Nonsurgical management of penetrating uterine trauma inpregnancy: A case report

Grubb, Debra K.

doi:10.1016/0002-9378(92)91677-3

Cited by 18 publications

(4 citation statements)

References 1 publication

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“…Those that do not appear to penetrate beyond the abdominal wall have been managed nonoperatively. 59 On the other hand, exploratory laparotomy is usually indicated with any evidence of peritoneal penetration, particularly if intraperitoneal hemorrhage or bowel perforation is suspected. It is noteworthy that tetanus prophylaxis is not contraindicated in pregnancy, and its indications are similar in both pregnant and nonpregnant states.…”

mentioning

confidence: 99%

Trauma in Pregnancy: A Systematic Approach

Mirza

Devine²,

Gaddipati³

2010

Amer J Perinatol

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Trauma in pregnancy remains one of the major contributors to maternal and fetal morbidity and mortality. Potential complications include maternal injury or death, shock, internal hemorrhage, intrauterine fetal demise, direct fetal injury, abruptio placentae, and uterine rupture. The leading causes of obstetric trauma are motor vehicle accidents, falls, assaults, and gunshots, and ensuing injuries are classified as blunt abdominal trauma, pelvic fractures, or penetrating trauma. Many of the assessment and management aspects of obstetric trauma are unique to pregnancy, although initial evaluation and resuscitation should always be maternally directed. Once maternal stability is established, vigilant evaluation of fetal well-being becomes warranted. Continuous fetal heart monitoring, ultrasonography, computed tomography, open peritoneal lavage, and/or exploratory laparotomy may be indicated in a case of obstetric trauma. In view of the significant impact of trauma on the pregnant woman and her fetus, preventive strategies are paramount.

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mentioning

confidence: 99%

Trauma in Pregnancy: A Systematic Approach

Mirza

Devine²,

Gaddipati³

2010

Amer J Perinatol

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“…Debridement of uterine wounds is not always required because the uterus is an elastic muscular organ that successfully sustains much of the missile's kinetic energy and cavitation. Nonsurgical management can also be applied in pregnant patients with stab wounds, as reported by Grubb et al 18 In our patient, temporary abdominal closure using the vacuum pack technique, similar to the one described by Barker et al, 19 was used. Indications for temporary abdominal closure are (1) the inability to approximate the abdominal wall without tension, (2) a reexploration or "second-look" procedure is planned after damage control, (3) the risk of abdominal compartment syndrome is high, (4) a grossly contaminated operative field, (5) or an increase in abdominal content edema.…”

Section: Management Of a Pregnant Patient With An Open Abdomenmentioning

confidence: 64%

Management of a Pregnant Patient with an Open Abdomen

Aboutanos

Malhotra

et al. 2005

The Journal of Trauma: Injury, Infection, and Critical Care

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T raumatic injury is the principle non-obstetric cause of maternal death. 1,2 Seven percent of pregnant women suffer from trauma. 3 Approximately 3 to 10% sustain injuries secondary to penetrating trauma. 4 -7 The maternal mortality rate resulting from penetrating trauma is less than 5%. Fetal mortality, however, can be as high as 70%, which is a result of direct missile injury or the effects of prematurity. 3,8 Emergent Cesarean delivery is indicated if the uterus obstructs the operative field or the viable fetus is in distress. The question remains whether expectant obstetric management is feasible when open abdominal management is deemed necessary for maternal care. Currently there are no guidelines that discuss open abdominal management for the pregnant trauma patient.The following is a report of a pregnant woman at 29 weeks gestation with an open abdomen status post-gunshot wound (GSW) to the abdomen and chest. Operative decision making, open abdomen management, and damage control therapy are discussed. The use of temporary abdominal closure using the vacuum technique in a patient with a gravid uterus has not been previously reported. CASE REPORTA 20-year-old, gravida 1, woman sustained multiple GSWs to the right chest and abdomen. The patient was 29 weeks pregnant and complaining of abdominal pain. Examination revealed a healthy, young woman with a Glasgow Coma Scale score of 15 in no acute distress. Her vital signs upon arrival to the emergency room were a blood pressure of 127/91 mm Hg, heart rate of 115 bpm, respiratory rate of 18 breathes/min, and O 2 saturation of 99% on room air.On primary survey, her chest examination revealed present and equal breath sounds bilaterally. The patient was tachycardic. Her heart sounds were regular in rhythm, and no murmurs or rubs were detected on auscultation. Two GSW were seen on the right breast, located on lateral and medial sides of the areola, respectively. A tangential GSW was present in the center of her chest between both breasts. Her abdomen was firm. The gravid uterus was symmetrically enlarged and consistent with reported gestational age. A right flank entrance GSW was present with no apparent exit wound. Fetal heart tones (FHT), assessed by the obstetric/ gynecology team in the emergency department, were present at 140 bpm.Laboratory data revealed a hematocrit of 27.6 vol%, a normal basic metabolic rate, and normal coagulation studies. Arterial blood gas results were pH 7.47, CO 2 36, O 2 230, HCO 3 26.5, base excess 2.7, lactate 1.3 mEq/ L, and O 2 saturation 100% on a 4-L nasal cannula. Anteroposterior roentgenogram of the chest was negative for pneumo/hemothorax.The patient was taken to the operating room for exploratory laparotomy. Under general endotracheal anesthesia, a midline incision along the full length of the abdomen was made. Intraoperative findings included a large hemoperitoneum (Ͼ1 L), an enlarging retroperitoneal hematoma caused by transection of the engorged right gonadal vessels, and a through-and-through GSW to the cecum. An excessivel...

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“…Es muss sich hier um eine hämodynamisch stabile Mutter handeln mit einer Eingangswunde unter dem Fundus uteri, eine abdominale Untersuchung muss negativ sein und es darf keine gastrointestinale Blutung oder eine Verletzung des Harntraktes vorliegen. Stichverletzungen des Uterus können konservativ behandelt werden, wenn keine Zeichen von hypovolämischem Schock, Peritonitis oder Austritt von Eingeweiden vorliegen [39]. Eine vaginale Geburt ist möglich mit einem Locus minores resistentiae des Uterus.…”

Section: Penetrierende Verletzungenunclassified

Trauma während der Schwangerschaft

Wolthuis¹,

Steinkamm²,

Broos³

et al. 2005

Z Geburtshilfe Neonatol

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In the past 60 years trauma has become the most important cause of morbidity and mortality in pregnancy. Motor vehicle accidents are the most common cause of abdominal trauma and lead to the highest mortality. The typical anatomical and physiological changes occurring during pregnancy demand a specific resuscitation procedure in which stabilization of the mother hemodynamically has to be done first. During the secondary survey the mother and fetus have to be examined thoroughly. The correct use of safety belts is an essential part of prevention.

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Nonsurgical management of penetrating uterine trauma inpregnancy: A case report

Cited by 18 publications

References 1 publication

Trauma in Pregnancy: A Systematic Approach

Trauma in Pregnancy: A Systematic Approach

Management of a Pregnant Patient with an Open Abdomen

Trauma während der Schwangerschaft

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