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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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Sauber-Schatz EK, Bodnar LM, Weiss HB, Wilson JW, Pearlman MD, Markovic N. Injury during pregnancy and nervous system birth defects: Texas, 1999 to 2003. ACTA ACUST UNITED AC 2013; 97:641-8. [DOI: 10.1002/bdra.23143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 03/15/2013] [Accepted: 04/09/2013] [Indexed: 11/12/2022]
Affiliation(s)
| | - Lisa M. Bodnar
- University of Pittsburgh; Graduate School of Public Health; Department of Epidemiology; Pittsburgh; Pennsylvania
| | | | - John W. Wilson
- University of Pittsburgh; Graduate School of Public Health; Department of Biostatistics; Pittsburgh; Pennsylvania
| | - Mark D. Pearlman
- University of Michigan; Department of Surgery and Department of Obstetrics and Gynecology; Ann Arbor; Michigan
| | - Nina Markovic
- University of Pittsburgh; Graduate School of Public Health; Department of Epidemiology; Pittsburgh; Pennsylvania
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Bard MR, Shaikh S, Pestaner J, Newell MA, Rotondo MF. Direct fetal injury due to airbag deployment and three-point restraint. ACTA ACUST UNITED AC 2009; 67:E98-E101. [PMID: 19820569 DOI: 10.1097/ta.0b013e318047c045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Michael R Bard
- Department of Surgery, The Brody School of Medicine, East Carolina University, University Health Care Systems of Eastern North Carolina, Greenville, North Carolina 27834, USA.
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Abstract
BACKGROUND Pregnant women represent a major challenge in trauma care because of the risks to both mother and child and because of the difficulties in following standard protocols. METHODS We analyzed data for all pregnant women admitted to the hospital in Canada over 7 years to test whether major trauma still clustered in the summer despite their aversion toward alcohol, recklessness, and extreme sports. RESULTS A total of 2,618 pregnant women sustained major trauma. The prevalence of pregnancy was marginally lower in summer than in winter (decrease, 3%; 95% confidence interval, 2-4%), whereas the incidence of major trauma in pregnant women was significantly higher in summer than in winter (increase, 12%; 95% confidence interval, 3-21%; p = 0.005). No evidence of offsetting decreases in severity appeared in analyses of length of stay, number of surgical procedures, or mortality. CONCLUSION We suggest that normal lifestyle choices contribute to an increased risk of major trauma during pregnancy and merit greater awareness throughout the year.
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Affiliation(s)
- Donald A Redelmeier
- Department of Medicine, University of Toronto, Sunnybrook and Women's College Health Sciences Centre, Ontario, Canada.
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