ABSTRACT
Non-obstetrical fetal head injury is an unusual clinical event. While multiple case reports describe motor vehicle collisions resulting in intrauterine fetal skull fractures, management of these injuries has not been emphasized. We report a case of a depressed fetal skull fracture with massive subgaleal and subperiosteal hemorrhage requiring neurosurgical intervention with good clinical outcomes for both mother and infant dyad.
Subject(s)
Craniotomy/methods , Decompression, Surgical/methods , Fetal Distress/surgery , Plastic Surgery Procedures/methods , Prenatal Injuries/surgery , Skull Fractures/embryology , Accidents, Traffic , Adult , Cesarean Section , Dura Mater/surgery , Female , Fetal Distress/diagnostic imaging , Fetal Distress/physiopathology , Gestational Age , Humans , Infant, Newborn , Intensive Care, Neonatal , Pregnancy , Pregnant Women , Prenatal Injuries/diagnostic imaging , Prenatal Injuries/physiopathology , Skull Fractures/diagnostic imaging , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Accidents, Traffic/mortality , Cesarean Section/methods , Heart Arrest/mortality , Skull Fractures/embryology , Adult , Cardiopulmonary Resuscitation , Decision Making , Emergency Medical Services , Fatal Outcome , Female , Fetal Monitoring , Humans , Pregnancy , Skull Fractures/diagnostic imaging , UltrasonographyABSTRACT
The purpose of this paper is to describe brain pathology in neonates after major traffic trauma in utero during the third trimester. Our patient cohort consisted of four neonates born by emergency cesarean section after car accident in the third trimester of pregnancy. The median gestational age ( n=4) was 36 weeks (range: 30-38). Immediate post-natal and follow-up brain imaging consisted of cranial ultrasound ( n=4), computed tomography (CT) ( n=1) and post-mortem magnetic resonance imaging (MRI) ( n=1). Pathology findings were correlated with the imaging findings ( n=3). Cranial ultrasound demonstrated a huge subarachnoidal hemorrhage ( n=1), subdural hematoma ( n=1), brain edema with inversion of the diastolic flow ( n=1) and severe ischemic changes ( n=1). In one case, CT demonstrated the presence and extension of the subarachnoidal hemorrhage, a parietal fracture and a limited intraventricular hemorrhage. Cerebellar hemorrhage and a small cerebral frontal contusion were seen on post-mortem MRI in a child with a major subarachnoidal hemorrhage on ultrasound. None of these four children survived (three children died within 2 days and one child died after 1 month). Blunt abdominal trauma during pregnancy can cause fetal cranial injury. In our cases, skull fracture, intracranial hemorrhage and hypoxic-ischemic encephalopathy were encountered.