Trauma in pregnant women: assessing detection of post-traumatic placental abruption on contrast-enhanced CT versus ultrasound

Jha, Priyanka; Melendres, Giselle; Bijan, Bijan; Ormsby, Eleanor L.; Chu, Lisa; Li, Chin‐Shang; McGahan, John P.

doi:10.1007/s00261-016-0970-x

Cited by 22 publications

(12 citation statements)

References 12 publications

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“…Management strategies of maternal trauma should be reliant on accurate assessment of the mother (41).Therefore, maternal evaluation and care should be done in an intelligent and organized manner following the general principles of trauma care in a close collaboration with perinatal specialists. (40)(41)(42). Therefore, as anatomy, physiology, and even laboratory findings change during pregnancy, clinicians should consider both mother and fetus in care and in the process of diagnosis and treatment.…”

Section: Pregnant Patients With Traumatic Injurymentioning

confidence: 99%

“…Because part of the traumatic injury occurs during pregnancy in the first trimester of pregnancy and is not detected in the trauma centers. Hence, these estimates are less than realistic because in most cases, pregnancy in trauma is not detected (35,36,42). A recurring dispute and disagreement between radiologists and clinicians, is a question of the appropriateness of medical imaging for a traumatic pregnancy patient.…”

Section: Pregnant Patients With Traumatic Injurymentioning

confidence: 99%

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A Narrative Review on the Radiation Risk of Medical Imaging for Traumatic Pregnant Patient and the Fetal Risks

2018

JSurgery

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Introduction: The incidence rate of trauma in pregnancy is about 5 to 7 percent. More than 50% of the trauma during pregnancy is caused by motor vehicle accidents, and about 80% of fetal deaths occur during these automobile accidents. A traumatic pregnant woman should be visited and evaluated typically because placental abruption can have sudden consequences for the fetus with or without signs. Management strategies of maternal trauma should be reliant on accurate assessment of the mother. In order to accurately assess the patient's trauma, it is essential to provide a medical image of the patient. Radiography and CT scan are the first, fastest and most accessible imaging techniques in most health centers. Imaging techniques based on ionizing radiation present hazards and harmful effects to living organisms. The risk of ionizing radiation during pregnancy is highly dependent on the absorption dose and the age of the fetus. Absorbed doses for different radiographic examinations are different. The aim of this study was to evaluate the received radiation dose by the pregnant traumatic patient, and secondly assess the received dose by the fetus. Methods: In this narrative review, we concentrated on literature in three fields relating to firstly traumatic pregnant patients, secondly ionizing radiation dose from different medical imaging and finally, fetal dose and risk. Results: Depending on the type of radiography, the dosage of the embryo is also different. For example, examinations in which the embryo is placed on the pathway of the primary beam increases the received dose. Considering the harmful effects of ionizing radiation in imaging traumatic patients with a large number of images, the examinations that include the abdominal and pelvic region should be justified in detail. And, as far as possible, use non-ionizing imaging techniques instead of ionizing methods. One of the most reliable methods for reducing fetal doses is the development and promotion of non-ionizing imaging methods in traumatic pregnant women, such as ultrasound and MRI. Conclusions: All efforts should be made on the pregnant women in such a way that the embryo dose is as low as possible. It is strongly recommended that physician and medical team staff have a good knowledge and attitudes towards the radiation protection principles and in practice use standard of radiation protection safety principles.

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Section: Pregnant Patients With Traumatic Injurymentioning

confidence: 99%

Section: Pregnant Patients With Traumatic Injurymentioning

confidence: 99%

A Narrative Review on the Radiation Risk of Medical Imaging for Traumatic Pregnant Patient and the Fetal Risks

2018

JSurgery

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“…Abstract branes, smoking, and trauma [8][9][10][11][12][13][14] . Placental abruption is one of the most important complications of pregnancy.…”

Section: Original Articlementioning

confidence: 99%

The Retrospective Analysis of Abruptio Placenta Cases In a Tertiary Center: Risk Factors and Perinatal Outcomes

Çakmak¹

2018

Haydarpasa Numune Med J

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This study aimed to evaluate risk factors and pregnancy outcomes of abruption cases. Methods: A total of 91 abruption cases between January 2016 and April 2018 were included in this study. Demographic findings, gestational age, sonographic and clinical findings, predisposing factors, laboratory parameters, birth weight, gender, Apgar scores, neonatal intensive care unit admission, and maternal complications were recorded. Results: The prevalence was 0.43%; and 65.9% were multiparous. Preterm birth was present in 70.3% of cases, hypertension in 40.7%, intrauterine growth restriction in 15.4%, polyhydramnios in 5.5%, cigarette in 17.6%, premature membrane rupture/ preterm delivery in 18.7%, non-vertex presentation in 12.1%, and trauma in 1.1%. The ratio of maternal death was 1.1%, of transfusion 46.2%, of pulmonary edema 1.1%, of acute renal failure 9.9%, of hypovolemic shock 15.4%, and of disseminated intravascular coagulation 13.2%. The mean gestational week was 33.9±4.32, and the mean birth weight was 2337.53±943.78 g. Neonates were generally male. The Apgar score was ≤7 in 37.4% in first and 29.7% at fifth minutes; and first-minute Apgar score was 0 in 18.7%. The neonatal intensive care unit admission rate was 29.7%. Discussion and Conclusion: Early diagnosis is crucial for abruption that is related with maternal and fetal mortality. It must be considered when pain and vaginal bleeding is present in third trimester and even sonography is normal. Since at least one risk factor is present in cases, it is important to manage them to prevent complications.

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“…However, in the absence of classical symptoms of significant pain, hemorrhage, and evidence of fetal distress, the diagnosis can often be delayed with catastrophic consequences for both mother and fetus [1,[3][4][5][6][7]. This is particularly true for post-traumatic placental abruption that presents to the emergency department, where attention to distracting injuries can delay the diagnosis [8]. Not all trauma that precipitates placental abruption is significant, and even minor injuries compounded by seatbelt injury can cause placental abruption [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…This is particularly true for post-traumatic placental abruption that presents to the emergency department, where attention to distracting injuries can delay the diagnosis [8]. Not all trauma that precipitates placental abruption is significant, and even minor injuries compounded by seatbelt injury can cause placental abruption [8,9]. The earlier the diagnosis, the better the prognosis [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Emergency Department Cesarean Section for Placental Abruption; Anticipation from Prehospital History with Preparation for Immediate Delivery

Sundararajan

Speybroeck

Marsee

et al. 2020

COGO

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Emergency department cesarean section for placental abruption is an uncommon surgical procedure that requires anticipation in the prehospital environment as well as preemptive recognition of impending fetal demise by the emergency physician. The presence of an obstetrician ready to perform immediate cesarean section on an unstable patient with placental abruption may be lifesaving for both the mother and the fetus. However, there are no specific guidelines for prehospital recognition of patients with placental abruption that require emergency cesarean section. While the emergency department is not the optimum surgical theatre for an emergency cesarean section, placental abruption often deteriorates so quickly that even a few minutes of delay can have catastrophic consequences for both mother and fetus. We describe a case of placental abruption following moderate motor vehicular trauma in an eight month pregnant woman whose only complaint was moderate abdominal pain. The emergency physician’s suspicion based on the mechanism of injury caused her to mobilize the obstetrician, who was ready to perform an emergency department cesarean section with successful delivery of the fetus. Subsequent managing of the mother’s surgical incision and coagulopathy was performed in the operating room. This case highlights the importance of vigilance that prehospital providers, emergency department physicians, and obstetricians should have for a pregnant patient involved in a motor vehicle crash.

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Trauma in pregnant women: assessing detection of post-traumatic placental abruption on contrast-enhanced CT versus ultrasound

Cited by 22 publications

References 12 publications

A Narrative Review on the Radiation Risk of Medical Imaging for Traumatic Pregnant Patient and the Fetal Risks

A Narrative Review on the Radiation Risk of Medical Imaging for Traumatic Pregnant Patient and the Fetal Risks

The Retrospective Analysis of Abruptio Placenta Cases In a Tertiary Center: Risk Factors and Perinatal Outcomes

Emergency Department Cesarean Section for Placental Abruption; Anticipation from Prehospital History with Preparation for Immediate Delivery

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