Newsgroup: it.scienza.medicina
Titolo: gravidanza e cinture di sicurezza

Anche se la legge esonera la donna in gravidanza dall'uso delle cinture di
sicurezza,  ne è consigliabile l'uso?
Esistono statistiche su problemi causati dalle cinture in caso di
piccoli/medi/gravi incidenti?
Grazie

 ne è consigliabile l'uso?
secondo me si, magari con un po' di intelligenza. Personalmente ho
sempre obbligato mia moglie ad indossarla con l'accortezza di tenere la
fascia inferiore "sotto" la pancia.
-- 
ciao
luh
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Premetto che non sono un'esperta, ma immagino che se il legilatore si
č dato pena di esonerare la gravida sia perchč, almeno a livello
teorico, il rischio di lesioni uterine/fetali da forze trancianti date
dalle cinture, che sono progettate per persone con caratteristiche
diverse da quella di una gravida, arriva ad essere paragonabile
all'effetto protettivo delle cinture stesse... quindi io penso che
quando il pancione fosse ormai molto ingombrante non le metterei piů,
se no la legge non la avrebbero fatta, no?
Lau

 se no la legge non la avrebbero fatta, no?
infatti nel mio precedente post avevo condizionato la cosa all'uso
"intelligente", se la fascia inferiore passa sopra al pancione (nel
senso che ci si poggia sopra, come verrebbe naturale) in caso di
incidente l'effetto e' devastante (sarebbe come cadere sulla pancia), se
invece la sposti sotto (e ce la devi mettere apposta) secondo me i
benefici diventano maggiori dei rischi (lo strappo non comprimerebbe la
pancia ma solo il bacino, per intenderci tra la pancia e il pube)
ricordati inoltre che in caso di urto frontale violento senza cintura e'
praticamente certo che sbatteresti col cranio contro il vetro, col
torace contro lo sterzo, e la pancia potrebbe sbattere in modo casuale
(a seconda della tua altezza e della regolazione del volante),
probabilmente sullo sterzo.
insomma, non e' una passeggiata, e te lo dice uno che un frontale lo ha
fatto e che ci ha tirato fuori la pelle solo grazie alle cinture. E
nonostante quello ci ho messo dei mesi a riprendermi.


 il legilatore si è dato pena di esonerare la gravida sia perchè,
Il legislatore si è dato pena di esonerare anche gli appartenenti alle
Forze dell'Ordine, immagino perchè le forze trancianti esercitate dalle
cinture di sicurezza costituiscano un grave impedimento ai movimenti...
:-) Tutto ciò mi appare in realtà alquanto strano, visto che indosso le
cinture di sicurezza da ben prima che diventasse un obbligo, e mi "sento"
molto meglio quando sono trattenuto sul sedile dalle cinture, specie se
guido "allegramente". La cintura costituisce un intralcio nel momento in
cui si allaccia: ma lo sgancio e l'arrotolamento automatico sono meno di
un instante, non provocano alcun impaccio, e mi chiedo perchè i tutori
della Legge non facciano il minimo sforzo per dare il buon esempio si
cittadini.
Quanto alle gravide, se la cintura è correttamente indossata e la fascia
obliqua è disposta in modo da non schiacciare il "pancione", la donna
incinta soffrirà certo molto meno, in caso di incidente, per essere
trattenuta dalle cinture piuttosto che per lo schiantarsi contro la parte
anteriore dell'abitacolo.
-- 
        ___
 /\/\/\/ _/ -Doctor Diabolicus-
/     / /_
\/\/\/\__/  -
http://web.tiscali.it/Scienza_e_Medicina

 piccoli/medi/gravi incidenti?
tieni presente che la salute della madre e del feto sono correlate fra loro;
durante un incidente con cinture di sicurezza si possono sviluppare forze
che danneggiano l'unità feto-placenta, ma le cinture riducono i danni
sostenuti dalla madre, e quindi dal feto stesso, nella maggioranza dei casi;
oltre tutto in assenza di cinture di sicurezza si possono verificare danni
seri anche in incidenti a bassa velocità. per questo la maggioranza delle
autorità sanitarie dei vari stati raccomanda le cinture anche in gravidanza,
anche nel III trimestre.
di seguito gli abstract di alcuni articoli sull'argomento:
Fortschr Med 1976 Sep 23;94(27):1496-9
[Seat belts and pregnancy]
Schumann K.
The best safety for the mother and her unborn child while driving a car is
the proper use of a seat belt. Only a correctly constructed and fitted
lap-shoulder safety harness should be used. The instruction to wear a seat
belt and to wear it correctly should be part of the pregnancy-care-program
for each physician.
J Reprod Med 1986 Mar;31(3):187-92
Automobile safety restraints for pregnant women and children.
Attico NB, Smith RJ 3rd, FitzPatrick MB, Keneally M.
Automobile safety restraints were introduced into the United States over 20
years ago but continue to be utilized by a minimum number of automobile
passengers. Universal usage could reduce highway crash fatalities by an
estimated 9,000-15,000 lives per year. Although women generally utilize
automobile safety restraints more than do men, there is a dramatic
diminution during pregnancy, when usage rates approximate those of men. In
pregnant women the largest single cause of maternal death is automobile
crashes. In infants and small children the restraint efficiency approaches
90% protection. Health care providers should become actively involved in
seeing that automobile safety restraints are properly utilized on pregnant
women, infants and children.
J Obstet Gynecol Neonatal Nurs 1986 Jul-Aug;15(4):339-44
Automobile seat belt practices of pregnant women.
Arneson S, Beltz E, Hahnemann B, Smith R, Triplett J, Witt V.
Despite the fact that seat belts have been proved effective in reducing
deaths and serious injuries, many pregnant women do not wear seat belts. A
study was conducted to examine the seat belt practices of pregnant women. Of
the 87 women who were interviewed, 40 reported using seat belts regularly
during pregnancy. However, almost one-third of them did not adjust the belts
properly for maximum protection. Older women and those with more education
were more likely to use their seat belts routinely. Only 20 women recalled
receiving information about seat belts during their pregnancies, but 48
women would have liked to receive more information.
J Trauma 1993 Jan;34(1):116-9 Related Articles, Links
A retrospective cohort study of seatbelt use and pregnancy outcome after a
motor vehicle crash.
Wolf ME, Alexander BH, Rivara FP, Hickok DE, Maier RV, Starzyk PM.
Harborview Injury Prevention and Research Center, Seattle, WA 98104.
To determine the effect of seatbelt use on pregnancy outcome we conducted a
population-based retrospective cohort study of pregnant women (20 weeks'
gestation or more) involved in motor vehicle collisions. Birth and fetal
death certificates were obtained for 1243 restrained and 1349 unrestrained
pregnant women involved in police-investigated motor vehicle crashes from
1980 through 1988. Unrestrained pregnant women drivers were 1.9 times more
likely to have a low birth weight baby (95% confidence intervals = 1.2, 2.9)
and 2.3 times more likely to give birth within 48 hours after the motor
vehicle crash (95% confidence intervals = 1.1, 4.8) than restrained pregnant
women drivers after adjusting for age and gestational age at crash. Although
a trend for an increased risk of fetal deaths was observed among
unrestrained women, too few fetal deaths occurred to accurately describe any
association with restraint status. This study provides reassurance that the
current recommendations on use of seatbelts by pregnant women are
appropriate and should be continued.
Am J Obstet Gynecol 1996 Oct;175(4 Pt 1):977-81
Automobile crash simulation with the first pregnant crash test dummy.
Pearlman MD, Viano D.
Department of Obstetrics and Gynecology, University of Michigan Medical
Center, Ann Arbor, USA.
OBJECTIVE: Our goal was to develop a pregnancy insert for the Hybrid III
(First Technology, Farmington, Mich.) crash dummy allowing evaluation of the
effects of various restraint conditions on energy transmission to both the
fetal and maternal compartments. STUDY DESIGN: A pregnancy insert with an
elasticized vinyl uterine shell, simulated silicon amniotic fluid, and a
28-week simulated fetus was fitted to a female crash dummy. The fetus was
instrumented with accelerometers in the head and thorax and a transducer to
measure force transmission through the uterus. Thirty-nine crash tests were
run under six different restraint conditions at speeds ranging from 10 to 25
miles/hr. Fetal responses were compared for different restraint conditions.
RESULTS: Increasing speed of the crash resulted in greater force
transmission through the uterus. Placement of the lap belt over the uterus
instead of under the uterus resulted in a threefold to fourfold increase in
force transmission through the uterus at all speeds tested. Air bag
deployment in the unbelted or out-of-position dummy (laying against air bag)
appears to impart significant energy transmission to the fetus. CONCLUSIONS:
Energy transmission can be measured in terms of both abdominal force and
acceleration within the fetal head and thorax. This new dummy demonstrates
substantial transmission of energy, which is accentuated in some restraint
conditions commonly used by pregnant women. The use of the 3-point restraint
system appears to reduce the likelihood of injury in this model.
West J Med 1997 Jul;167(1):19-22 Related Articles, Links
Motor vehicle crashes and maternal mortality in New Mexico: the significance
of seat belt use.
Schiff M, Albers L, McFeeley P.
Department of Obstetrics and Gynecology, College of Nursing, Albuquerque,
New Mexico.
In recent years, as deaths from medical complications during pregnancy have
declined, injuries-specifically those sustained in motor vehicle
crashes-represent a growing proportion of all pregnancy-associated deaths.
To investigate pregnancy-associated deaths in motor vehicle crashes in New
Mexico, we scrutinized the database of the New Mexico Office of the Medical
Investigator for all deaths during pregnancy and up to 6 weeks postpartum
from 1986 through 1995. A total of 97 deaths were identified, 47 of which
were injury-related. Motor vehicle crashes accounted for 33 (approximately
70%) of the injury-related deaths. We analyzed the data on motor vehicle
crashes for decedent's age and ethnicity, fetal gestational age, time of
crash, rural vs urban location of crash, seat belt use, and drug and alcohol
use. Compared with non-Hispanic white women, proportionately higher numbers
of Hispanic and American Indian pregnant women were killed in motor vehicle
crashes. In searching for modifiable risk factors, we noted that 45% of the
crashes involved alcohol and that the majority of pregnant women killed
(77%) were not wearing seat belts at the time of the crash. We conclude that
education about seat belt use during pregnancy (as well as the dangers of
alcohol use and riding with intoxicated drivers while pregnant) is a
promising strategy to reduce motor vehicle fatalities.
J Trauma 1998 Jul;45(1):83-6
Trauma in pregnancy: maternal and fetal outcomes.
Shah KH, Simons RK, Holbrook T, Fortlage D, Winchell RJ, Hoyt DB.
Division of Trauma, University of California San Diego Medical Center, USA.
OBJECTIVE: Pregnancy imposes significant physiologic demands that may
confuse and complicate the evaluation, resuscitation, and definitive
management of pregnant women who sustain trauma. Accurate prediction of
fetal outcome after trauma remains elusive. The objective of this study was
to characterize patterns of injury in pregnant women, to determine if
pregnancy affects maternal morbidity and mortality after trauma, and to
identify predictors of fetal death. METHODS: We performed a retrospective,
case-control analysis of all injured pregnant patients admitted to the
Trauma Service at the University of California San Diego Medical Center from
1985 to 1995. RESULTS: We identified 114 injured pregnant patients. Motor
vehicle crashes accounted for 70% of injuries, and of these, 46% of patients
were not using seat belts or helmets. Violence accounted for 12% of
injuries. Injured pregnant women with Injury Severity Scores > 8
demonstrated similar mortality, morbidity, and length of stay to matched
nonpregnant control patients. Pregnant women were more likely to sustain
serious abdominal injury and were less likely to sustain severe head injury.
Identified risk factors for fetal loss include maternal death, overall
maternal injury severity, the presence of severe abdominal injury, and the
presence of hemorrhagic shock. CONCLUSION: There appears to be a group of
pregnant women in San Diego at high risk for traumatic injury who should be
targeted for preventative strategies including improved seat belt use.
Pregnancy does not increase mortality or morbidity after trauma but
influences the pattern of injury. Maternal death, high Injury Severity
Score, serious abdominal injury, and hemorrhagic shock are risk factors for
fetal loss.
Annu Proc Assoc Adv Automot Med 2000;44:37-55
Investigations of crashes involving pregnant occupants.
Klinich KD, Schneider LW, Moore JL, Pearlman MD.
Biosciences Division, University of Michigan Transportation Research
Institute, Ann Arbor, Michigan, USA.
Case reports of 16 crashes involving pregnant occupants are presented that
illustrate the main conclusions of a crash-investigation program that
includes 42 crashes investigated to date. Some unusual cases that are
exceptions to the overall trends are also described. The study indicates a
strong association between adverse fetal outcome and both crash severity and
maternal injury. Proper restraint use, with and without airbag deployment,
generally leads to acceptable fetal outcomes in lower severity crashes,
while it does not affect fetal outcome in high-severity crashes. Compared to
properly restrained pregnant occupants, improperly restrained occupants have
a higher risk of adverse fetal outcome in lower severity crashes, which
comprise the majority of all motor-vehicle collisions.
in gravidanza le cinture andrebbero quindi usate, e con delle precauzioni di
impiego; questa brochune è stata sviluppata dal national highway traffic
safety administration del dipartimento dei trasporti degli stati uniti in
collaborazione con l'american college of obstetricians and gynecologists e
la national healthy mothers, healthy babies coalition, ed è una fonte
piuttosto autorevole. tra l'altro la stessa brochure raccomanda di non
disinserire l'air-bag.
http://www.dps.state.mn.us/ots/resource_catalog/images/BUA_Preg.pdf