuthor":true,"prefix":"","firstName":"Sharon","middleName":"","lastName":"Goldman","suffix":""},{"id":372556952,"identity":"afd8e784-8b4d-49cc-a344-5a4fcd9f1a29","order_by":1,"name":"Morel Ragoler","email":"","orcid":"","institution":"Gertner Institute for Health Policy and Epidemiology","correspondingAuthor":false,"prefix":"","firstName":"Morel","middleName":"","lastName":"Ragoler","suffix":""},{"id":372556953,"identity":"55f5c5c0-120e-4e32-b384-4181b7ae0309","order_by":2,"name":"Adi Givon","email":"","orcid":"","institution":": Gertner Institute for Health Policy and Epidemiology","correspondingAuthor":false,"prefix":"","firstName":"Adi","middleName":"","lastName":"Givon","suffix":""},{"id":372556954,"identity":"1df5aaa4-584c-4d52-9eb0-e92241d96112","order_by":3,"name":"Irina Radomislensky","email":"","orcid":"","institution":"Gertner Institute for Health Policy and Epidemiology","correspondingAuthor":false,"prefix":"","firstName":"Irina","middleName":"","lastName":"Radomislensky","suffix":""},{"id":372556955,"identity":"b6dd5969-5289-44ad-a2dc-4618e3d5e01e","order_by":4,"name":"Israel Trauma Group (ITG)","email":"","orcid":"","institution":"Gertner Institute for Health Policy and Epidemiology","correspondingAuthor":false,"prefix":"","firstName":"Israel","middleName":"Trauma Group","lastName":"(ITG)","suffix":""},{"id":372556956,"identity":"e3f27a86-9bf5-4601-9e46-266a612b3526","order_by":5,"name":"Eldad Katorza","email":"","orcid":"","institution":"Gertner Institute for Health Policy and Epidemiology","correspondingAuthor":false,"prefix":"","firstName":"Eldad","middleName":"","lastName":"Katorza","suffix":""}],"badges":[],"createdAt":"2024-08-26 07:38:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4976030/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4976030/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13584-025-00727-y","type":"published","date":"2025-11-12T15:58:36+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69949443,"identity":"0295ad26-9d11-44a9-9ccb-90e6b74810c0","added_by":"auto","created_at":"2024-11-27 02:05:58","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":34614,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy population- women ages 18-45 hospitalized with injuries, 2012-2021\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe flowchart presents the final study population from the total number hospitalized adult women with trauma injuries and \u0026nbsp;included in the Israel National Trauma Registry between 2012 and 2021.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4976030/v1/fc74b275b16138659c59f7ea.jpg"},{"id":69949442,"identity":"18c007f2-e9f0-479f-820b-5e7a344779ea","added_by":"auto","created_at":"2024-11-27 02:05:58","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":41909,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eInjury mechanism of hospitalized pregnant and nonpregnant women (ISS \u003c/strong\u003e\u003cu\u003e\u003cstrong\u003e\u0026gt;\u003c/strong\u003e\u003c/u\u003e\u003cstrong\u003e 2), 2012-2021\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 2 presents the distribution of hospitalized pregnant and nonpregnant women, with an ISS \u003cu\u003e\u0026gt;\u003c/u\u003e2, by injury mechanism. As shown, pregnant women were more likely to endure a fall related injuries, whereas nonpregnant women were more likely to be hospitalized for traffic and intentional injuries.\u003c/p\u003e\n\u003cp\u003eOther/unknown refers to mechanism of injury not classified in the above groups or unknown mechanism of injury (n= 23,0.18%) for nonpregnant women.\u003c/p\u003e\n\u003cp\u003eP\u0026lt;0.0001\u003c/p\u003e\n\u003cp\u003e* Refers to unintentional incidents without a specific classification.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4976030/v1/7dae5950a6ede57de759e34b.jpg"},{"id":96105102,"identity":"330cb01e-173a-415b-a841-57cb37ad35be","added_by":"auto","created_at":"2025-11-17 16:08:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1146252,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4976030/v1/953e91c9-1f3e-4451-871d-391417e75949.pdf"}],"financialInterests":"","formattedTitle":"Hospitalization of injured pregnant women - is it justified? A decade of data","fulltext":[{"header":"Background","content":"\u003cp\u003eTrauma-related injuries during pregnancy have tremendous consequences for maternal and fetal well-being.(1\u0026ndash;3) Injury outcomes among pregnant women include placental abruption, pelvic fracture, preterm delivery and high mortality rates among both the woman and fetus.(3\u0026ndash;5)\u003c/p\u003e \u003cp\u003ePregnant women commonly sustain injuries following traffic collisions, falls, and intentional incidents such as domestic violence.(2,6,7) Traffic collisions are the most frequent and fatal for both the woman and the fetus, as reported in a 2019 literature review, with 13.7% and 10.7% mortality rates among pregnant women and fetuses, respectively.(2\u0026ndash;4,8) Furthermore, one out of four pregnant women falls during pregnancy, often due to increased weight and a shift in the center of gravity, leading to bodily imbalance.(8)\u003c/p\u003e \u003cp\u003eThe management of injured pregnant women poses serious medical challenges.(4,9) The physiological changes that occur during pregnancy may influence the manner of treatment; hence, a multidisciplinary team, including obstetric experts and a team manager, is needed. (2,3,9,10)The risk of significant fetal injuries and even mortality among injured pregnant women emphasizes the importance of treatment protocols and policies.(3)\u003c/p\u003e \u003cp\u003e Since pregnancy cannot be determined by the naked eye, the Advanced Trauma Life Support (ATLS) guidelines recommend that a pregnancy test be performed for all fertile-aged women being treated following a trauma-related incident.(2,10) The initial treatment of injured women should be consistent with trauma casualty care protocols, regardless of pregnancy status. (2,8,10) These guidelines include gathering information about trauma-related incidents, gravid uterus displacement to one side, vital sign assessment and stabilization of the pregnant woman (e.g., maternal hemodynamic stability)(3,4,8,10) via ABCDE (airway, breathing, circulation, disability, and exposure) actions. (3,4,6,8,10)\u003c/p\u003e \u003cp\u003eFetal monitoring should be performed immediately after establishing maternal stability. (6,10) The ATLS guidelines also recommend gathering information regarding physical assessments and obstetric history, including gestational age, fetal maturity, and date of delivery.(2,4) Since fetal injuries may not be apparent immediately following trauma, a minimum of 4\u0026ndash;6 hours of monitoring is recommended.(1,6) The main concern following trauma is placental abruption, which can occur even 24 hours and longer after the incident.(3,4,8) Placental abruption may ultimately result in premature birth, fetal death, and other complications.(3)\u003c/p\u003e \u003cp\u003eThe severity of maternal injuries has a direct impact on the duration of fetal monitoring.(4) For instance, women with minor maternal injuries such as minor bruising, minor lacerations or an ISS of zero, require four hours of monitoring.\u003csup\u003e1,4\u003c/sup\u003e In contrast, those with more severe injuries, such as positive Kleihauer\u0026ndash;Betke (KB) tests, vaginal bleeding, or uterine contractions, necessitate at least 24 hours of fetal monitoring.(3,6)\u003c/p\u003e \u003cp\u003eGestational age also affects the duration of fetal monitoring.(10) For instance, a viable fetus (i.e., at least 22 weeks gestation) must be monitored for longer than the minimum monitoring duration and may even last for 48 hours.(1,6,8) Efficient and effective treatment protocols for trauma during pregnancy should be constructed and embedded in relevant medical care facilities. These evidence-based protocols should rely on analyses of large quantities of data originating from numerous medical centers.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAims\u003c/h2\u003e \u003cp\u003eThis study aimed to analyze and describe the demographic, injury, and hospitalization characteristics of pregnant and nonpregnant women hospitalized due to a trauma-related injury in an effort to establish operational protocols for hospitalized pregnant women. In addition, the injury characteristics of the pregnant women were examined with respect to gestational age.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003eThe Israel National Trauma Registry (INTR) was the data source for this retrospective study. The INTR includes comprehensive data on hospitalized trauma patients from 21 hospitals, of which six are level I trauma centers (TCs) and 14 are level II TCs. Trained trauma registrars recorded data from each trauma center under the guidance of a trauma director. Data quality checks were conducted before data analysis. The data are anonymous. All hospitalized trauma patients classified with an ICD-9-CM diagnosis code 800\u0026ndash;989.9 who were admitted to the Department of Emergency Medicine (ER) and hospitalized, died in the ER, or were transferred to another hospital were included in the database. The INTR does not include casualties who died onsite or en route to the hospital, admissions 72 hours or more after the incident, poisonings, suffocations, or drownings. This study was approved by the Sheba Medical Center Institutional Review Board (IRB) (SMC 5138\u0026ndash;18).\u003c/p\u003e \u003cp\u003eFor the purposes of this study, the data obtained from the INTR included pregnant (cases) and nonpregnant (control) women hospitalized following a trauma-related incident between January 1, 2012, and December 31, 2021. All women aged 18\u0026ndash;45 years were included in this study. A negligible percentage of pregnant women under the age of 18 (0.32%) and older than 45 years (0.22%) were also considered during this process.\u003c/p\u003e \u003cp\u003eData regarding gestational age at the time of trauma-related incidents were also included in this study. Injured pregnant women and medical staff reported pregnancy status and related information. Age, ethnicity, length of stay, injury severity, and injured body region were analyzed in relation to gestational age.\u003c/p\u003e \u003cp\u003eThe variables extracted from the INTR included:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDemographic information\u003c/strong\u003e \u003cp\u003eAge and ethnicity (Jew/non-Jew).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMechanism of injury\u003c/strong\u003e \u003cp\u003etraffic crash (private vehicle, pedestrian, bus, bicycle, motorcycle, and other), fall (from height, same level, and stairs), burns, intentional (violence, suicide, terror/war), and other unintentional injuries. (Suicide due to strangulation and poisoning is not included in the INTR).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eSeat position for two- and four-wheel vehicles\u003c/em\u003e (driver, front seat, rear seat).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eType of injury\u003c/strong\u003e \u003cp\u003eblunt, penetrating.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInjury Severity\u003c/strong\u003e \u003cp\u003eThe Injury Severity Score (ISS), is the sum of the squares of the single highest AIS score for each of the three most severely injured body regions.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInjured body region\u003c/strong\u003e \u003cp\u003ehead/neck, torso, extremities; pelvic fractures.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eHospital resource utilization\u003c/em\u003e: Length of \u003cem\u003estay\u003c/em\u003e (LOS), admission to intensive care units (ICUs), and surgical intervention.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEvacuation Method\u003c/strong\u003e \u003cp\u003eprivate vehicles and emergency medical services (EMS).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eGestational age\u003c/em\u003e (The length of time that a fetus grows inside the mother\u0026rsquo;s uterus, in weeks. The gestational age was divided into trimesters.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eCategorical variables were compared using the chi-square test or Fisher's exact test depending on the sample size of the groups. A t- test was used to investigate the normally distributed age among the investigated groups. The median age is presented as the interquartile range (IQR). All the statistical analyses were performed using S.A.S. software; version 9.4 (SAS Institute, Cary, NC, USA). All comparisons were considered statistically significant at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the study population\u003c/h2\u003e \u003cp\u003eA total of 33,377 women aged 18\u0026ndash;45 years, were hospitalized between 2012 and 2021 due to trauma-related injuries. Among them, 14,606 (43.8%) were pregnant at the time of hospitalization and 18,771 (56.2%) were not pregnant. \u003cem\u003e(\u003c/em\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAmong pregnant women, only 8,801 (60.3%) reported gestational age. Among the 14,606 pregnant women, 5,712 (39.1%) were injured during the third trimester, 2,816 (19.3%) during the second trimester, and 273 (1.9%) during the first trimester; for the remaining 5,805 (39.7%), the gestational age was unknown. \u003cem\u003e(\u003c/em\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e \u003cp\u003eCompared with their nonpregnant counterparts, pregnant women were younger, with a median age of 29.0 (IQR 25.0,33.0) years (nonpregnant median age\u0026thinsp;=\u0026thinsp;30.0; IQR 23.0, 38.0) (t\u0026thinsp;=\u0026thinsp;19.07, df\u0026thinsp;=\u0026thinsp;32,095, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). While non-Jews accounted for 24% of pregnant women, they accounted for 32.8% of nonpregnant women. (X2\u0026thinsp;=\u0026thinsp;311.60, df\u0026thinsp;=\u0026thinsp;1, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e Demographic and injury characteristics among hospitalized pregnant and nonpregnant women, 2012\u0026ndash;2021\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePregnant women\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNonpregnant women\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14,606\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18,771\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMedian (IQR 25,75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.0 (25.0,33.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.0 (23.0, 38.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.3 (\u0026plusmn;\u0026thinsp;5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.8 (\u0026plusmn;\u0026thinsp;8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity n (%)\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11,071 (76.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12,425 (67.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Jews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,483 (23.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,064 (32.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInjury Mechanism\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraffic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,563 (51.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8,039 (42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFalls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,888 (40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,811 (31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntentional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e328 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,217 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther unintentional\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e807 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,704 (19.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTraffic, of which\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e7,563\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e8,039\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate vehicle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,818 (90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,506 (56.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePedestrian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e243 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,312 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e188 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBicycle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e397 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMotorcycle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e551 (6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers/unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e281 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,130 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFalls\u003c/b\u003e, \u003cb\u003eof which\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e5,888\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5,811\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFall on same level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,252 (72.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,468 (59.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFall on stairs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,199 (20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,096 (18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFall from height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e337 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,116 (19.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther fall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntentional, of which\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e328\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1,217\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eViolence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e296 (90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e713 (58.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuicide attempts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e381 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTerror / warfare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInjured body region\u003c/b\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead and Neck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,001 (6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,743 (30.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTorso\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11,250 (77.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,087 (32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpine/back\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e192 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,139 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtremities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,031 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11,491 (61.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMethod of transportation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate vehicle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11,194 (76.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,213 (49.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency medical services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,412 (23.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,558 (80.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003cp\u003e\u003csup\u003e1\u003c/sup\u003eUnknown ethnicity, n\u0026thinsp;=\u0026thinsp;334\u003c/p\u003e \u003cp\u003e\u003csup\u003e2\u003c/sup\u003e Other unintentional includes burns, other and unknown unintentional injuries\u003c/p\u003e \u003cp\u003e\u003csup\u003e3\u003c/sup\u003eCasualties can sustain injuries to more than one body region.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eInjury mechanism\u003c/h2\u003e \u003cp\u003eTraffic collisions (51.8% vs. 42.8%) and falls (40.3% vs. 31.0%) were the leading causes of hospitalization among pregnant and nonpregnant women, respectively (X2\u0026thinsp;=\u0026thinsp;1,948.39, df\u0026thinsp;=\u0026thinsp;5, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOver half of the pregnant women were hospitalized because of traffic-related injuries, of which 90.2% (n\u0026thinsp;=\u0026thinsp;6,818) were injured in a private vehicle (X2\u0026thinsp;=\u0026thinsp;2,781.08, df\u0026thinsp;=\u0026thinsp;6, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and 67% (n\u0026thinsp;=\u0026thinsp;5,069) were drivers (X2\u0026thinsp;=\u0026thinsp;970.16, df\u0026thinsp;=\u0026thinsp;4, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). In comparison, 56.1% of nonpregnant women hospitalized with traffic-related injuries were injured in private vehicles. Nonpregnant women were more likely than pregnant women to be injured as pedestrians; pedestrian injuries accounted for 3.2% and 16.3% of traffic-related hospitalizations for pregnant and nonpregnant women, respectively. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) Seat position was identified, and 67% of pregnant women and 52.4% of nonpregnant women were driving the vehicle during the traffic collision. (data not shown).\u003c/p\u003e \u003cp\u003eFalls accounted for 40% (n\u0026thinsp;=\u0026thinsp;5,888) of hospitalizations among the pregnant women. Of these, 72.2% (n\u0026thinsp;=\u0026thinsp;4,52) were same level falls, 5.7% (n\u0026thinsp;=\u0026thinsp;337) from height, and 20.4% (n\u0026thinsp;=\u0026thinsp;1,199) on stairs. In comparison, falls accounted for only 31% of hospitalizations among nonpregnant women, of which 59.7% were on the same level, 19.2% were from a higher level and 18.9% were on stairs (X2\u0026thinsp;=\u0026thinsp;505.56, df\u0026thinsp;=\u0026thinsp;3, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Intentional injuries were more common in nonpregnant women (6.5%, n\u0026thinsp;=\u0026thinsp;1,217) than in pregnant women (2.3%, n\u0026thinsp;=\u0026thinsp;328) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among hospitalizations due to intentional injuries, violence accounted for 90.2% and 58.6% of injuries in pregnant and nonpregnant women, respectively. Eleven pregnant women were hospitalized for attempted suicide. In comparison, among nonpregnant women, 31.3% (n\u0026thinsp;=\u0026thinsp;381) of the intentional injuries were suicide attempts. (X2\u0026thinsp;=\u0026thinsp;123.02, df\u0026thinsp;=\u0026thinsp;2, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003ePregnant women were more likely to be transported to the hospital by private car (76.6%), whereas nonpregnant women were more likely to be transported by EMS (50.9%) (X2\u0026thinsp;=\u0026thinsp;2,625.82, df\u0026thinsp;=\u0026thinsp;1, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eHospital resource utilization\u003c/h3\u003e\n\u003cp\u003eA substantial number of pregnant women (75.9%) were hospitalized for a single day, as opposed to nonpregnant women (32.0%) (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;7,020.16, df\u0026thinsp;=\u0026thinsp;2, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e) Nonpregnant women were much more likely to be admitted to the ICU (0.35% and 5.9% for pregnant and nonpregnant casualties, respectively) (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;749.26, df\u0026thinsp;=\u0026thinsp;1, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and to undergo surgical interventions (2.3% and 37.6% for pregnant and nonpregnant casualties, respectively) (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;5,913.29, df\u0026thinsp;=\u0026thinsp;1, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e Hospitalization and injury severity characteristics among hospitalized pregnant and non-pregnant women, 2012\u0026ndash;2021\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInjury Severity Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eALL hospitalized women\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eHospitalized women classified with ISS\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePregnant women n (%)\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;14,606)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-pregnant women n (%) (N\u0026thinsp;=\u0026thinsp;18,771)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePregnant women n (%) (N\u0026thinsp;=\u0026thinsp;1,217)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNonpregnant women n (%) (N\u0026thinsp;=\u0026thinsp;12,928)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLOS (days)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11,081 (75.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,999 (32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e597 (49.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,046 (23.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,051 (14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,767 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e184 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,448 (18.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,474 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,005 (48.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e436 (35.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7,434 (57.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eISS\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13,385 (91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,802 (31.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,217 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12,928 (69.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eICU (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,100 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,052 (8.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical intervention\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderwent surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e342 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7,054 (37.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e276 (22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6,275 (48.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMortality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(0.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e115 (0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003cp\u003eAbbreviations: Injury Severity Score \u0026ndash; ISS; Length of Stay \u0026ndash; LOS; Intensive Care Unit - ICU\u003c/p\u003e \u003cp\u003e\u003csup\u003e1\u003c/sup\u003eUnknown ISS n\u0026thinsp;=\u0026thinsp;45\u003c/p\u003e \u003cp\u003e\u003csup\u003e2\u003c/sup\u003eN/A\u0026thinsp;=\u0026thinsp;variable not relevant for this group\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInjury and hospitalization characteristics among the pregnant women by gestational age 2012\u0026ndash;2021\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst trimester\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;273)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSecond trimester\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;2,816)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThird trimester\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;5,712)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnknown gestational age\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;5,805)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMechanism of injury\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraffic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148 (54.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,568 (55.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,661 (46.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,186 (54.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFalls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (27.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,002 (35.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,646 (46.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,164 (37.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntentional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (9.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e127 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther/unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e151 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e324 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e328 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLOS (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e146 (53.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,166 (76.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,357 (76.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4,412 (76.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127 (46.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e650 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,355 (23.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,393 (24.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eISS\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e174 (64.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,551 (90.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,230 (91.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5,430 (93.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98 (36.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e265 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e481 (8.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e373 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInjured body region\u003c/b\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead and Neck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (28.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e246 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e330 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e348 (6.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTorso\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e176 (64.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,293 (81.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,433 (77.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4,348 (74.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtremities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101 (37.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e442 (15.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e881 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e607 (10.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003cp\u003eAbbreviations: Injury Severity Score \u0026ndash; ISS; Length of Stay \u0026ndash; LOS\u003c/p\u003e \u003cp\u003e\u003csup\u003e1\u003c/sup\u003eMissing data for ISS: first trimester n\u0026thinsp;=\u0026thinsp;1, third trimester n\u0026thinsp;=\u0026thinsp;1, unknown gestational age n\u0026thinsp;=\u0026thinsp;2.\u003c/p\u003e \u003cp\u003e\u003csup\u003e2\u003c/sup\u003eA casualty may be injured in more than one body region\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eInjury severity\u003c/p\u003e \u003cp\u003eA sizable number of hospitalized pregnant women had an ISS of 1 (91.7%, n\u0026thinsp;=\u0026thinsp;13,385). In comparison, only 31% (5,802) of the nonpregnant women had an ISS of 1. (X2\u0026thinsp;=\u0026thinsp;12,371.26, df\u0026thinsp;=\u0026thinsp;1, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Hospitalization and injury characteristics were analyzed separately for women with an ISS\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;2, which revealed similar results regarding LOS (X2\u0026thinsp;=\u0026thinsp;383.34, df\u0026thinsp;=\u0026thinsp;2, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), ICU admission (X2\u0026thinsp;=\u0026thinsp;30.65, df\u0026thinsp;=\u0026thinsp;1, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and surgical intervention (X2\u0026thinsp;=\u0026thinsp;299.14, df\u0026thinsp;=\u0026thinsp;1, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) as found in the entire sample. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAmong pregnant women, the torso accounted for the majority of injuries (77.0%), whereas among nonpregnant women, the extremities were the major injured body regions (61.2%). Only 13.9% of pregnant women sustained injuries to their extremities (X2\u0026thinsp;=\u0026thinsp;7,629.38, df\u0026thinsp;=\u0026thinsp;1, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Among pregnant women, 1,001 (6.9%) sustained head and neck injuries, whereas 5,743 (30.6%) of nonpregnant women experienced head and neck injuries (X2\u0026thinsp;=\u0026thinsp;2,871.79, df\u0026thinsp;=\u0026thinsp;1, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Furthermore, among pregnant women, blunt injuries accounted for 99.3% (14,504) of all injuries. In-hospital mortality was rare, three pregnant women (0.02%) and 115 (0.6%) nonpregnant women died.\u003c/p\u003e \u003cp\u003eAfter excluding patients with an ISS of 1, 57% of the pregnant women sustained injuries to the torso, whereas 29% of the control group sustained such injuries (X2\u0026thinsp;=\u0026thinsp;378.32, df\u0026thinsp;=\u0026thinsp;1, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Injuries to the head and neck were found in 20.3% of pregnant women and 29.1% of nonpregnant women (X2\u0026thinsp;=\u0026thinsp;42.52, df\u0026thinsp;=\u0026thinsp;1, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). No differences were found between the cases and controls regarding injuries to the extremities (p\u0026thinsp;=\u0026thinsp;0.79) (data not shown).\u003c/p\u003e \u003cp\u003eAmong casualties with ISS\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;2, falls accounted for 54.7% (n\u0026thinsp;=\u0026thinsp;666) of hospitalizations among pregnant women and 37.2% (n\u0026thinsp;=\u0026thinsp;4,809) among nonpregnant women. Traffic collisions led to hospitalizations among 36.6% (n\u0026thinsp;=\u0026thinsp;445) and 43.2% (n\u0026thinsp;=\u0026thinsp;5,586) of pregnant and nonpregnant women with ISS\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;2, respectively (X2\u0026thinsp;=\u0026thinsp;171.81, df\u0026thinsp;=\u0026thinsp;5, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eGestational age\u003c/h3\u003e\n\u003cp\u003eAmong pregnant women, only 8,801 (60.3%) reported gestational age. Among the 14,606 pregnant women, 5,712 (39.1%) were injured during the third trimester, 2,816 (19.3%) during the second trimester, and 273 (1.9%) during the first trimester; for the remaining 5,805 (39.7%) casualties, the gestational age was unknown. More than half of the pregnant women hospitalized during the first (54.2%) and second (55.7%) trimesters were involved in traffic collisions. Among women hospitalized during the third trimester, 46.6% were due to traffic collisions and 46.3% were fall injuries. Intentional injuries were more prominent among women in their first (9.2%) trimester than in their second (3.4%) and third (1.4%) trimesters (X2\u0026thinsp;=\u0026thinsp;236.48, df\u0026thinsp;=\u0026thinsp;9, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eA greater percentage of women were hospitalized for more than one day during their first trimester (46.5%) than during the second (23.1%) and third (23.7%) trimesters (X2\u0026thinsp;=\u0026thinsp;77.01, df\u0026thinsp;=\u0026thinsp;3, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e) A greater proportion of women with an ISS\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;2 were hospitalized during the first trimester (36.0%) than during the second (9.4%) and third trimesters (8.4%) (X2\u0026thinsp;=\u0026thinsp;305.02, df\u0026thinsp;=\u0026thinsp;3, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e) Furthermore, women injured during the second (81.4%) and third (77.6%) trimesters sustained a greater number of injuries to the torso than those during the first trimester (64.5%) (X2\u0026thinsp;=\u0026thinsp;71.06, df\u0026thinsp;=\u0026thinsp;3, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The latter group had a greater percentage of head and neck injuries (28.2%) and extremities injuries (37.0%) than during the second and third trimesters (head/neck: X2\u0026thinsp;=\u0026thinsp;227.66, df\u0026thinsp;=\u0026thinsp;3, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001; extremities: X2\u0026thinsp;=\u0026thinsp;197.81, df\u0026thinsp;=\u0026thinsp;3, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eData from the INTR provide a vast amount of information regarding trauma-related hospitalizations. For the purpose of this study, the data focused on pregnant and nonpregnant women aged 18\u0026ndash;45 years who were hospitalized over a ten-year period. Pregnant women were more likely than nonpregnant women to sustain minor injuries, whereas nonpregnant women were more likely to have longer hospital stays and undergo surgery. This study also revealed that most hospitalized pregnant women were injured during the third trimester, followed by the second trimester (for casualties with known gestational age). However, women in the first trimester sustained more severe injuries and were hospitalized for longer periods.\u003c/p\u003e \u003cp\u003eIn this study, the majority of pregnant women sustained minor injuries and were hospitalized for only one day. A possible explanation, as suggested by Azar et al., is that pregnant women are more likely to seek medical care following a traumatic event than nonpregnant women are (15). In addition, concerns for the fetus may lead to hospitalization of pregnant women sustaining minor injuries.(14,15) Low injury severity among hospitalized pregnant women has also been documented in previous studies.(7,9,14\u0026ndash;18) This can be emphasized by the relatively few medical interventions (e.g., surgery and blood transfusion) reported for pregnant women.(7,9,15)\u003c/p\u003e \u003cp\u003eBetween 2012\u0026ndash;2021, traffic collisions were the leading cause of hospitalizations among women aged 18\u0026ndash;45, the majority of whom were drivers in private cars. A large body of evidence supports the findings of this study, confirming that traffic-related events are the leading cause of injury among pregnant women.(7,9,11\u0026ndash;14) However, the percentages of pregnant women injured in traffic collisions were inconsistent with those reported in previous studies. In the present study, 51.8% of the pregnant women were hospitalized due to a traffic collision, while other countries reported varying results, such as 55.5% in the UK, 58.1% in the USA, 64.4% in Japan, 74.7% in Qatar, and 82.5% in Australia.(7,13,9,12,11) Most (~\u0026thinsp;90%) pregnant women hospitalized due to traffic-related injuries were injured while in a private vehicle, and the majority of all vehicle occupants were drivers. These findings and the proximity of the abdomen to the steering wheel may explain the high frequency of torso injuries among pregnant women. These findings are supported by previous studies, which concluded that 88.6%-90% of pregnant women are injured in private vehicles.(14,15) Furthermore, an Israeli study reported that between 2006 and 2013, 67% of hospitalized pregnant women involved in motor vehicle accidents were drivers.(14) A study in the U.S. reported that 54% of pregnant women involved in traffic accidents were drivers and that thoracic and abdominal injuries were the most common injuries among these women.(15) During a fifteen-year period, 24.8% and 14.6% of pregnant Japanese women sustained chest and abdominal injuries, respectively.(9) Differences in the investigated body regions may partially explain the differences between the studies.\u003c/p\u003e \u003cp\u003eIn comparison to other research, in the current study a greater percentage of pregnant women were hospitalized following a fall related injury. Falls led to hospitalizations among ~\u0026thinsp;40% of the pregnant women investigated in this study, whereas 9.5%-16.7% were reported in other studies.(7,11,12) Differences in the study design and population characteristics may explain the variations in trauma-related hospitalizations among pregnant women. For example, the current study included all pregnant women hospitalized due to an injury, whereas Sato et al. focused on younger females with severe trauma (ISS\u0026thinsp;\u0026gt;\u0026thinsp;12).(11) The various studies also differed by study period. Similar to the current study, Deshpande et al. focused on a ten-year period, in contrast to the two- and twelve-year periods reported in other studies.(11,12)\u003c/p\u003e \u003cp\u003eA short LOS for hospitalized pregnant women has also been previously documented.(9,14\u0026ndash;17) For example, in Australia, 78% of pregnant women were hospitalized for one day, and only 12% of pregnant and 28% of nonpregnant women involved in traffic collisions were hospitalized for six days or more.(16) In contrast to the findings of this study, no differences between pregnant and nonpregnant women involved in traffic accidents were found regarding LOS, mortality, ICU, or surgery reported in a single level I trauma center in the USA.(18) The relatively small percentage (2.3%) of surgical interventions among pregnant women found in the currentr study was inconsistent with the 12.1% reported in a single level I trauma center study conducted in the USA.(17) These two previous studies obtained information from a single trauma center, unlike the data described in this study, which were collected from numerous trauma centers.\u003c/p\u003e \u003cp\u003eThe outcomes of the current study revealed that most hospitalized women of known gestational age were injured during the third trimester. Supporting evidence has been documented in previous studies, in which most pregnant women were more likely to be injured during the third trimester.(5,12) For example, one study reported that approximately 70% of injured pregnant women in Israel (between 2000 and 2008) were injured during the third trimester.(5) A slightly smaller percentage (47.7%) was documented in Qatar between2013\u0026ndash;2015.(12) As shown in this study, most pregnant women hospitalized following a fall were injured during the second and third trimesters. Body weight and the center of gravity change during these trimesters and provide possible explanations.(4) Indeed, women in the third trimester show reduced postural stability and hence are more susceptible to falls.(2)\u003c/p\u003e \u003cp\u003eFetal monitoring is often derived from concerns regarding placental abruption, which may occur after trauma-related injury.(6,19) However, the monitoring duration varies and should be determined for each case. While some minor injuries are not associated with adverse pregnancy outcomes, severe trauma may lead to placental abruption, or as well as fatal fetal and maternal injuries.(6,18) Thus, the importance to differentiate between vital and unjustified hospitalizations.\u003c/p\u003e \u003cp\u003eUnwarranted hospitalizations place a burden on the pregnant woman, the family and the health system. The hospital is usually a hectic environment and can cause unnecessary anxiety especially for the pregnant woman. In addition, hospitalization can be a financial hardship on the individual and family level due to missed work days and child care. On the institutional and national level, it is known that hospitalization is costly, which often includes unnecessary testing. Finally, hospitals are often the source of exposure to viruses and infections. Pregnant women are at high risk and thus unnecessary exposure should be limited.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe major limitation of this study is that the INTR includes limited obstetric information and data on fetal health and outcomes. Fetal injuries and outcomes due to the trauma-related injuries were unknown and thus not discussed in this study.\u003c/p\u003e \u003cp\u003eIn addition, the INTR includes only hospitalized patients; thus, casualties discharged from the emergency room (without hospitalization) were not included. Since this research was specific to hospitalized patients, the study was not inhibited.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePolicy implications and recommendations\u003c/h2\u003e \u003cp\u003eWhen an injured pregnant women arrives at the hospital emergency department, careful attention is needed for both maternal and fetal health. This study highlights the need for effective observational and treatment protocols regarding the care for injured pregnant women. While traumatic injuries are the leading cause of nonobstetric maternal death, the majority of hospitalized pregnant women suffer from minor injuries. While minor injuries are not usually associated with adverse pregnancy outcomes, some injuries can lead to fatal fetal injuries, (6,18) thus, the importance of protocols and observation for both the fetus and the mother. Protocols and guidelines should be developed or revised to include outpatient care and monitoring in an effort to prevent unnecessary hospitalizations. The guidelines should be based on maternal injury severity and the gestational age of the fetus.(8,10)\u003c/p\u003e \u003cp\u003eIt is important to identify the gestational age of the fetus in order to make educated decisions for monitoring the fetus. The risk for fetal loss occurs during the first two trimesters while the risk for fetal distress, premature delivery or fetal death occurs during the third trimester. Type of testing and monitoring differs depending on the gestational week.\u003c/p\u003e \u003cp\u003eEvidence of fetal compromise usually becomes apparent within the first 4\u0026ndash;6 hours of electronic monitoring, thus, pregnant women with minor injuries should be monitored for six hours.(20,21) Monitoring also reflects the concerns regarding placental abruption, which may occur following a trauma-related injury.(6,18) Following hospital monitoring, if no adverse events are identified the pregnant patient should be discharged for further monitoring at the community level, rather than hospitalization. For example, in this study, a large percentage of the hospitalized women suffered from minor injuries with an ISS\u0026thinsp;=\u0026thinsp;1. According to the recommended protocols, many of these hospitalized women could have been monitored in the ED for six hours and then discharged, and if needed, further observation at the local clinic.\u003c/p\u003e \u003cp\u003eWhile patients with an ISS of one should usually be discharged for non-hospitalization observation, patients with ISS greater than 8 should remain in the hospital for fetal and maternal observation and monitoring. In these cases the medical staff should check for shock, evidence of contractions, uterine tenderness and vaginal bleeding.\u003c/p\u003e \u003cp\u003eCriteria for discharging the injured pregnant woman should include: Stable maternal vital signs (normal blood pressure, pulse, and respiratory rate); Absence of vaginal bleeding or abdominal pain; Normal fetal heart rate and absence of fetal distress on monitoring; No signs of uterine contractions or preterm labor; Negative findings on any necessary imaging (e.g., ultrasound to check for placental integrity) and No need for further medical interventions (21). Women with Rh-negative should continue to be monitored.(1)\u003c/p\u003e \u003cp\u003e In order to design relevant guidelines, a multidisciplinary panel of experts, including neonatal specialists and obgyn physicians, should design the criteria for hospitalization and discharge of pregnant injured women in an effort to prevent any adverse events while also avoiding unwarranted hospitalization. The protocols should focus not only on the institutional level, but also be directed to community health specialists.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePregnant women are more likely than nonpregnant women to be hospitalized after sustaining minor injuries. The findings from this study raise several questions regarding the justification for hospitalizing pregnant women with minor injuries. Advantageous observation and treatment protocols for the pregnant trauma patient and her fetus should be reviewed and updated in an effort to limit unnecessary hospitalizations while properly caring for fetal and maternal health. Policy makers, neonatal and obgyn experts should work together to optimize trauma care for pregnant women and their fetuses.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eATLS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdvanced Trauma Life Support\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEMS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmergency medical services\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eER\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDepartment of emergency medicine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive care unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eINTR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIsrael National Trauma Registry\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIRB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInstitutional Review Board\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eISS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInjury Severity Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLOS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLength of stay\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSMC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSheba Medical Center\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTrauma center\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthical approval and consent to participate-\u003c/em\u003e This study was conducted at the National Center for Trauma and Emergency Medicine Research, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel. Since no identifying information was available to the researchers, there was no need in receiving any type of informed consent. In addition, this study received approval from the Sheba Medical Center Institutional Review Board (IRB) (SMC 5138\u0026ndash;18). All methods were performed in accordance with the ethical standards as laid down in the Declaration of Helsinki and its later amendments or comparable ethical standards.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication \u0026ndash;\u003c/em\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials \u0026ndash;\u0026nbsp;\u003c/em\u003eThe datasets analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConflict of interest-\u003c/em\u003e The authors report no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Funding source-\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthor contributions\u003c/em\u003e\u003cstrong\u003e:\u003c/strong\u003e EK and MR conceived the study and study design. AG and IR oversaw the methodology and data analysis. \u0026nbsp;MR and SG drafted the manuscript. ITG collected data. \u0026nbsp;All authors contributed substantially to the manuscript review, editing and revision. The\u0026nbsp;Israeli Trauma Group is a study group composed of trauma units of all hospitals belonging to the Israel Trauma Registry, tasked with producing the data for the registry.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e-\u0026nbsp;Israel\u0026nbsp;Trauma\u0026nbsp;Group\u0026nbsp;(ITG)\u0026nbsp;includes: H.\u0026nbsp;Bahouth, M. Bala, A.\u0026nbsp;Bar, A. Braslavsky, D. Czeiger, D.\u0026nbsp;Fadeev,\u0026nbsp;A. L. Goldstein, I.\u0026nbsp;Grevtsev, G.\u0026nbsp;Hirschhorn,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e I. Jeroukhimov, A. Kedar, Y. Klein, A. Korin, B. Levit , I. Schrier, A. D. Schwarz, W. Shomar, D. Soffer, M. Weiss, O. Yaslowitz, I. Zoarets.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLiggett MR, Amro A, Son M, Schwulst S. Management of the Pregnant Trauma Patient: A Systematic Literature Review. Journal of Surgical Research. 2023 May;285:187\u0026ndash;96. \u003c/li\u003e\n\u003cli\u003eLucia A, Dantoni SE. Trauma Management of the Pregnant Patient. Crit Care Clin. 2016 Jan;32(1):109\u0026ndash;17. \u003c/li\u003e\n\u003cli\u003eGreco PS, Day LJ, Pearlman MD. Guidance for Evaluation and Management of Blunt Abdominal Trauma in Pregnancy. Obstetrics \u0026amp; Gynecology. 2019 Dec 4;134(6):1343\u0026ndash;57. \u003c/li\u003e\n\u003cli\u003ePetrone P, Jim\u0026eacute;nez-Morillas P, Axelrad A, Marini CP. Traumatic injuries to the pregnant patient: a critical literature review. European Journal of Trauma and Emergency Surgery. 2019 Jun 15;45(3):383\u0026ndash;92. \u003c/li\u003e\n\u003cli\u003eMelamed N, Aviram A, Silver M, Peled Y, Wiznitzer A, Glezerman M, et al. Pregnancy course and outcome following blunt trauma. The Journal of Maternal-Fetal \u0026amp; Neonatal Medicine. 2012 Sep;25(9):1612\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eMurphy NJ QJD. Trauma in pregnancy: assessment, management, and prevention. Am Fam Physician. 2014;90:717\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eDeshpande NA, Kucirka LM, Smith RN, Oxford CM. Pregnant trauma victims experience nearly 2-fold higher mortality compared to their nonpregnant counterparts. Am J Obstet Gynecol. 2017 Nov;217(5):590.e1-590.e9. \u003c/li\u003e\n\u003cli\u003eMendez-Figueroa H, Dahlke JD, Vrees RA, Rouse DJ. Trauma in pregnancy: an updated systematic review. Am J Obstet Gynecol. 2013 Jul;209(1):1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eMakino Y, Kiguchi T, Kato H, Inada S. Epidemiology and outcomes of pregnant trauma patients in Japan: a nationwide descriptive study. European Journal of Trauma and Emergency Surgery. 2023 Jun 17;49(3):1287\u0026ndash;93. \u003c/li\u003e\n\u003cli\u003eAmerican College of Surgeons. Committee on Trauma. ATLS, Advanced Trauma Life Support for Doctors: Student Course Manual. In: ATLS, Advanced Trauma Life Support for Doctors: Student Course Manual. 9th ed. 2012. \u003c/li\u003e\n\u003cli\u003eSato N, Cameron P, Thomson BN, Read D, McLellan S, Woodward A, et al. Epidemiology of pregnant patients with major trauma in Victoria. Emergency Medicine Australasia. 2022 Feb 23;34(1):24\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eAl-Thani H, El-Menyar A, Sathian B, Mekkodathil A, Thomas S, Mollazehi M, et al. Blunt traumatic injury during pregnancy: a descriptive analysis from a level 1 trauma center. European Journal of Trauma and Emergency Surgery. 2019 Jun 27;45(3):393\u0026ndash;401. \u003c/li\u003e\n\u003cli\u003eBattaloglu E, McDonnell D, Chu J, Lecky F, Porter SK. Epidemiology and outcomes of pregnancy and obstetric complications in trauma in the United Kingdom. Injury. 2016 Jan;47(1):184\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eMiller N, Biron-Shental T, Peleg K, Fishman A, Olsha O, Givon A, et al. Are pregnant women safer in motor vehicle accidents? J Perinat Med. 2016 Jan 1;44(3). \u003c/li\u003e\n\u003cli\u003eAzar T, Longo C, Oddy L, Abenhaim HA. Motor vehicle collision‐related accidents in pregnancy. Journal of Obstetrics and Gynaecology Research. 2015 Sep 14;41(9):1370\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eVivian‐Taylor J, Roberts C, Chen J, Ford J. Motor vehicle accidents during pregnancy: a population‐based study. BJOG. 2012 Mar 10;119(4):499\u0026ndash;503. \u003c/li\u003e\n\u003cli\u003eMaxwell BG, Greenlaw A, Smith WJ, Barbosa RR, Ropp KM, Lundeberg MR. Pregnant trauma patients may be at increased risk of mortality compared to nonpregnant women of reproductive age: trends and outcomes over 10 years at a level I trauma center. Women\u0026rsquo;s Health. 2020 Jan 24;16:174550652093302. \u003c/li\u003e\n\u003cli\u003eOwattanapanich N, Lewis MR, Benjamin ER, Wong MD, Demetriades D. Motor vehicle crashes in pregnancy: Maternal and fetal outcomes. Journal of Trauma and Acute Care Surgery. 2021 May;90(5):861\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eCahill AG, Bastek JA, Stamilio DM, Odibo AO, Stevens E, Macones GA. Minor trauma in pregnancy\u0026mdash;is the evaluation unwarranted? Am J Obstet Gynecol. 2008 Feb;198(2):208.e1-208.e5. \u003c/li\u003e\n\u003cli\u003ePearlman MD, Tintanalli JF, Lorenz RP. A prospective controlled study of outcome after trauma during pregnancy. AM JObstet Gynecol. 1990;162:1502\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eJain V, Chari R, Maslovitz S, Farine D, Bujold E, Gagnon R, et al. Guidelines for the Management of a Pregnant Trauma Patient. Journal of Obstetrics and Gynaecology Canada. 2015 Jun;37(6):553\u0026ndash;71. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"israel-journal-of-health-policy-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jhpr","sideBox":"Learn more about [Israel Journal of Health Policy Research](http://ijhpr.biomedcentral.com/)","snPcode":"13584","submissionUrl":"https://www.editorialmanager.com/jhpr/default2.aspx","title":"Israel Journal of Health Policy Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"hospitalization, pregnant women, trauma-related injuries, gestational age, traffic collisions, falls","lastPublishedDoi":"10.21203/rs.3.rs-4976030/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4976030/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePregnant women commonly sustain injuries following traffic collisions, falls, and intentional incidents such as domestic violence. Injuries sustained by pregnant women can lead to placental abruption, pelvic fracture, preterm delivery as well as maternal and fetal mortality. The aim of this study was to compare injury and hospitalization characteristics among hospitalized pregnant and nonpregnant women. For pregnant women, gestational age was analyzed according to injury severity and hospitalization characteristics.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe Israel National Trauma Registry was the data source for this retrospective study. Demographic, injury and hospitalization characteristics were collected and analyzed for pregnant and nonpregnant women hospitalized between Jan 1, 2012 and December 31, 2021. Among pregnant females, gestational age was identified. Categorical variables were compared using the Chi-square Test and Fisher's Exact Test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 33,377 women, aged 18\u0026ndash;45 years, were hospitalized due to trauma-related injury; 14,606 (43.8%) were pregnant, and 18,771 (56.2%) were not pregnant. Among the pregnant women, 91.7% had an Injury Severity Score (ISS) of 1, and 75.9% were hospitalized for a single day. In comparison, 31% of the nonpregnant women had an ISS of 1 (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;12,371.26, df\u0026thinsp;=\u0026thinsp;1, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and 32% were hospitalized for one day. Traffic accidents contributed to 51.8% of hospitalizations among pregnant women, compared with 42.8% among nonpregnant women. While falls were more prevalent among pregnant women, a greater proportion of nonpregnant women were hospitalized with intentional injuries. Among pregnant women, injuries during the third trimester are most common. However, those hospitalized during the first trimester suffered from more severe injuries than injuries during the second and third trimesters did. Compared with nonpregnant women, pregnant women are more likely to sustain minor injuries, have shorter hospitalization stays, have fewer surgical interventions and have fewer admissions to intensive care units (ICUs).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study provides important data for medical personnel and policymakers regarding trauma-related injuries among pregnant women. The results highlight the need to construct effective prevention and treatment protocols and criteria for hospitalizing injured women during pregnancy. A multidisciplinary team of experts, including neonatal and obgyn physicians should design criteria for hospital observation and discharge in an effort to prevent any adverse events while also avoiding unnecessary hospitalization.\u003c/p\u003e","manuscriptTitle":"Hospitalization of injured pregnant women - is it justified? A decade of data","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-27 02:05:53","doi":"10.21203/rs.3.rs-4976030/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2024-11-02T18:03:08+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-31T09:21:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-30T17:19:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"Israel Journal of Health Policy Research","date":"2024-10-30T05:20:54+00:00","index":"","fulltext":""},{"type":"decision","content":"Major revision","date":"2024-09-02T05:19:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"israel-journal-of-health-policy-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jhpr","sideBox":"Learn more about [Israel Journal of Health Policy Research](http://ijhpr.biomedcentral.com/)","snPcode":"13584","submissionUrl":"https://www.editorialmanager.com/jhpr/default2.aspx","title":"Israel Journal of Health Policy Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"508adc82-995e-4247-b84e-f8bcd5ada422","owner":[],"postedDate":"November 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-17T16:03:33+00:00","versionOfRecord":{"articleIdentity":"rs-4976030","link":"https://doi.org/10.1186/s13584-025-00727-y","journal":{"identity":"israel-journal-of-health-policy-research","isVorOnly":false,"title":"Israel Journal of Health Policy Research"},"publishedOn":"2025-11-12 15:58:36","publishedOnDateReadable":"November 12th, 2025"},"versionCreatedAt":"2024-11-27 02:05:53","video":"","vorDoi":"10.1186/s13584-025-00727-y","vorDoiUrl":"https://doi.org/10.1186/s13584-025-00727-y","workflowStages":[]},"version":"v1","identity":"rs-4976030","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4976030","identity":"rs-4976030","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}