|Ann. Medit. Burns Club - voL VII - n. 3 - September 1994
PREGNANCY AND BURNS: EXPERIENCE FROM FIVE CASES*
loannovich J, Kastana D., Alexakis D., Tsoutsos D., Panayotou P.
Department of Plastic Surgery and Microsurgery, General State Hospital of Athens, Greece
SUMMARY. The bums disease influences the course of pregnancy and has specific effects on both mother and fetus. The already hypermetabolic pregnant woman has to overcome the metabolic and septic complications of the bums disease. The alterations in the metabolic, hydrostatic, electrolytic and hormonal environment of the mother have direct consequences on the fetus's growth, metabolism, nutrition and the general status. Spontaneous abortion is often due to heat-induced degradation of albumins and to the circulation of various tissue hormones. The septic complications of the burns disease may also induce premature labour. This study presents five cases of pregnant women with burns and discusses the consequences of the burns disease in pregnancy.
The burns disease influences the course of
pregnancy and has specific effects on both mother and fetus. The already hypermetabolic
pregnant woman also has to overcome the metabolic and septic complications of the burns
Material and method
Five pregnant women with burns disease
were treated in our unit in the period 1988-1993 (burn range: 9-60% T13SA, partial- and
full-thickness). Four patients survived and one died of acute respiratory failure. Of the
survivors, one patient had a miscarriage and the other three continued their gestation.
The second patient was 16 years old and in
her 28th week of pregnancy. She was admitted on day 2 post-bum with 30% T13SA burns in the
chest, abdomen and lower extremities. The leg burns were full-thickness. The patient was
operated on with epidural anaesthesia on day 10 postburn. All full-thickness areas were
covered with splitthickness meshed skin grafts. The post-operative recovery was uneventful
and the grafts took well. The patient was then transferred to a maternity hospital, where
she had a normal delivery.
All five pregnant women with burns were resuscitated using the Parkland formula with alterations adjusted to individual needs and changes in the intravascular volume. Gynaecological advice and treatment were immediate and continued throughout the patients' treatment. All the patients received tocolytic drugs.
All metabolic changes of the burn disease are enhanced by the hypennetabolic state of gestation. There is also an increase of the intravascular space in pregnant women of up to 40% in volume. Extreme care should therefore be taken to initiate resuscitation therapy as soon as possible, since the mother's intravascular space is in equilibrium with the amniotic fluid. Resuscitation should be vigorous to prevent intrauterine death of the child due to loss of amniotic fluid.
Special care should also be taken regarding the position of the patient in order to prevent:
Absorbable local antiseptic or antibacterial agents should be avoided, specially when the TBSA burned is extensive.
The burn disease has serious consequences for the pregnant woman. There is an increase in morbidity and mortality in the mother and fetus, and the normal termination of gestation is endangered.
RESUMIE. La maladie des brûlés modifie le cours de la grossesse et produit des effets spécifiques sur la mère et sur l'enfant. La femme enceinte, hypermétabolique à cause de sa condition, doit surmonter les complications métaboliques et septiques provoquées par les brûlures. Les altérations des conditions métaboliques, hydrostatiques, électrolytiques et hormonales de la mère ont des conséquences directes sur la croissance, le métabolisme, la nutrition et les conditions générales du foetus. L'avortement spontané est souvent causé par la dégradation des albumines provoquée par la chaleur ou par la circulation des divers hormones des tissus. Les complications septiques de la maladie des brûlés peut aussi provoquer le travail prématuré. Les auteurs présentent cinq cas de femmes enceintes atteintes de brûlures et ils considérent les conséquences des brûlures pendant la grossesse.