Intrauterine Fetal Traumatic Brain Injury Following Motor Vehicle Accident; A Case Report and Review of the Literature

Abstract

Trauma, especially traumatic injuries due to car accidents are one of the causes of maternal and fetal mortality and morbidity during pregnancy. Fetus brain injuries are usually caused fetus death. We herein report a pregnant woman in 28 weeks of gestation. The fetus was found to be normal during in-hospital. At birth, the female neonate demonstrated developmental delay and neurological deficits (hypotonicity). Neuroimaging after birth revealed extreme dilatation of lateral ventricles, hypoplasia and aplasia of the brain. In 4 months, she had multiple morbidities including developmental delay, hypotonia, blindness, oropharyngeal dysphagia and simple partial seizure. Motor and response to stimulation was normal. Appropriate seatbelt usage can protect the fetus from sustaining severe intracranial injuries.

Congenital Depressed Skull Fracture Due to Maternal-Fetal Trauma

“…In case of suspected head trauma of the fetus, the gynecological and obstetric evaluation must include monitoring of his heart rate. This constitutes an appropriate method for checking his health state [8]. Changes in heart rate usually occur before the onset of fetal brain damage [9].…”

“…Some authors have said that CT scan is the best test to assess posttraumatic brain damage to the fetus. According to them, the damage due to radiation would be much less than that caused by delayed diagnosis [8]. Others will go further by proposing a brain MRI [9] [10].…”

“…In our opinion, this examination would have a mainly prognostic value and we think that the transfontanellar ultrasound can be sufficient in certain cases to make the diagnosis of fetal cerebral lesions. Once the diagnosis has been made, management of the lesions becomes an emergency in order to avoid subsequent complications such as delayed neonatal development, hypotonia, blindness or even convulsions [8]. This therapeutic management most often involves surgery.…”

Intrauterine stab injury of youth pregnant

“…Более 50% случаев связано с дорожно-транспортными происшествиями, примерно 22% -с падениями и физическим насилием. Реже отмечаются ожоги, электрошок и проникающие ранения [2]. Травма во время беременности считается ведущей причиной смерти беременных неакушерской этиологии -46%, а смерть плода при тяжелых травмах в среднем составляет 61% и достигает 80%, если у матери развился шок [3].…”

Severe brain trauma to the fetus in a car accident: Literature review and a clinical case

“…Черепно-мозговые травмы (ЧМТ) -самый частый вариант внутриутробного повреждения при тупой травме живота в результате автомобильных аварий, большинство из них происходит в III триместре, когда голова плода становится уязвима вследствие своего расположения над лоном [4]. Основными проявлениями травматического воздействия на плод могут быть переломы костей черепа, субарахноидальное, субдуральное и мозжечковое кровоизлияния, отек мозга с нарушением кровотока, гипоксические и ишемические изменения и, как следствие, гидроцефалия, судороги, церебральный паралич, диффузное церебральное повреждение и перивентрикулярная лейкомаляция [24][25][26][27][28].…”