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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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Genetic Profiling of Idiopathic Antenatal Intracranial Haemorrhage: What We Know? Genes (Basel) 2021; 12:genes12040573. [PMID: 33920939 PMCID: PMC8071218 DOI: 10.3390/genes12040573] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022] Open
Abstract
Intracranial hemorrhage (ICH) is reported in premature infants and rarely, in prenatal life. Fetal ICH can be accurately identified in utero and categorized by antenatal sonography and/or MRI. Infectious disease, maternal drug exposure, alloimmune thrombocytopenia, maternal trauma, coagulation disorders and twin-to-twin transfusion syndrome can cause fetal ICH. However, in many cases, the cause is not identified and a genetic disorder should be taken into consideration. We conducted a review of the literature to investigate what we know about genetic origins of fetal ICH. We conducted targeted research on the databases PubMed and EMBASE, ranging from 1980 to 2020. We found 311 studies and 290 articles were excluded because they did not meet the inclusion criteria, and finally, 21 articles were considered relevant for this review. Hemostatic, protrombotic, collagen and X-linked GATA 1 genes were reported in the literature as causes of fetal ICH. In cases of ICH classified as idiopathic, possible underlying genetic causes should be accounted for and investigated. The identification of ICH genetic causes can guide the counselling process with respect to the recurrence risk, in addition to producing relevant clinical data to the neonatologist for the optimal management and prompt treatment of the newborn.
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