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April MD, Long B. Trauma in pregnancy: A narrative review of the current literature. Am J Emerg Med 2024; 81:53-61. [PMID: 38663304 DOI: 10.1016/j.ajem.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION Trauma accounts for nearly half of all deaths of pregnant women. Pregnant women have distinct physiologic and anatomic characteristics which complicate their management following major trauma. OBJECTIVE This paper comprises a narrative review of the most recent literature informing the management of pregnant trauma patients. DISCUSSION The incidence of trauma during pregnancy is 6-8%. The focus of clinical assessment must be on the mother, starting with the primary survey. During airway management, clinicians should consider early intubation if necessary and utilize gastric tubes to minimize the risk of aspiration. Pregnant women experience progesterone-mediated hyperventilation, and normal PaCO2 levels may portend imminent respiratory failure. Clinicians should utilize left lateral tilt in hypotensive pregnant women to displace the uterus off the inferior vena cava. Ultrasonography is an attractive imaging modality for pregnant women which is specific for ruling in intraabdominal hemorrhage but not sufficiently sensitive to exclude this diagnosis. Clinicians should not hesitate to order computed tomography imaging in unstable patients if there is diagnostic ambiguity. Cardiotocographic monitoring simultaneously assesses uterine contractions and fetal heart rate and should last at least 4 h for pregnant women following even minor abdominal trauma if their fetus has achieved viable gestational age (approximately 24 weeks). In the event of cardiac arrest, peri-mortem cesarean section may improve outcomes for the mother and fetus alike. Unique specific complications include uterine rupture and placental abruption, which require emergent resuscitation and obstetrics consultation for definitive management. Emergency clinicians should maintain a low threshold for transfer to a tertiary care center given correlations between even isolated and relatively minor traumatic injuries with adverse fetal and maternal outcomes. CONCLUSIONS Trauma is a common cause of morbidity and mortality in pregnant women. Emergency clinicians must understand the evaluation and management of pregnant trauma patients.
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Affiliation(s)
- Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 14th Field Hospital, Fort Stewart, GA, USA.
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Di Filippo S, Godoy DA, Manca M, Paolessi C, Bilotta F, Meseguer A, Severgnini P, Pelosi P, Badenes R, Robba C. Ten Rules for the Management of Moderate and Severe Traumatic Brain Injury During Pregnancy: An Expert Viewpoint. Front Neurol 2022; 13:911460. [PMID: 35756939 PMCID: PMC9218270 DOI: 10.3389/fneur.2022.911460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Moderate and severe traumatic brain injury (TBI) are major causes of disability and death. In addition, when TBI occurs during pregnancy, it can lead to miscarriage, premature birth, and maternal/fetal death, engendering clinical and ethical issues. Several recommendations have been proposed for the management of TBI patients; however, none of these have been specifically applied to pregnant women, which often have been excluded from major trials. Therefore, at present, evidence on TBI management in pregnant women is limited and mostly based on clinical experience. The aim of this manuscript is to provide the clinicians with practical suggestions, based on 10 rules, for the management of moderate to severe TBI during pregnancy. In particular, we firstly describe the pathophysiological changes occurring during pregnancy; then we explore the main strategies for the diagnosis of TBI taking in consideration the risks related to mother and fetus, and finally we discuss the most appropriate approaches for the management in this particular condition. Based on the available evidence, we suggest a stepwise approach consisting of different tiers of treatment and we describe the specific risks according to the severity of the neurological and systemic conditions of both fetus and mother in relation to each trimester of pregnancy. The innovative feature of this approach is the fact that it focuses on the vulnerability and specificity of this population, without forgetting the current knowledge on adult non-pregnant patients, which has to be applied to improve the quality of the care process.
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Affiliation(s)
- Simone Di Filippo
- Department of Biotechnology and Sciences of Life, Anesthesia and Intensive Care, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Daniel Agustin Godoy
- Neurointensive Care Unit, Sanatorio Pasteur, Catamarca, Argentina
- Intensive Care, Hospital Carlos Malbran, Catamarca, Argentina
| | - Marina Manca
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Camilla Paolessi
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Federico Bilotta
- Department of Anesthesiology, University of Rome “Sapienza”, Rome, Italy
| | - Ainhoa Meseguer
- Department of Obstetrics, Hospital Francesc de Borja, Gandia, Spain
| | - Paolo Severgnini
- Department of Biotechnology and Sciences of Life, Anesthesia and Intensive Care, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de València, Universitat de València, Valencia, Spain
| | - Chiara Robba
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
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Weißleder A, Kulla M, Annecke T, Beese A, Lang P, Beinkofer D, Lefering R, Trentzsch H, Jost C, Treffer D. [Acute treatment of pregnant women after severe trauma-a retrospective multicenter analysis]. Unfallchirurg 2020; 123:944-953. [PMID: 33180155 DOI: 10.1007/s00113-020-00915-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND For the medical team, the management of pregnant trauma patients is a particular challenge. The aim of this study is to compile this data and to determine differences between pregnant and not pregnant trauma patients. MATERIALS AND METHODS We carried out a retrospective data analysis from the TraumaRegister DGU® with a comparison of 102 pregnant and 3135 not pregnant women of child-bearing age (16-45 years) from 2016-2018 who were treated in a trauma center. All patients were delivered to the resuscitation room and received intensive care treatment. RESULTS In Germany, Austria and Switzerland 3.2% of all trauma patients (102 women) were pregnant. Women with an average age of 29 years suffered most often trauma as a result of a road traffic accident. Major trauma (Injury Severity Score [ISS] ≥16 points) was seen in 24.5% of the pregnant women and 37.4% of the nonpregnant women. A computer tomography (whole body computer tomography) was carried out in 32.7% of all pregnant women but in 79.8% of the nonpregnant women. As a result of the trauma, 2.9% of the pregnant and 3.5% of the not pregnant women died. The standardised mortality rate (SMR) was 0.42 in pregnant women and 0.63 in nonpregnant women. CONCLUSION For the first time there is data regarding incidence, trauma mechanism, prehospital and in-hospital care as well as intensive care of pregnant trauma patients in Germany, Austria and Switzerland. Further research regarding foetal outcome and trauma-related injuries in pregnant women is needed to develop an adjusted management for these patients ready to implement in trauma centres. Gynaecologists and obstetricians should be implemented in the trauma room team when needed.
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Affiliation(s)
- A Weißleder
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
- Klinik XX Gynäkologie, Bundeswehrkrankenhaus Westerstede, Westerstede, Deutschland.
| | - M Kulla
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - T Annecke
- Universität zu Köln, Medizinische Fakultät und Uniklinik, Klinik für Anästhesiologie und Operative Intensivmedizin, Kerpener Straße 62, 50937, Köln, Deutschland
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke - Krankenhaus Köln-Merheim, Köln, Deutschland
| | - A Beese
- Praxis für Frauenheilkunde & Geburtshilfe Jena, Jena, Deutschland
| | - P Lang
- Klinik für Unfallchirurgie und Orthopädie, Septische und Rekonstruktive Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
- Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke am Campus Köln-Merheim, Köln-Merheim, Deutschland
| | - D Beinkofer
- Klinik XX Gynäkologie, Bundeswehrkrankenhaus Westerstede, Westerstede, Deutschland
| | - R Lefering
- Klinik für Unfallchirurgie und Orthopädie, Septische und Rekonstruktive Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
- Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke am Campus Köln-Merheim, Köln-Merheim, Deutschland
| | - H Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstraße 53, 80336, München, Deutschland
| | - C Jost
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - D Treffer
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
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Greco PS, Day LJ, Pearlman MD. Guidance for Evaluation and Management of Blunt Abdominal Trauma in Pregnancy. Obstet Gynecol 2019; 134:1343-1357. [PMID: 31764749 DOI: 10.1097/aog.0000000000003585] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Blunt abdominal trauma is the leading type of traumatic injury in pregnancy, with motor vehicle crashes, falls, and assault being the most common etiologies. Several adverse outcomes can occur in pregnancy, including placental abruption, preterm labor and preterm delivery, uterine rupture, and pelvic fracture. Understanding and integration of key anatomic and physiologic changes in pregnancy are key when evaluating a pregnant trauma patient. Pregnant women should be managed in a medical center with the ability to provide adequate care to both trauma patients-the pregnant woman and fetus. Multiple clinical providers are usually involved in the care of pregnant trauma patients, but obstetric providers should play a central role in the evaluation and management of a pregnant trauma patient given their unique training, knowledge, and clinical skills. An algorithm for management of trauma in pregnancy should be used at all sites caring for pregnant women. An alignment of policies within each system optimizes appropriate triage, integration of care, management, and monitoring of pregnant trauma patients and their fetuses. Ensuring effective protocols for prehospital and hospital treatment, as well as thorough training of involved health care providers, is essential in ensuring that optimal care is provided.
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Affiliation(s)
- Patricia S Greco
- University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, Michigan
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Traumatic injuries to the pregnant patient: a critical literature review. Eur J Trauma Emerg Surg 2017; 45:383-392. [DOI: 10.1007/s00068-017-0839-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/12/2017] [Indexed: 11/26/2022]
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Battaloglu E, McDonnell D, Chu J, Lecky F, Porter K. Epidemiology and outcomes of pregnancy and obstetric complications in trauma in the United Kingdom. Injury 2016; 47:184-7. [PMID: 26404664 DOI: 10.1016/j.injury.2015.08.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/09/2015] [Accepted: 08/15/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To understand the epidemiology of pregnancy and obstetric complications encountered in the management of pregnant trauma patients. METHODS AND DESIGN Retrospective analysis of national trauma registry for recording of pregnancy status or obstetric complication in cases of trauma. Sub-division of patient cohort by severity of trauma and stage of pregnancy. Comparison of data sets between pregnant trauma patients and age-matched non-pregnant female trauma patients to determine patterns of injury and impact upon clinical outcomes. SETTINGS National registry data for the United Kingdom. OUTCOME For the five year period between 2009 and 2014, a total of 15,140 female patients, aged between 15 years old and 50 years old were identified within the trauma registry. A record of pregnancy was identified in 173 patients (1.14%) from within this cohort. Mechanisms of injury within the cohort of pregnant trauma patients saw increased rate of vehicular collision and interpersonal violence, especially penetrating trauma. Higher abbreviated injury scores were recorded for the abdominal region in pregnancy than in the non-pregnant cohort. Maternal mortality rates were seen to be higher, when compared with the non-pregnant trauma patient. Foetal survival rate from this series was 56% following trauma. Foetal death in pregnant trauma patients most frequently occurred in the 2nd trimester. No cases of isolated foetal survival were recorded following maternal trauma. CONCLUSIONS Trauma to pregnant patients is rare in the United Kingdom, encountered in 1% of female trauma patients of child bearing age. Observations in altered mechanisms of injury and clinical outcomes were recorded. This provides useful information regarding the clinical management of pregnant trauma patients and offers potential areas to investigate to optimise their care, as well as to focus injury prevention measures. LEVEL OF EVIDENCE IV--Case series.
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Affiliation(s)
- Emir Battaloglu
- Trauma & Orthopaedics Specialist Registrar, University Hospitals Birmingham, Birmingham, United Kingdom.
| | - Declan McDonnell
- Core Surgical Trainee Year One, University Hospital Southampton, Southampton, United Kingdom
| | - Justin Chu
- Obstetrics & Gynaecology Specialist Registrar and Clinical Research Fellow, Birmingham Women's Hospital, Birmingham, United Kingdom
| | - Fiona Lecky
- Trauma Audit Research Network, Salford, United Kingdom
| | - Keith Porter
- Clinical Traumatology and Trauma & Orthopaedics Consultant Surgeon, University Hospitals Birmingham, Birmingham, United Kingdom
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7
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Petrone P, Marini CP. Trauma in pregnant patients. Curr Probl Surg 2015; 52:330-51. [DOI: 10.1067/j.cpsurg.2015.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 07/08/2015] [Indexed: 11/22/2022]
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Abstract
Trauma in pregnancy is the leading non-obstetrical cause of maternal death and remains the most common cause of foetal demise. Many diagnostic and management challenges are present when dealing with the injured pregnant patient. Anatomical and physiological variations of pregnancy need to be understood in order to adapt medical management and overcome the numerous challenges which exist for such patients. The relative unfamiliarity of anatomical and physiological changes experienced in pregnancy means great care must be taken when managing such patients, especially in high energy trauma injuries. Review of the available evidence provides an epidemiological understanding for provision of trauma services. Obstetrics in trauma is a relative rare condition in the United Kingdom, however evidence based in the UK regarding the epidemiology is limited. This article also outlines the principle factors for the assessment and treatment of the injured obstetric patients, as well as discussing areas of ongoing uncertainty.
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Affiliation(s)
| | | | - Justin Chu
- Birmingham Women’s Hospital, Birmingham, UK
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9
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Pasley JD, Demetriades D. Penetrating fetal trauma with late complications: a case report. J Pediatr Surg 2012; 47:E9-11. [PMID: 22974637 DOI: 10.1016/j.jpedsurg.2012.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 03/13/2012] [Accepted: 04/05/2012] [Indexed: 11/18/2022]
Abstract
Survival after direct penetrating trauma to a fetus is very unusual. Our case below illustrates nonoperative management of a penetrating thoracoabdominal gunshot injury to the retroperitoneum with a late complication arising 15 years after the initial incident.
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Affiliation(s)
- Jason D Pasley
- Division of Trauma Surgery and Critical Care, LAC+USC Medical Center, Los Angeles, CA 90033, USA.
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10
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Ducarme G, Bonne S, Khater C, Ceccaldi PF, Poujade O, Luton D. [Acute non-obstetrical diseases during pregnancy and role of the obstetrician]. Presse Med 2011; 41:125-33. [PMID: 21632203 DOI: 10.1016/j.lpm.2011.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 03/17/2011] [Accepted: 04/07/2011] [Indexed: 10/14/2022] Open
Abstract
The management of a pregnant woman with an acute non-obstetrical disease must be made in narrow collaboration with an obstetrician. This one must be warned from the beginning of the care of the patient. In a pregnant woman, any acute medical, surgical or traumatic non-obstetrical disease can have obstetrical consequences. The diagnostic and therapeutic management of an acute non-obstetrical disease can have iatrogenic consequences during pregnancy. The most often described risks are early pregnancy loss, intra-uterine fetal death, placenta abruption, direct fetal hurts, preterm labor, prematurity and its complications. Obstetrical complications can induce maternal and neonatal life-threatening risks. Simple and easily accessible examinations in emergency allow detecting the obstetrical consequences of an acute non-obstetrical disease. During the management of an acute non-obstetrical disease in a pregnant woman, the induced obstetrical consequence of the disease can require emergency action of the obstetrician in conditions associated with maternal life-threatening risk. During the management of an acute non-obstetrical disease in a pregnant woman, once the mother condition was stabilized, the obstetrician had to estimate the fetal consequences and to adapt his or her therapeutic attitude. He or she sets up the fetal and placental surveillance adapted to the obstetrical risks and decides on the duration of this surveillance.
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Affiliation(s)
- Guillaume Ducarme
- Université Paris VII, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Beaujon, département de gynécologie obstétrique, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
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Petrone P, Talving P, Browder T, Teixeira PG, Fisher O, Lozornio A, Chan LS. Abdominal injuries in pregnancy: a 155-month study at two level 1 trauma centers. Injury 2011; 42:47-9. [PMID: 20655042 DOI: 10.1016/j.injury.2010.06.026] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 06/25/2010] [Accepted: 06/25/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Trauma in pregnancy is the leading cause of non-obstetrical maternal death and remains a major cause of fetal demise. The objective of this study was to examine the outcomes of pregnant patients sustaining abdominal injury. PATIENTS AND METHODS This is a retrospective analysis of all pregnant trauma patients admitted to two level 1 trauma centers from February 1, 1996 to December 31, 2008. Patient data abstracted included mechanism of injury, physiologic parameters on admission, Injury Severity Score (ISS), abdominal Abbreviated Injury Scale (AIS), gestational age, diagnostic and surgical procedures performed,complications, and maternal and fetal mortality. Univariate analysis and logistic regression analysis were used. RESULTS During the 155-month study period, 321 pregnant patients were included, of which 291 (91%)sustained a blunt injury, while 30 (9%) were victims of penetrating trauma. Of the penetrating injuries,22 (73%) were gunshot wounds, 7 (23%) stab wounds, and 1 (4%) shotgun injury. The overall maternal and fetal mortality was 3% (n = 9) and 16% (n = 45), respectively. Mean age was 22 6 year-old, and the mean ISS was 12 16. The overall mean abdominal AIS was 2 1.2. When adjusted for age, abdominal AIS,ISS, and diastolic blood pressure, the penetrating trauma group experienced higher maternal mortality [7%vs. 2% (adjusted OR: 7; 95% CI: 0.65–79), p = 0.090], significantly higher fetal mortality [73% vs. 10% (adjusted OR: 34; 95% CI: 11–124), p < 0.0001] and maternal morbidity [66% vs. 10% (adjusted OR: 25; 95% CI: 9–79)p < 0.0001]. CONCLUSIONS Fetal mortality and overall maternal morbidity remains exceedingly high, at 73% and 66%,respectively, following penetrating abdominal injury. Penetrating injury mechanism, severity of abdominal injury and maternal hypotension on admission were independently associated with an increased risk for fetal demise following traumatic insult during pregnancy.
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Affiliation(s)
- Patrizio Petrone
- Division of Acute Care Surgery (Trauma, Emergency Surgery & Surgical Critical Care), Department of Surgery, University of Southern California, Keck School of Medicine, LAC + USC Medical Center, Los Angeles, CA, United States.
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Shehu BB, Ismail NJ, Hassan I, Mahmud MR, Lasseini A. Fetal head injury from intentional penetrating abdominal trauma in pregnancy. ACTA ACUST UNITED AC 2010; 30:69-72. [PMID: 20196938 DOI: 10.1179/146532810x12637745452194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A male fetus was extruded from the uterus following multiple lower abdominal stab wounds to the mother. He was brought to the emergency room at 8 hours of age. He had sustained a compound skull fracture with brain contusion. There was no neurological deficit. Debridement and primary wound closure were undertaken. His mother had multiple lacerations to the uterus and a laceration of the fundus of the bladder. Following resuscitation, she had repair of the uterus and bladder and made an uneventful recovery. At 3 years of age, the boy is developing normally.
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Affiliation(s)
- B B Shehu
- Regional Centre for Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
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13
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Prähospitale geburtshilfliche Notfälle in einem bodengebundenen städtischen Notarztsystem. Anaesthesist 2009; 58:353-61. [DOI: 10.1007/s00101-009-1510-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Søreide K, Søiland H, Lossius HM, Vetrhus M, Søreide JA, Søreide E. Resuscitative emergency thoracotomy in a Scandinavian trauma hospital--is it justified? Injury 2007; 38:34-42. [PMID: 17083941 DOI: 10.1016/j.injury.2006.06.125] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2006] [Accepted: 06/12/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Resuscitative emergency thoracotomy (ET) is of value in selected (penetrating) trauma patients. Current survival-estimates and recommended guidelines are based on data from the United States. However, reports from European trauma centres are lacking. We report the current experience from a Scandinavian trauma hospital. METHODS Identification of all consecutive ETs performed during a 5-year period. Data on demographics, and injury severity score (ISS), mechanism and location were recorded. Physiological status on admission (revised trauma score, RTS) and probability of survival (Ps) were calculated. Signs of life (SOL) and need for closed-chest cardiopulmonary resuscitation (CC-CPR) were recorded through the post-injury phase. RESULTS Ten patients underwent ET with no survivors. The annual incidence of ET was 0.7 per 100,000 inhabitants during the study period, with an increasing trend during the last years (r=0.74, p=0.014). ETs were performed in 0.7% of all trauma admissions, and in 2.5% of all severely injured patients (ISS>or=16). Blunt mechanism dominated; only three had penetrating injuries. Most frequent location of major injury was "multiple" (n=4) and "thoracic" (n=4). The male to female ratio was 7:3. Median age was 51 years (range 21-77). Median ISS was 34.5 (range 26-75), indicating severely injured patients, with seriously deranged physiology (median RTS of 0.0, range 0-6.1) with poor chance of survival (median Ps of 4.4%, range 0-89.5%). Males had significantly lower RTS and Ps (p=0.007 and 0.03, respectively) than females. Eight patients had signs of life at some time post-injury, but only four in the emergency room. Six patients had both pre- and in-hospital CC-CPR. Four patients had additional surgery to ET. Two possible preventable deaths were identified (Ps) of 51 and 89%), one in a third trimester pregnancy. CONCLUSION Emergency thoracotomy is a rarely performed procedure in a rather busy Scandinavian trauma hospital, and outcome is dismal. Reevaluation of our decision-making process concerning the use of emergency thoracotomy is needed. How survival data and clinical experience in Europe compare to current figures from North America deserves further attention.
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Affiliation(s)
- K Søreide
- Department of Surgery, Stavanger University Hospital, Norway.
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