Objective: Was to present the management of a pregnant woman at 39 SA received for severe head trauma in the emergency room. Severe trauma in pregnant women can have serious maternal and especially fetal consequences in the absence of a diagnostic and therapeutic strategy. We report the case of serious trauma in a 39 WA pregnant woman, nulliparous. Admitted to the emergency room for serious head trauma following a public road accident. The clinical picture was dominated by impaired consciousness with a Glasgow score of 8/15, right otorrhagia, desaturation at 89% AA and respiratory rate at 36 cycles/min. The obstetrical examination noted a fundal height of 32 cm, a fetal heart sound (BCF) of 167 beats/min, a cephalic presentation, a cervical opening of 3 cm and uterine contractures. Imaging examinations outside the hospital because not available. The abdominopelvic ultrasound shows a monofetal pregnancy without placental abruption. The cerebral scanner shows an edemato-haemorrhagic contusion intra parenchymatous frontotemporal left. Respiratory support and an indication for caesarean section allowed the extraction of a live male child, Apgar at one minute 10/10 to five minutes 10/10, weighing 3000 g without abnormality on clinical examination. The evolution was favorable after 27 days of resuscitation. Conclusion: The care of a severely traumatized pregnant woman relies above all on good multidisciplinary coordination, based on close collaboration between emergency physicians, anesthetists-resuscitators, obstetricians, pediatricians, neonatologists and biologists.
References
[1]
Sachs, B.P., Brown, D.A., Driscoll, S.G., Schulman, E., Acker, D., Ransil, B.J., et al. (1987) Maternal Mortality in Massachusetts: Trends and Prevention. The New England Journal of Medicine, 316, 667-672. https://doi.org/10.1056/NEJM198703123161105
[2]
Fildes, J., Reed, L., Jones, N., Martin, M. and Barrett, J. (1992) Trauma: The Leading Cause of Maternal Death. The Journal of Trauma, 32, 643-645. https://doi.org/10.1097/00005373-199205000-00017
[3]
Ikossi, D.G., Lazar, A.A., Morabito, D., Fildes, J. and Knudson, M.M. (2005) Profile of Mothers at Risk: An Analysis of Injury and Pregnancy Loss in 1,195 Trauma Patients. Journal of the American College of Surgeons, 200, 49-56. https://doi.org/10.1016/j.jamcollsurg.2004.09.016
[4]
Esposito, T.J., Gens, D.R., Smith, L.G., Scorpio, R. and Buchman, T. (1991) Trauma during Pregnancy. A Review of 79 Cases. The Archives of Surgery, 126, 1073-1078. https://doi.org/10.1001/archsurg.1991.01410330027003
[5]
Crosby, W.M. and Costiloe, J.P. (1971) Safety of Lap-Belt Restraint for Pregnant Victims of Automobile Collisions. The New England Journal of Medicine, 284, 632-636. https://doi.org/10.1056/NEJM197103252841203
[6]
Muench, M.V. and Canterino, J.C. (2007) Trauma in Pregnancy. Obstetrics and Gynecology Clinics of North America, 34, 555-583. https://doi.org/10.1016/j.ogc.2007.06.001
[7]
Barre, M., Winer, N., Caroit, Y., Boog, G. and Philippe, H.J. (2006) Trauma during Pregnancy: Relevance of Monitoring Elements in the Evaluation of Obstetrical Consequences. Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 35, 673-677. https://doi.org/10.1016/S0368-2315(06)76462-6
[8]
Richard-Jourjon, V., Dehours, E., Parant, M., Parant, O., Marchetti, M. and Lauque, D. (2016) Obstetrical Complications of Trauma in Pregnant Women: Epidemiology in a Maternity Hospital of a University Hospital in France. Annales Françaises de Médecine d’urgence, 6, 307-312. https://doi.org/10.1007/s13341-016-0661-9
[9]
Bagou, G., Hamel, V., Cewaldi, P.F., Comte, G., Corbillon, M., et al. (2011) Formalized Expert Recommendations SFAR-SFMU 2010: Extra-Hospital Obstetric Emergencies. Annales Françaises de Médecine d’urgence, 1, 141-155. https://doi.org/10.1007/s13341-011-0046-z
[10]
Hyde, L.K., Cook, L.J., Olson, L.M., et al (2003) Effect of Motor Vehicle Crashes on Adverse Fetal Outcomes. Obstetrics & Gynecology, 102, 279-286. https://doi.org/10.1097/00006250-200308000-00013
[11]
Weiss, H.B., Songer, T.J. and Fabio, A. (2001) Fetal Deaths Related to Maternal Injury. JAMA, 286, 1863-1868. https://doi.org/10.1001/jama.286.15.1863
[12]
Yamada, S., Nishijima, K., Takahashi, J., Takahashi, N., Tamamura, C. and Yoshida, Y. (2017) Intrauterine Fetal Death Caused by Seatbelt Injury. Taiwanese Journal of Obstetrics and Gynecology, 56, 558-560. https://doi.org/10.1016/j.tjog.2016.08.009
[13]
Weiss, H.B. and Strotmeyer, S. (2002) Characteristics of Pregnant Women in Motor Vehicle Crashes. Injury Prevention, 3, 207-210. https://doi.org/10.1136/ip.8.3.207
[14]
Pearlman, M.D. (1997) Motor Vehicle Crashes, Pregnancy Loss and Preterm Labour. International Journal of Gynecology & Obstetrics, 57, 127-132. https://doi.org/10.1016/S0020-7292(96)02829-9
[15]
Raimond, E. and Gabriel, R. (2021) Trauma in Pregnant Women. ECM-Obstetrics, 44, 1-9.
[16]
Oxford, C.M. and Ludmir, J. (2009) Trauma in Pregnancy. Clinical Obstetrics and Gynecology, 52, 611-629. https://doi.org/10.1097/GRF.0b013e3181c11edf
[17]
Badaoui, R., El Kettani, C., Radji, M., Samkaoui, M.A., Byhet, M. and Ossart, M. (2003) Trauma of the Spleen during Pregnancy (about a Case). Annales Françaises d’Anesthésie et de Réanimation, 22, 736-738. https://doi.org/10.1016/S0750-7658(03)00307-1
[18]
Breyssen, L., Cossey, V., Mussen, E., Demaerel, P., Van de Voorde, W. and Smet, M. (2004) Fetal Trauma: Brain Imaging in Four Neonates European Radiology, 14, 1609-1614. https://doi.org/10.1007/s00330-004-2357-6
[19]
Curet, M., Schermer, C., Demarest, G., Bieneik, E. and Curet, L. (2000) Predictors of Outcome in Trauma during Pregnancy: Identification of Patients Who Can Be Monitored for Less than 6 Hours. The Journal of Trauma, 49, 18-24. https://doi.org/10.1097/00005373-200007000-00003
[20]
Goodwin, H., Holmes, J. and Wisner, D. (2001) Abdominal Ultrasound Examination in Pregnant Blunt Trauma Patients. The Journal of Trauma, 50, 689-694. https://doi.org/10.1097/00005373-200104000-00016
[21]
Dahmus, M.A. and Sibai, B.M. (1993) Blunt Abdominal Trauma: Are There Any Predictive Factors for Abruptio Placentae or Maternal-Fetal Distress? American Journal of Obstetrics & Gynecology, 169, 1054-1059. https://doi.org/10.1016/0002-9378(93)90053-L
[22]
Muench, M.V., Baschat, A.A., Reddy, U.M., Mighty, H.E., Weiner, C.P., Scalea, T.M., et al. (2004) Kleihauer-Betke Testing Is Important in All Cases of Maternal Trauma. The Journal of Trauma, 57, 1094-1098. https://doi.org/10.1097/01.TA.0000096654.37009.B7
[23]
Dhanraj, D. and Lambers, D. (2004) The Incidences of Positive Kleihauer-Betke Test in Low-Risk Pregnancies and Maternal Trauma Patients. American Journal of Obstetrics & Gynecology, 190, 1461-1463. https://doi.org/10.1016/j.ajog.2004.02.029
[24]
Barré, M., Winer, N., Caroit, Y., et al (2006) Trauma during Pregnancy: Relevance of Monitoring Elements in the Evaluation of Obstetrical Consequences about a Series of 98 Patients. Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 5, 312-316. https://doi.org/10.1016/S1637-4088(06)76067-9
[25]
French Society of Anesthesia-Intensive Care (SFAR) and French Society of Emergency Medicine (SFMU) (2019) Management of Severe Abdominal Trauma in Adults: The First 48 Hours. https://www.sfar.org
