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A burn is an injury caused by an energy source, such as heat, a flame, solar radiation, or an electrical shock. Types of energy burns include thermal burns (burns from heat), chemical burns, electrical burns, and radiation burns (burns from x-rays, ultraviolet radiation, and other types of radiation). Sunburns are a type of radiation burn. Doctors diagnose burns based on your history of exposure to an energy source able to cause the burn, plus physical examination of the burned area, or areas, of your skin.
Burns can occur during pregnancy, just as they can occur outside of pregnancy. In pregnant women, burns can occur as accidents, or from being in the sun too long. In the case of sunburns, generally the more fair your skin the greater your susceptibility. Pregnancy furthermore increases your susceptibility to sunburn, due to the hormonal changes. This means that it will take less time in the sunlight for you to burn while pregnant compared with being in sunlight at the same time of day and same time of year when you are not pregnant.
Mild burns localized to a small area of the skin, including mild sunburns, do not cause problems other than pain and irritation in that area. However, severe sunburns, as well as severe other burns, can lead to loss of body fluids, leading to dehydration. Such injuries can lead to changes in regulation of body temperature that can disrupt your physiology, leading to lightheadedness, dizziness, and fainting. Severe burns also can lead to infections, since the skin is an important barrier against penetration of agents into the body, including microorganisms.
Burns are rated in terms of severity as follows:
- First-degree burns affect only the epidermis, the outer layer of the skin. The affected site is red, dry, and painful, without blisters, and usually there is no long-term damage. Mild sunburns typically fall into this category.
- Second-degree burns reach partway into the inner layer of skin called the dermis. The site is red, with blisters, and can be swollen and painful.
- Third-degree burns involve both the epidermis and dermis, and also can damage underlying tissue, such as muscle, tendon, and bone, although sometimes the term ‘fourth-degree burn’ is applied to burns reaching muscle, tendon, and bone. The site is white, or charred, and sensation is lost, due to destruction of the nerve endings.
Long-term effects of sunburn include skin cancer, typically a mild type of skin cancer called basal cell carcinoma, which can disfigure, but does not kill. Some controversy, and certainly complexity, surrounds associations between sunlight exposure and a very dangerous type of skin cancer called cutaneous malignant melanoma. In the setting of severe burn injuries, survival and death are related directly to the total body surface area of burns (TBSAB). The greater the TBSAB, the lower the chances of survival.
If any kind of burn is severe enough to disrupt your body fluids and/or temperature, this increases the risk of preterm labor, which can have long-term effects on the child’s health as an infant, and possibly behavioral effects later in childhood. Such physiological changes also increase the risk of spontaneous abortion (miscarriage).
Pain and irritation from minor burns can be treated with over-the-counter pain medications, such as acetaminophen and paracetamol, which are thought to be safe during pregnancy. However, NSAIDs (such as ibuprofen, naproxen) and salicylates (such as aspirin) should be avoided, particularly toward the end of pregnancy. In the past, it was thought that NSAIDs could be most dangerous during the earlier phases of pregnancy on the grounds that they could cause a spontaneous abortion (miscarriage), but the overall picture from the evidence to date is that there is no major miscarriage risk from NSAIDs. Nevertheless, there is increasing risk from NSAIDs as pregnancy advances. During fetal life, blood enters the right side of the fetal heart and much of it is detoured into the left side of the heart. The rest goes into the pulmonary artery, and from there is detoured through a vessel called the ductus arteriosus, which carries the blood to the fetal aorta, the same vessel that receives blood from the left side of the heart. Normally, the ductus arteriosus closes and disappears within a couple of days after birth, which helps the baby adjust to the outside environment, where her own lungs supply oxygen and remove carbon dioxide. Exposure to NSAIDs during fetal life can close the ductus arteriosus prematurely, causing high pressure in the lungs, in which case the baby can be born with a serious condition called persistent pulmonary hypertension in newborns (PPHN), which can be fatal. It’s also possible that NSAIDs used during pregnancy may cause kidney problems in the child. Acetaminophen, paracetamol, and NSAIDs are thought to be relatively safe in mothers who breastfeed.
Along with pain medications, sunburns can be treated with lotions containing aloe vera, or a moisturizer, none of which pose harm during pregnancy. Lotions applied to the skin for burns, including sunburns, should be kept away from areas of the skin where the infant is nursing. Severe burns, whether from the sun or other causes, require several different types of medications, as well as procedures, but such injuries are life threatening to the point that preserving the pregnancy may not always be possible. Burns can be treated with a range of surgical strategies, including skin grafts, subsequent to the initial management of fluids and electrolytes.
