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Stokes SC, Rubalcava NS, Theodorou CM, Bhatia MB, Gray BW, Saadai P, Russo RM, McLennan A, Bichianu DC, Austin MT, Marwan AI, Alkhoury F. Recognition and management of traumatic fetal injuries. Injury 2022; 53:1329-1344. [PMID: 35144809 DOI: 10.1016/j.injury.2022.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 02/02/2023]
Abstract
Trauma during pregnancy is the leading non-obstetric cause of morbidity and mortality, and accounts for five per 1000 fetal deaths. Direct fetal injury due to trauma during pregnancy is rare, and limited information is available about how to optimize fetal outcomes after injury. Early recognition and appropriate management of direct fetal trauma may improve outcomes for the fetus. There are currently no available guidelines to direct management of the injured fetus. We provide a detailed literature review of the management and outcomes of direct fetal injury following blunt and penetrating injury during pregnancy, and describe a suggested initial approach to the injured pregnant patient with a focus on evaluation for fetal injury. We identified 45 reported cases of blunt trauma resulting in direct fetal injury, with 21 surviving past the neonatal period, and 33 of penetrating trauma resulting in direct fetal injury, with 24 surviving past the neonatal period. Prenatal imaging identified fetal injury in 19 cases of blunt trauma and was used to identify bullet location relative to the fetus in 6 cases. These reports were used to develop management algorithms for the injured fetus.
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Affiliation(s)
- Sarah C Stokes
- Division of Pediatric General, Thoracic and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA.
| | - Nathan S Rubalcava
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI 48109, USA
| | - Christina M Theodorou
- Division of Pediatric General, Thoracic and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA
| | - Manisha B Bhatia
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Brian W Gray
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Payam Saadai
- Division of Pediatric General, Thoracic and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA
| | - Rachel M Russo
- Division of Trauma/Critical Care, Department of Surgery, University of California, Davis Medical Center, Sacramento, CA 95817, USA
| | - Amelia McLennan
- Department of Obstetrics and Gynecology, University of California Davis Medical Center, Sacramento, 95817, USA
| | - Dana C Bichianu
- Neonatology, Department of Child Health, University of Missouri, School of Medicine, Women's and Children's Hospital, Columbia, MO 65201, USA
| | - Mary T Austin
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston TX 77030, United States
| | - Ahmed I Marwan
- Division of Pediatric Surgery, University of Columbia School of Medicine, Columbia, MO, USA; Department of Pediatric Surgery, Nicklaus Children's Hospital, Miami, FL 33155, USA
| | - Fuad Alkhoury
- Division of Pediatric Surgery, University of Columbia School of Medicine, Columbia, MO, USA
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Abstract
The treatment of severely injured pregnant women places the highest demands on interdisciplinary cooperation in order to adequately account for maternal and fetal requirements. In the preclinical stage the mother must be optimally stabilized and treated. Important is the correct left lateral position (15° to relieve the vena cava) during the transfer to the trauma unit. On arrival at the hospital, obstetricians and neonatologists should be involved in the diagnostic and therapeutic measures at an early stage. In principle, all methods that are used in non-pregnant polytrauma patients should also be used without hesitation, especially in the initial routine diagnostics in order to establish the best treatment plan. The question of emergency delivery depends on the gestational age, the acute situation of the fetus and the mother as well as the risks resulting from the next therapeutic steps with respect to monitoring and intervention options in favor of the child.
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Affiliation(s)
- Uwe Hasbargen
- Klinik für Frauenheilkunde und Geburtshilfe, Perinatalzentrum, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland.
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