Gunshot wound to the pregnant uterus: case report

Abstract

Crime and violence have become a public health problem. Pregnant women have not been the exception and gunshot injuries occupy an important place as a cause of trauma. An important fact is that pregnant women, who suffer trauma, are special patients because pregnancy causes physiological and anatomical changes. Management of these patients should be multidisciplinary, by the general surgeon, the obstetrician and the neonatologist. However, even trauma referral centers could neither have the staff nor the ideal training for these specific cases. In this context we present the following case.

Abruptio Placenta Caused by Gunshot Injury in Second Trimester: A Case Report

“…Gunshot wounds to the abdomen during pregnancy are becoming increasingly common, especially in countries adjacent to those impacted by war. There is extensive literature about gunshot wound in pregnancy influencing the fetus, rectosigmoid junction, and the jejunum [4,5]. In our case, only AP was observed and had not affected any part of the fetus, membranes, bowel, and other maternal abdominal organs.…”

“…These changes allow a loss of up to 30 % of circulating volume without changes in vital signs; however, the fetus may be affected. Management of these patients should be multidisciplinary, by the general surgeon, the obstetrician and the neonatologist [5]. In our case the patient was hemodynamically stable but the fetus was born 350 g, a single male and APGAR score was 0-0, so the neonatologist resuscitated but the fetus didn't respond to resuscitation.…”

Prenatal gunshot wound, a rare cause of maternal and fetus trauma, a case report

“…Trauma injuries warrant a special consideration when a pregnant woman is affected, due to maternal physiology and anatomy particularities. During pregnancy, there is an increase in blood volume by 50%, an increase in 15 beats per minute in the normal heart rate and a state of hypotension because of the vasodilator effect of progesterone [2,3]. Moreover, the abdominal viscera are displaced to allow for the progressive size increase of the uterus [5].…”

“…Blunt trauma is the most common mechanism of trauma (69%) among the pregnant population, with car accidents at the top of the list. Other common causes of blunt trauma are falls (22%), assaults (22%), and burns (1%) [2]. Penetrating trauma accounts for less than 2% of all pregnant trauma admittances.…”

Causas externas de mortalidade em mulheres grávidas e puérperas

“…(16) These deaths are also associated, in most cases, with violence perpetrated by intimate partners and often include situations of sexual violence. (31) A review of the overall prevalence of intimate partner homicides has shown that in the USA about 45% of homicides against women were committed by intimate partner. In the United Kingdom this proportion is 54% and in South Africa 50%.…”