Fetal trauma: brain imaging in four neonates

Abstract

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.

The association between developmental handicaps and traumatic brain injury during pregnancy: An issue that deserves more systematic evaluation

“…Former work involved mainly isolated cases [15][16][17][18][19][20] or small series [21,22] and also reported a variety of lesions which included leucomalacia, localized infarction, haemorrhage, hydrocephalus and cerebral atrophy. Probably four principal pathogenic conditions are involved:…”

Cerebral palsy after maternal trauma in pregnancy

“…1,2 It is well recognized that lethal placental or fetal injury can occur without signs of maternal injury. 3,4 Fetal brain injury may result from direct trauma 5 or indirectly from circulatory disturbance following placental abruption. If immediate delivery ensues, acute brain injury may be confirmed clinically and on brain imaging.…”

Case report: lethal fetal head injury and placental abruption in a pregnant trauma patient

“…The most common fetal trauma that occurs is a fetal head injury when the fetal head is situated low often in the setting of a pelvic fracture as in this case. Fetal head trauma is almost universally fatal to the fetus [2].…”

“…Fetal trauma in the pregnant patient who sustains blunt abdominal trauma is extremely uncommon and is limited to case reports and case series in the literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The most common injury that occurs to the fetus in pregnancy is a fetal skull fracture that may be associated with acute intracranial hemorrhage.…”