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Recognition and management of traumatic fetal injuries

  • Sarah C. Stokes
    Correspondence
    Corresponding author.
    Affiliations
    Division of Pediatric General, Thoracic and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA
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  • Nathan S. Rubalcava
    Affiliations
    Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI 48109, USA
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  • Christina M. Theodorou
    Affiliations
    Division of Pediatric General, Thoracic and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA
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  • Manisha B. Bhatia
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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  • Brian W. Gray
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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  • Payam Saadai
    Affiliations
    Division of Pediatric General, Thoracic and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA
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  • Rachel M. Russo
    Affiliations
    Division of Trauma/Critical Care, Department of Surgery, University of California, Davis Medical Center, Sacramento, CA 95817, USA
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  • Amelia McLennan
    Affiliations
    Department of Obstetrics and Gynecology, University of California Davis Medical Center, Sacramento, 95817, USA
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  • Dana C. Bichianu
    Affiliations
    Neonatology, Department of Child Health, University of Missouri, School of Medicine, Women's and Children's Hospital, Columbia, MO 65201, USA
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  • Mary T. Austin
    Affiliations
    Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston TX 77030, United States
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  • Author Footnotes
    1 Dr. Marwan and Dr. Alkhoury contributed equally and are co-senior authors.
    Ahmed I. Marwan
    Footnotes
    1 Dr. Marwan and Dr. Alkhoury contributed equally and are co-senior authors.
    Affiliations
    Division of Pediatric Surgery, University of Columbia School of Medicine, Columbia, MO, USA

    Department of Pediatric Surgery, Nicklaus Children’s Hospital, Miami, FL 33155, USA
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  • Author Footnotes
    1 Dr. Marwan and Dr. Alkhoury contributed equally and are co-senior authors.
    Fuad Alkhoury
    Footnotes
    1 Dr. Marwan and Dr. Alkhoury contributed equally and are co-senior authors.
    Affiliations
    Division of Pediatric Surgery, University of Columbia School of Medicine, Columbia, MO, USA
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  • on behalf of theAPSA Fetal Diagnosis and Therapy Committee
  • Author Footnotes
    1 Dr. Marwan and Dr. Alkhoury contributed equally and are co-senior authors.
Published:February 05, 2022DOI:https://doi.org/10.1016/j.injury.2022.01.037

      Abstract

      Trauma during pregnancy is the leading non-obstetric cause of morbidity and mortality, and accounts for five per 1000 fetal deaths. Direct fetal injury due to trauma during pregnancy is rare, and limited information is available about how to optimize fetal outcomes after injury. Early recognition and appropriate management of direct fetal trauma may improve outcomes for the fetus. There are currently no available guidelines to direct management of the injured fetus. We provide a detailed literature review of the management and outcomes of direct fetal injury following blunt and penetrating injury during pregnancy, and describe a suggested initial approach to the injured pregnant patient with a focus on evaluation for fetal injury. We identified 45 reported cases of blunt trauma resulting in direct fetal injury, with 21 surviving past the neonatal period, and 33 of penetrating trauma resulting in direct fetal injury, with 24 surviving past the neonatal period. Prenatal imaging identified fetal injury in 19 cases of blunt trauma and was used to identify bullet location relative to the fetus in 6 cases. These reports were used to develop management algorithms for the injured fetus.

      Keywords

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