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Kutty RK, Sreemathyamma SB, Sivanandapanicker JL, Asher P, Peethambaran A. Spontaneous Fetal Subdural Hematoma. Neurol India 2022; 70:2249-2253. [PMID: 36352664 DOI: 10.4103/0028-3886.359288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Raja K Kutty
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | | | | | - Prasanth Asher
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Anilkumar Peethambaran
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
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2
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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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3
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Germano JRG, de Melo ACT, Ribeiro LG, Franco CL, Ribeiro PRJ, Morais BA. Fetal epidural hematoma secondary to a mild blunt prenatal trauma: case report and review of the literature. Childs Nerv Syst 2022; 38:683-686. [PMID: 34129080 DOI: 10.1007/s00381-021-05251-3] [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: 05/17/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
Fetal intracranial hemorrhage affects 1 in every 10,000 pregnancies. In most cases, the etiology of the bleeding is multifactorial, and they can be either related to the mother or the fetus. Blunt prenatal trauma was occasionally associated with these hemorrhages, nevertheless, reports of hematomas secondary to mild traumas are rare. Within the prenatal intracranial bleedings, the most frequent are the subarachnoid hematoma and intraparenchymal, scarcely ever the epidural hematoma. Treating these bleedings is challenging due to the ongoing pregnancy. Thus, the prognosis is often reserved, with a mortality rate of 43% and 25% of neurological sequelae. Here, we report a singular case of a fetal epidural hematoma secondary to a mild blunt trauma at the third trimester with a good outcome.
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Affiliation(s)
| | | | | | | | - Paulo Ronaldo Jubé Ribeiro
- Department of Neurological Surgery, Children's Hospital, Goiânia, Brazil.,Department of Neurological Surgery, Hospital das Clinicas, School of Medicine, Federal University of Goiás, Goiânia, Brazil
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4
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Mathur S, Nicolaou S. Invited Commentary on “Traumatic Brain Injury: Imaging Patterns and Complications”. Radiographics 2019; 39:1595-1597. [DOI: 10.1148/rg.2019190186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shobhit Mathur
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medical Imaging, St Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Savvas Nicolaou
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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5
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Christian MA, Samms-Vaughan M, Lee M, Bressler J, Hessabi M, Grove ML, Shakespeare-Pellington S, Coore Desai C, Reece JA, Loveland KA, Boerwinkle E, Rahbar MH. Maternal Exposures Associated with Autism Spectrum Disorder in Jamaican Children. J Autism Dev Disord 2019; 48:2766-2778. [PMID: 29549549 DOI: 10.1007/s10803-018-3537-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with poorly understood etiology. Many maternal exposures during pregnancy and breastfeeding potentially interfere with neurodevelopment. Using data from two age- and sex-matched case-control studies in Jamaica (n = 298 pairs), results of conditional logistic regression analyses suggest that maternal exposures to fever or infection (matched odds ratio (MOR) = 3.12, 95% CI 1.74-5.60), physical trauma (MOR 2.02, 95% CI 1.01-4.05), and oil-based paints (MOR 1.99, 95% CI 1.14-3.46) may be associated with ASD. Additionally, maternal exposure to oil-based paints may modify the relationship between maternal exposure to pesticides and ASD, which deepens our understanding of the association between pesticides and ASD.
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Affiliation(s)
- MacKinsey A Christian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Maureen Samms-Vaughan
- Department of Child and Adolescent Health, The University of the West Indies (UWI), Mona Campus, Kingston, Jamaica
| | - MinJae Lee
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, USA.,Division of Clinical and Translational Sciences, Department of Internal Medicine, The University of Texas McGovern Medical School, Houston, TX, USA
| | - Jan Bressler
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Manouchehr Hessabi
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Megan L Grove
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Charlene Coore Desai
- Department of Child and Adolescent Health, The University of the West Indies (UWI), Mona Campus, Kingston, Jamaica
| | - Jody-Ann Reece
- Department of Child and Adolescent Health, The University of the West Indies (UWI), Mona Campus, Kingston, Jamaica
| | - Katherine A Loveland
- Department of Psychiatry and Behavioral Sciences, The University of Texas McGovern Medical School, Houston, TX, USA
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Mohammad H Rahbar
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA. .,Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, USA. .,Division of Clinical and Translational Sciences, Department of Internal Medicine, The University of Texas McGovern Medical School, Houston, TX, USA.
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Nishida N, Ina S, Hata Y, Nakanishi Y, Ishizawa S, Futatani T. Fetal closed head injuries following maternal motor vehicle accident: A clinicopathologic case report. Medicine (Baltimore) 2018; 97:e13133. [PMID: 30383704 PMCID: PMC6221710 DOI: 10.1097/md.0000000000013133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The clinicopathologic appearance of fetal closed head injury (FCHI) due to a maternal motor vehicle accident has not been fully investigated because of its extreme rarity. PATIENTS CONCERN A 22-year-old woman at 31 weeks of gestation was riding in the front passenger seat of a car, and another rightward-turning car struck the right side of her vehicle. DIAGNOSIS Uterine injury with placental abruption was strongly suspected. INTERVENTION A live female infant in breech presentation was delivered by emergency caesarean section. OUTCOMES Although the female infant was and showed no evidence of trauma on her body surface. She exhibited a convulsion on the day of birth, and subsequent ultrasonography revealed possible intracranial hemorrhage. Although laboratory parameters associated with circulatory and respiratory function suggested a good response to the intensive care administered during the treatment course, the infant died 6 days later despite intensive care. Autopsy showed severe brain softening, subarachnoid hemorrhage with cerebral and cerebellar contusion, and bilateral thalamic hemorrhage. No hypoxic/ischemic changes of the thoracoabdominal organs were evident at autopsy. LESSONS This was a clear case of FCHI by both shear and tensile forces. Multiple factors including the structural vulnerability of the fetal brain, the head posture of the fetus, the crash location and direction of force on the vehicle, and the employment of safety equipment may have contributed to the occurrence of FCHI in the present case.
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Affiliation(s)
- Naoki Nishida
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | | | - Yukiko Hata
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Yuko Nakanishi
- Department of Pathology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Shin Ishizawa
- Department of Pathology, Toyama Prefectural Central Hospital, Toyama, Japan
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7
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Cerebellar hemorrhage in utero associated with ‘massive’ fetal thrombotic vasculopathy. ASIAN BIOMED 2018. [DOI: 10.2478/abm-2010-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract
Background: Cerebellar hemorrhage is a rare but serious perinatal condition with various etiologies leading to fetal and neonatal death and adverse neurological complications. Complete autopsy and placental examination are essential for identification of a cause of the bleeding. Objective: Present a case of cerebellar hemorrhage in utero associated with ‘massive’ fetal thrombotic vasculopathy (FTV). Method: Autopsy of a stillborn female fetus, 26 weeks gestation, with intrauterine growth restriction, delivered by a 37-year-old woman. Results: The fetus showed multiple recent peticheal hemorrhages along the cerebellar cortex. The placenta revealed a large thrombosed chorionic blood vessel. Microscopic findings showed multiple vascular thrombosis and massive FTV throughout the placental villi. These were recognized as two histologic patterns, ‘early’ stromal karryorhxis, and ‘late’ villous stromal involution. Conclusion: Massive FTV was a leading cause of fetal stress due to increased resistant of downstream placental villi. This longstanding stressful environment induced auto-regulation impairment of fetal cerebral blood flow resulting in cerebellar parenchymal bleeding. Careful placental examination is beneficial for understating the mode and mechanism of fetal death.
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8
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Delanghe G, Squier W, Sonnaert M, Dudink J, Lequin M, Govaert P. Neonatal subcortical bruising. Clin Case Rep 2018; 6:407-415. [PMID: 29445487 PMCID: PMC5799613 DOI: 10.1002/ccr3.1360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 11/23/2017] [Accepted: 11/29/2017] [Indexed: 12/04/2022] Open
Abstract
A specific type of acute brain injury can occur during birth, presenting on ultrasound examination with focal, unilateral, or asymmetrical change in the core of the superior frontal gyri. Ultrasound inspection of the superior gyri near the convexity of the frontal lobe is warranted following mechanically difficult delivery.
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Affiliation(s)
- Gwenda Delanghe
- Department of NeonatologyMiddelheim Hospital AntwerpAntwerpBelgium
| | - Waney Squier
- Formerly Consultant Neuropathologist at Oxford John Radcliffe University HospitalOxfordUK
| | - Michel Sonnaert
- Department of NeonatologyUniversity Hospital BrusselsBrusselsBelgium
| | - Jeroen Dudink
- Department of NeonatologyWilhelmina Children's Hospital UtrechtUtrechtThe Netherlands
| | - Maarten Lequin
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Paul Govaert
- Department of NeonatologyMiddelheim Hospital AntwerpAntwerpBelgium
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Yu M, Xu D, Zhang A, Shen J. Spontaneous fetal femoral fracture: a case report and literature review. J Int Med Res 2018; 46:1282-1287. [PMID: 29332432 PMCID: PMC5972261 DOI: 10.1177/0300060517744923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Spontaneous fetal femoral fractures are uncommon in the paediatric setting. The major clinical presentations of a spontaneous fetal femoral fracture are femoral angulation, shortness of the femur and even a marked fracture line. This case report describes a spontaneous fetal femoral fracture of the right femur, which was detected by routine ultrasonography during the 19th week of gestation in a 24-year-old woman. On routine follow-up visits, the angulation of the right femur in the fetus gradually improved. A caesarean section was undertaken at 39 weeks +5 days of gestation and an X-ray was taken on the second day after birth, which showed that the fracture had healed and the callus had been absorbed. The lengths of the two femurs of the baby were not equal; the right femur was 84 mm, which was 11 mm shorter than the left femur. In cases like this, postnatal follow-up is essential so that an operation can be carried out in a timely manner when the deformity is apparent.
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Affiliation(s)
- Mingming Yu
- Department of Paediatric Surgery, Nanjing Medical University, Affiliated 261546 Wuxi People's Hospital , Wuxi, Jiangsu Province, China
| | - Dapeng Xu
- Department of Paediatric Surgery, Nanjing Medical University, Affiliated 261546 Wuxi People's Hospital , Wuxi, Jiangsu Province, China
| | - Aiguo Zhang
- Department of Paediatric Surgery, Nanjing Medical University, Affiliated 261546 Wuxi People's Hospital , Wuxi, Jiangsu Province, China
| | - Jun Shen
- Department of Paediatric Surgery, Nanjing Medical University, Affiliated 261546 Wuxi People's Hospital , Wuxi, Jiangsu Province, China
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10
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Abstract
The term “birth trauma” is one that is well ingrained into the lexicon of medical providers. There is ample information of the types of injuries that are incurred during the birth process. However, there is no uniformed term for the process of an unforeseen act that leads to a precipitous birth. We would like to show a case report of such an act. The infant's injuries were sustained while in utero and the trauma induced a medical team to deliver the infant due to non-reassuring heart tones. Also, we would like to introduce the term of “trauma-induced delivery” into the medical literature as a way to describe similar types of deliveries that are influenced by factors related to physical forces applied to the mother's body, either intentional or unintentional. Introduction of the term “trauma-induced delivery(ies)” into the literature Leading cause of non-obstetric maternal deaths has been from trauma. Around 7% of all pregnancies may have been affected by a traumatic event. Trauma-induced deliveries can be set off by accidents, physical abuse, or self-inflicted.
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Joseph JR, Smith BW, Garton HJL. Blunt prenatal trauma resulting in fetal epidural or subdural hematoma: case report and systematic review of the literature. J Neurosurg Pediatr 2017; 19:32-37. [PMID: 27739945 DOI: 10.3171/2016.7.peds16282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Blunt prenatal trauma is known to have consequences to the developing brain, and can result in subdural hematoma (SDH) or epidural hematoma (EDH). The authors present a case of blunt prenatal trauma resulting in a fetal SDH, intraparenchymal hematoma, and intraventricular hemorrhage, and perform a systematic review of the literature. This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Relevant studies (up to April 2016) that reported on cases of fetal SDH or EDH after blunt prenatal trauma were identified from the PubMed database. The primary outcome was fetal mortality, and the secondary outcome was neurological outcome. Fourteen studies were included in the analysis, comprising a total of 14 patients including the present case. The average gestational age at discovery of hemorrhage was 30.1 weeks. Nine mothers were in a motor vehicle collision and 3 were assaulted; the mechanism of injury for 2 mothers was not defined. Twelve patients had SDH, 1 had EDH, and 1 had conflicting reports. Three patients had intrauterine fetal demise, and 3 died in the neonatal period after birth. Three patients had persistent neurological deficit, and 5 were neurologically intact. Fetal SDH or EDH after blunt trauma to the mother trauma is rare and is associated with mortality. However, a significant number of patients can have good neurological outcomes.
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Affiliation(s)
- Jacob R Joseph
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Brandon W Smith
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Hugh J L Garton
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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12
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Gallo Vallejo J, Gallo Padilla D. Traumatismos pélvicos que ocasionan fracturas del anillo pélvico en la gestante Manejo. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2015. [DOI: 10.1016/j.gine.2014.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Imaging of Trauma: Part 2, Abdominal Trauma and Pregnancy—A Radiologist's Guide to Doing What Is Best for the Mother and Baby. AJR Am J Roentgenol 2012; 199:1207-19. [DOI: 10.2214/ajr.12.9091] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Sadro CT, Zins AM, Debiec K, Robinson J. Case report: lethal fetal head injury and placental abruption in a pregnant trauma patient. Emerg Radiol 2012; 19:175-80. [DOI: 10.1007/s10140-011-1017-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 12/27/2011] [Indexed: 10/14/2022]
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Abstract
UNLABELLED Intrauterine fracture is an extremely rare finding, but can occur as the result of maternal trauma, osteogenesis imperfecta (OI), or theoretically other metabolic/structural abnormalities. Increased clinical awareness of the diagnosis and optimal management of these cases can lead to more positive outcomes for the patient and her child. Blunt abdominal trauma late in gestation increases the risk of fetal skull fracture, while a known diagnosis of OI or other abnormalities leading to decreased fetal bone density creates concern for long bone fracture. Biochemical and genetic tests can aid in the prenatal diagnosis of OI, while ultrasound is the best overall imaging modality for identifying fetal fracture of any etiology. When fetal fracture is diagnosed radiologically, specific management is recommended to promote optimal outcomes for mother and fetus, with special consideration given to the mother with OI. With the exception of fetal fractures due to lethal conditions, cesarean delivery is recommended in most cases, especially when fetal or maternal well-being cannot be assured. When a patient presents with risk factors for intrauterine fracture, careful evaluation via thorough history-taking, ultrasonography of the entire fetal skeleton, and laboratory tests should be performed. Heightened awareness of intrauterine fracture allows better postpartum management, whether for simple fracture care or for long-term care of patients with OI or genetic/metabolic abnormalities. TARGET AUDIENCE Obstetricians & Gynecologist, Family Physicians. LEARNING OBJECTIVES After completion of this educational activity, the reader will be able to compare x-ray, ultrasound modalities and MRI and their utility in diagnosing fetal fracture. Formulate a differential diagnosis for fetal fracture. Propose a delivery plan for a patient whose fetus has a prenatally diagnosed fetal fracture.
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Abstract
Fetal MRI is clinically performed to evaluate the brain in cases where an abnormality is detected by prenatal sonography. These most commonly include ventriculomegaly, abnormalities of the corpus callosum, and abnormalities of the posterior fossa. Fetal MRI is also increasingly performed to evaluate fetuses who have normal brain findings on prenatal sonogram but who are at increased risk for neurodevelopmental abnormalities, such as complicated monochorionic twin pregnancies. This paper will briefly discuss the common clinical conditions imaged by fetal MRI as well as recent advances in fetal MRI research.
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Piastra M, Pietrini D, Massimi L, Caldarelli M, De Luca D, Del Lungo LM, De Carolis MP, Di Rocco C, Conti G, Zecca E. Severe subdural hemorrhage due to minimal prenatal trauma. J Neurosurg Pediatr 2009; 4:543-6. [PMID: 19951041 DOI: 10.3171/2009.7.peds08223] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report a case of minimal prenatal trauma producing a large subdural hematoma in the fetus, which was diagnosed in utero by MR imaging. The occurrence of such a complication is extremely rare in the absence of significant maternal trauma. Prenatally diagnosed intracranial hemorrhages, particularly those that are subdural in origin, have a poor prognosis in most cases. After birth, brain compression required a complex neurosurgical intervention because simple hematoma evacuation was not possible. The clinical and neurological outcome at 6 months was excellent, as confirmed by the neuroimaging findings.
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Affiliation(s)
- Marco Piastra
- Paediatric Intensive Care Unit, Catholic University Medical School, A.Gemelli Hospital, L.go Gemelli 8, 00168 Rome, Italy.
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18
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Poretti A, Prayer D, Boltshauser E. Morphological spectrum of prenatal cerebellar disruptions. Eur J Paediatr Neurol 2009; 13:397-407. [PMID: 18945628 DOI: 10.1016/j.ejpn.2008.09.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2008] [Revised: 06/25/2008] [Accepted: 09/01/2008] [Indexed: 02/06/2023]
Abstract
There is increasing evidence that the cerebellum is susceptible to both prenatal infections and haemorrhages as well as being vulnerable in extremely preterm babies, but not to perinatal and postnatal hypoxic-ischaemic injuries. Starting with the imaging appearance we describe and illustrate a spectrum of prenatal cerebellar disruptions: cerebellar agenesis; unilateral cerebellar hypoplasia; unilateral cerebellar cleft; global cerebellar hypoplasia; vanishing cerebellum in myelomeningocele; and disruption of cerebellar development in preterm infants. We discuss neuroradiological characteristics, possible disruptive events, and clinical findings in the different morphological patterns. Remarkably, the same disruptive agent can cause different neuroradiological patterns, which appear likely to represent a morphological spectrum. The analysis of imaging patterns is crucial in recognising cerebellar disruptions. Recognition of cerebellar disruptions and their differentiation from cerebellar malformations is important in terms of diagnosis, prognosis, and genetic counselling.
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Affiliation(s)
- Andrea Poretti
- Department of Paediatric Neurology, University Children's Hospital of Zurich, Zurich, Switzerland
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19
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AU-YONG ITH, WARDLE SP, McCONACHIE NS, JASPAN T. Isolated cerebral cortical tears in children: aetiology, characterisation and differentiation from non-accidental head injury. Br J Radiol 2009; 82:735-41. [DOI: 10.1259/bjr/81603888] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Leroy-Malherbe V, Bonnier C, Papiernik E, Groos E, Landrieu P. The association between developmental handicaps and traumatic brain injury during pregnancy: an issue that deserves more systematic evaluation. Brain Inj 2007; 20:1355-65. [PMID: 17378227 DOI: 10.1080/02699050601102202] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS Trauma during pregnancy is commonly viewed as benign for the foetus when the delivery occurs normally. This study revisits that point of view. METHOD We included eighteen patients having a neurological handicap with an anamnesis of an accident during pregnancy and a follow-up sufficient to determine a definite outcome. RESULTS Pregnancy outcome and observed management. Foetal abnormalities were detected in six cases between the first and the thirteenth day after the trauma. Emergency delivery or rapid birth after signs of foetal distress occurred in five cases. One baby died soon after birth. One-third of cases were not submitted to any investigation. VARIOUS NEUROLOGICAL HANDICAPS WERE RECORDED: Congenital microcephaly (three patients), congenital hydrocephalus (three), Infantile cerebral hemiplegy (six), quadriplegy with severe encephalopathy (four), diplegy (one), clumsiness with cerebellar atrophy (one), Moebius syndrome (one), mental retardation with autistic features (two), learning disability (one) auditory agnosia (one). Cerebral imaging showed macroscopic abnormalities in fourteen patients, evoking various pathogenetic hypotheses. CONCLUSION The association between maternal trauma and foetal brain lesions lacks sufficient investigation in many cases. Prospective studies are needed to clarify both medical and legal issues. Guidelines are proposed for obstetrical and paediatric management after significant maternal trauma.
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Affiliation(s)
- V Leroy-Malherbe
- Service de Neurologie Pédiatrique, CHU KREMLIN-BICETRE, LE KREMLIN-BICETRE 94275, France
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Abstract
Ten children (six males, four females) with spastic (n=9) and mixed spastic-dyskinetic (n=1) cerebral palsy were born at term to mothers who earlier in the pregnancy had been involved in accidents without suffering overt abdominal injury, placental abruption, or premature onset of labour. At follow-up (at ages 2-24y), Gross Motor Function Classification System levels were II (n=7) and V (n=3). Cognitive level was normal in five patients, while learning disability was mild to moderate in two and severe in three. Magnetic resonance imaging of the brain in all children, assessed blind to the dates of maternal trauma in pregnancy, showed lesions consistent with prenatal vascular insult at the time of the trauma. Feasible mechanisms of brain injury include reduced placental blood flow and/or placental embolization.
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Affiliation(s)
- B Hayes
- Department of Neurology, Children's University Hospital, Dublin, Republic of Ireland
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22
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Abstract
Traumatic injuries although uncommon (affect 6% to 7% of all pregnancies) are associated with poor maternal, fetal, neonatal, and infant outcomes. The magnitude of the problem is most likely largely underestimated secondary to lack of standardized reporting. Newer data are available that stratify maternal risk by type of injury sustained, and may assist in evaluation of the pregnant trauma victim. Long-term adverse events after maternal discharge for a traumatic injury are emerging, and suggest closer monitoring of the patient for preterm labor, growth restriction, and placental abruption during the affected pregnancy.
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Affiliation(s)
- Dina El Kady
- North Shore University Hospital, New York University, Manhasset, New York 11030, USA.
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23
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Mut Buigues J, Ferrández Berenguer MJ. [Brain injury after fetal traumatism due to maternal traffic accident]. An Pediatr (Barc) 2006; 65:628-9. [PMID: 17194335 DOI: 10.1157/13095860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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24
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Current awareness in prenatal diagnosis. Prenat Diagn 2005; 25:269-74. [PMID: 16007763 DOI: 10.1002/pd.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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