Abdominal gunshot wound to pregnant woman at 22 weeks of gestation: A case report

Abstract

bsbd@balikesir.edu.tr www.bau-sbdergisi.com ÖZET Hamilelik sırasındaki delici travmalar günümüz şiddet toplumunda giderek artan bir problem haline gelmektedir. Delici travma sonucu fetal, plasental, kord ve intraabdominal organ hasarları rapor edilmiştir. Bu travmaların derecesinin belirlenip tedavisinin yapılması için sıklıkla eksploratif laparotomi gerekli olmaktadır. 26 yaşında gebe hasta ateşli silah yaralanması sonrası hastanemiz acil servisine getirildi. Operasyon odasında preoperatif olarak yapılan sonografi muayenesinde fetal kalp atımının ciddi bradikardik (30 atım/dk) ve uterusun koagulum ile dolu olduğu saptandı. Hasta acil olarak eksploratif laparotomi için operasyona alındı. Operasyon esnasında uterus sol round ligament etrafından aktif kanamalı bir adet küçük giriş deliği ve bir adet çıkış deliği gözlendi. Diğer batın içi organlarda herhangi bir yaralanma yoktu. Maternal vital bulguların stabilizasyonundan sonra sezaryen gerçekleştirildi ve 420 gr ölü fetus çıkarıldı. Uterin defektler primer olarak kapatıldı. Hasta operasyon sonrası altıncı gün taburcu edildi.Anahtar Kelimeler: ateşli silah yaralanması, travma, delici yaralanma, gebelik, laparotomi SUMMARY Penetrating trauma during pregnancy is an increasing problem in today's ever -violent society. Multiple direct fetal, placental, cord and intraabdominal organs injuries have been reported as a result of penetrating. Laparotomy is often required for determine the degree of trauma as well as treatment. A 26-year-old pregnant woman was brought into the emergency department of our hospital after suffering a gunshot wound. A preoperative transabdominal ultrasonography examination in the operating room determined that the fetal heart rate was severely bradycardic (30 beats/min) and the uterus was filled with coagulum. The patient was taken urgently to the operation for exploratory laparotomy. One bullet entry point was found at the root of the round ligament, and one bullet-exit point was at the posterior wall of the uterus and that site was actively bleeding. No injury was found to the other intraabdominal organs. After stabilization of the maternal vital signs, it was carried out a cesarean section and and a 420 g exanimate female fetus was taken out. The uterine defects were closed primarily. The patient was discharged on the 6th postoperative day

Maternal and Neonatal Outcomes of Gunshot Wounds in Pregnancy: A Systematic Review of Case Reports

“…56 Table 1 demonstrates the results of the appraisal, finding all 41 studies to be detailed enough to be replicated, relevant to contemporary practice, and demonstrate adequately ascertained exposure (GSW) and coprimary outcomes (maternal and/or neonatal death). While 82% (34/41) of studies had adequate follow-up of surviving patient(s) until or beyond discharge, [4][5][6][7][8][12][13][14][15][16][17][18][19][20][23][24][25][27][28][29][30][31][32][33][34][35][36][38][39][40][41][42][43][44] few studies (6/41) with a clear selection method were limited to the case series and small registries in this review. 5,6,11,16,41,43 In the GRADE 57 assessment of our review based on observational studies, our certainty of evidence was downgraded due to risk of selection bias and upgraded as possible confounders not discussed in the studies (comorbidities, obstetric history, socioeconomic status, degree of education, global variation in standards of care, etc.)…”

“…56 Table 1 demonstrates the results of the appraisal, finding all 41 studies to be detailed enough to be replicated, relevant to contemporary practice, and demonstrate adequately ascertained exposure (GSW) and coprimary outcomes (maternal and/or neonatal death). While 82% (34/41) of studies had adequate follow-up of surviving patient(s) until or beyond discharge, 4-8,12-20,23-25,27-36,38-44 few studies (6/41) with a clear selection method were limited to the case series and small registries in this review. 5,6,11,16,41,43…”

“…2,3 The primary literature on maternal and neonatal outcomes of GSW in pregnancy is limited, with most publications consisting of case reports or small case series. 4-44 Several reports 45-49 predate the classification of perimortem cesarean delivery as the primary method of maternal resuscitation. 50…”