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

Abstract

Fetal trauma in blunt abdominal trauma is uncommon, but traumatic fetal head injury is almost universally fatal to the fetus. Placental abruption is the most common injury to the gravid uterus in trauma, and when the mother survives, it is the most common cause of fetal death. The imaging diagnosis of these conditions may be difficult since there are only three cases reported in the literature of intrauterine skull fractures on plain films [3, 8, 10], ultrasound is in sensitive in the diagnosis of placental abruption [24], and the most sensitive test to diagnose placental abruption is external fetal monitoring with devices that measure uterine tone and contractility and fetal heart rate [23]. The diagnosis of fetal trauma and placental abruption may be made on contrast enhanced CT performed through the abdomen and pelvis of pregnant trauma patients. For these reasons, it is useful for the radiologist interpreting the CT scan to recognize fetal head injuries and placental abruption in pregnant trauma patients.Fig. 7 Axial scans through the bony pelvis demonstrate an unstable pelvic fracture with posterior pelvic ring disruption.There is a zone 2 fracture of the left sacrum and a fracture of the left obturator ring (arrowheads)

Congenital Depressed Skull Fracture Due to Maternal-Fetal Trauma

“…As in our patient, the result is good in case of early management in simple depressed skull fracture. The prognosis may be poor in the event of underlying lesions associated with the depressed skull fracture [6]. The treatment of these depressed skull fracture is controversial.…”

“…They had concerned 2.8% of pregnant women in the United States[4]. Traumatic brain injuries can have a poor prognosis[5] [6]. They are often associated with a skull fracture and usually occur in the third trimester of pregnancy[6] [7]…”

Imaging of Trauma: Part 2, Abdominal Trauma and Pregnancy—A Radiologist's Guide to Doing What Is Best for the Mother and Baby

“…By the late third trimester, the volume of amniotic fluid relative to the volume of the fetus is decreased, providing less cushion effect. The most common injuries to the fetus are skull fracture and head injury, seen in the late third trimester with cephalic presentation, often in the setting of a maternal pelvic fracture [58] (Fig. 8).…”

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

“…However, it is well established that significant intracranial pathologies such as subdural hematoma (SDH) is associated with severe maternal abdominal trauma [ 4 ]. Fetal trauma in pregnant women who have suffered from blunt trauma is very rare but if the damage reach to fetus head, it is usually fatal [ 5 ]. Also about penetrating traumas, however is accompanied with low mother mortality but usually the fetus mortality is high [ 6 ].…”