Maternal and fetal outcomes in pregnant women Presenting with burn injuries at PIMS Islamabad

Abstract

Objective:   To document the clinical presentation of burn injuries among pregnant women and determine the fetomaternal outcomes.

Design Retrospective cohort study

 Methodology All the pregnant ladies that presented to MCH and the ones for which call of consultation was sent from burn center of Pakistan Institute of Medical Sciences, Islamabad were recruited after informed consent. The study was conducted from May 2008 to October 2024 that is 15years 5 months. Non probability simple random technique was employed .Ethical approval was taken. Data was collected retrospectively .A structured questionnaire was filled. The particulars like total burn surface areas, type of burn, mode of burn was documented. The obstetrical management of the patients that is no intervention, supportive or delivery of fetus trimester wise was recorded. The primary outcome measures included the clinical presentation and trimester-wise distribution of the patients. The secondary outcome measures included feto-maternal outcomes.

Results: A total of 33 pregnant burn patients were managed at PIMS between 2008 and 2023, with ages ranging from 20 to 45 years (63.6%, n = 21, aged 21–30 years). Patients presented equally across trimesters: first (n = 11), second (n = 10), and third (n = 12). Flame burns predominated (75.8%, n = 25), followed by electric (n = 4), scald (n = 3), and chemical burns (n = 1). Nearly all cases were accidental (97.0%, n = 32), with one suicidal instance (3.0%). Burn severity varied: <30% TBSA (n = 10), 30–50% (n = 5), 50–70% (n = 7), and >70% (n = 11). Maternal mortality correlated strongly with TBSA (p < 0.001*), declining from 90% survival at <30% TBSA (n = 9/10 alive) to 9.1% at >70% (n = 1/11 alive). Fetal mortality followed a similar pattern (p = 0.008*), with 100% demise at >70% TBSA (n = 6/6 expired).

Patient admissions increased over time, peaking in 2020–2023 (n = 15) compared to 2008–2011 (n = 4), while maternal mortality decreased significantly (p = 0.007*) under multidisciplinary care. Active management strategies improved outcomes: maternal survival was highest with supportive therapy (55.6%, n = 5/9) and fetomaternal surveillance (57.1%, n = 4/7), while fetal survival reached 100% with delivery (n = 5/5 alive). In contrast, no intervention led to 9.1% maternal survival (n = 1/11 alive) and universal fetal mortality (n = 0/9 alive), and termination of pregnancy resulted in 0% survival for both mother (n = 0/1*) and fetus (n = 0/1*; p < 0.001*). Younger maternal age showed a non-significant trend toward better fetal survival (p = 0.527*). Overall, 39.4% of mothers (n = 13) and 30.3% of fetuses (n = 10) survived, with improved outcomes observed in recent years.

Conclusion Among the various patients managed it was found that supportive therapy is better for good maternal outcomes in first and second trimester. In third trimester it is best to deliver fetus as soon as reasonably possible for better pregnancy outcome in pregnant patients inflicted with burn injuries.  Over the years the patients were better managed by having multidisciplinary care. PIMS is about to become a center of excellence of care for pregnant women presenting with burns.

Key Words Maternal mortality, TBSA, Fetus