Introduction

The incidence of acute burn injuries in pregnant women is very low (1); therefore, to delve into this problem, studying large populations over long periods of time is required. Burns during pregnancy are often associated with high rates of fetal and maternal mortality and morbidity. Various factors can affect the rate of mortality and morbidity in burns patients during pregnancy, including depth and size of burn injury, maternal health, age at pregnancy, and simultaneous existence of inhalation and burn injuries (2).

In a study performed by Agrawal, pregnancy did not influence the outcome of acute burn, but it increased the risk of abortion or premature birth (3). In a study by Maghsoudi et al., burn surface area and inhalation injury were the most important predictors of maternal and fetal mortality (4).

Imam Reza Hospital burn center in Mashhad, Khorasan Razavi province, Iran, serves more than 5.4 million people in an area of 302,000 km² with nearly 1,150 annual admissions (5). In this study, we aimed to review cases of burn injury during pregnancy and evaluate the outcome of these patients in Mashhad, Iran.

Materials and Methods

In this retrospective study, the research protocol was approved by the Ethics Committee of Mashhad University of Medical Sciences. We reviewed the medical records of all cases of burns during pregnancy, who were admitted to Imam Reza Hospital, Mashhad, Iran, during March 2000-March 2013. The obtained data were analyzed regarding age, percentage of total body surface area (TBSA) burned, etiology (self-inflicted or suicidal against incidental burns) and cause of injury (kerosene, hot liquids, or gas explosion), gestational age, and fetal and maternal outcome.

Patients with mild (first-degree) burn injuries were excluded from the study. For all the included pregnant patients, the data regarding pregnancy laboratory tests, ultrasonography, and gynecologic consultation were recorded.

Results

The results demonstrated that 48 cases of burns during pregnancy were admitted during a 13-year period. On admission, the patients’ age ranged from 15 to 43 years, with a mean age of 25.0±6.32 years. In a one-year period (March 2009-March 2010), 439 female burns patients were admitted to our center, 79 (18.0%) of whom died, and 173 (39.4%) were in reproductive age (15-45 years old). The etiology of injury was accidental and self-inflicted in 28 (58.3%) and 20 (41.7%) of the cases, respectively.

The injury in 34 (70.8%), 12 (25.0%), and two (4.2%) cases was due to kerosene, gas explosion, and scald. The TBSA ranged between 10% and 95%, with a mean of 45.1±25.49%. The patients’ gestational age ranged from 8 to 41 weeks. In addition, 8, 27, and 13 patients were in the first, second, and third trimesters (Table 1).

Twenty-four mothers (50.0%) were dis-charged without any problems, eight (16.7%) had fetal death, 13 (27.1%) had abortion, two (4.2%) had normal vaginal delivery, and one (2.1%) had non-complicated cesarean section, totally, 21 (43.8%) fetuses died. Thirty-four patients were eventually discharged, and 14 mothers died. In the other words, in eight cases, both mother and fetus died (intrauterine death). Out of 13 abortions, six mothers died later and seven mothers were discharged. The burn surface area of the dead mothers was more than the survived ones (73.1% vs. 19.0%; P<0.001; Table 2).

The rate of maternal mortality, based on gestational trimester, was as follows: none in the first trimester, 8 out of 27 cases (29.6%) in the second trimester, and 6 out of 13 cases (46.2%) in the third trimester. These results indicate increased rate of maternal mortality with increasing gestational age. Table 3 demonstrates the etiology, TBSA, and maternal and fetal rate of mortality according to gestation trimesters.

Discussion

The etiology of burns in 58.3% and 41.7% of the pregnant patients was accidental and suicidal, respectively. Most of the accidental burns took place while cooking. The etiology of burns had a significant relationship with the rate of mortality (3). Among the 28 patients with accidental burn, only two (7.1%) deaths occurred, while one of them had previous history of seizure. Among the 20 patients with self-inflicted burns, there were 12 (60.0%) deaths. The mean TBSA in the accidental and self-inflicted groups was 32.8% and 63.6%, respectively, which were significantly different (P< 0.001).