Blunt abdominal trauma to a pregnant woman resulting in a child with hemiplegic spastic cerebral palsy and permanent eye damage
© Taha et al.; licensee BioMed Central Ltd. 2013
Received: 8 February 2013
Accepted: 22 October 2013
Published: 6 December 2013
In today's life trauma is a common and important complication of pregnancy and remains one of the major contributors to maternal and fetal morbidity and mortality.
The authors reported a case of 4 years old child with hemiplegic spastic cerebral palsy and permanent left eye damage due to antenatal trauma. He was an off spring to a 33 years old woman gravida 6 para 5 from western Sudan, who sustained a domestic blunt abdominal trauma during her routine daily activities. The abdominal trauma occurred during the third trimester at 36th week gestation of the pregnancy when the mother hit herself by the woody part of an axe non intentionally.
The findings from this case conclude that relatively minor trauma can have significant adverse effects on the fetus and can be devastating.
KeywordsTrauma Pregnancy Eye Cerebral palsy Sudan
In today's life trauma is a common and important complication of pregnancy and remains one of the major contributors to maternal and fetal morbidity and mortality [1, 2]. Even minor maternal trauma can lead to serious complications include maternal injury, death, shock, internal hemorrhage, intrauterine fetal demise, direct fetal injury, abruptio placentae, and uterine rupture [1–4]. 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 [1–6]. The causes are different with different life styles and different socio-economic and cultural background. We aimed in this case report to highlight the effect of blunt abdominal trauma on the obstetric outcome after we obtained a written consent from the patient for publication of this case report and any accompanied images.
We report a rare case of cerebral palsy as a result of abdominal trauma during the third trimester to highlight the effect of blunt trauma on pregnancy. The effect of trauma on pregnancy depends on the gestational age of the fetus, the type and severity of the trauma, and the extent of disruption of normal uterine and fetal physiology. Trauma occurring during the second and third trimester has different clinical consequences than during the first trimester. First trimester, minor trauma is not threatening to the pregnancy [1–6]. During the second and third trimester, even relatively minor trauma can have significant adverse effects on the fetus. Such adverse effects include placental abruption, preterm labor, uterine rupture, and direct fetal injury. In this case, regular uterine contractions began shortly after the trauma (within 4 hours), progressed steadily and resulted in delivery. Premature rupture of the fetal membranes can also occur, within the first 4 hours of injury and usually result in a premature delivery. Direct fetal injury may occur, resulting in contusions, fractures or fetal death. Uterine rupture can occur and usually result in the loss of the fetus . Eye damage which occurred in our case possibly might be related to the fetal position at time of trauma and the amount of liquor that represent an insulator and could absorb the blunt trauma, while cerebral palsy could be explained by the fetal head injury after the abdominal trauma. The effect of trauma on the pregnant woman and unborn fetus can be devastating. The major causes of maternal injury are blunt trauma, penetrating trauma, burns, falls, and assaults . With the active life-style of today's pregnant women, the effects of trauma have become an important obstetric concern. A protocol was developed to monitor pregnancies complicated by major blunt abdominal trauma in the third trimester, looking specifically for delayed placental and/or fetal problems. In a series of the 84 pregnancies studied, the most serious complication was placental abruption. Although abruption occurred in only two cases, one case was associated with a ruptured uterus and fetal death. There were no cases of delayed abruption or delayed fetal compromise. The most common complication was preterm labor, occurring in 28% of cases when the traumatic insult happened before 37 weeks' gestation. Of these 17 patients, 15 were successfully treated with tocolysis. There were no cases of direct fetal injury or Rhesus-isoimmunization. A revised protocol is recommended for limited outpatient observation with non stress testing and screening ultrasonography to rule out preterm labor and placental abruption and to document fetal well-being . The survival of the fetus after trauma depends on the mother's condition in regard to respiratory passage, oxygenation, and hypovolemia . Thus in conclusion, the findings from this case confirmed that relatively minor trauma can have significant adverse effects on the fetus and can be devastating.
Written informed consent was obtained from the mother for publication for this case report and any accompanying images. A copy of the written consent is available for review by the series editor of this journal.
- Vivian-Taylor J, Roberts CL, Chen JS, Ford JB: Motor vehicle accidents during pregnancy: a population-based study. BJOG. 2012, 119 (4): 499-503. 10.1111/j.1471-0528.2011.03226.x.PubMedView ArticleGoogle Scholar
- Melamed N, Aviram A, Silver M, Peled Y, Wiznitzer A, Glezerman M, Yogev Y: Pregnancy course and outcome following blunt trauma. J Matern Fetal Neonatal Med. in pressGoogle Scholar
- Tarvonen M, Ulander VM, Süvari L, Teramo K: Minor trauma during pregnancy can cause severe fetomaternal hemorrhage. Duodecim. 2011, 127 (16): 1727-1731.PubMedGoogle Scholar
- Takehana CS, Kang YS: Acute traumatic gonadal vein rupture in a pregnant patient involved in a major motor vehicle collision. Emerg Radiol. 2011, 18 (4): 349-351. 10.1007/s10140-011-0935-x.PubMedView ArticleGoogle Scholar
- Petrone P, Talving P, Browder T, Teixeira PG, Fisher O, Lozornio A, Chan LS: Abdominal injuries in pregnancy: a 155-month study at two level 1 trauma centers. Injury. 2011, 42 (1): 47-49. 10.1016/j.injury.2010.06.026.PubMedView ArticleGoogle Scholar
- Morgan JA, Marcus PS: Prenatal diagnosis and management of intrauterine fracture. Obstet Gynecol Surv. 2010, 65 (4): 249-259. 10.1097/OGX.0b013e3181dbc50b.PubMedView ArticleGoogle Scholar
- Aboutanos SZ, Aboutanos MB, Dompkowski D, Duane TM, Malhotra AK, Ivatury RR: Predictors of fetal outcome in pregnant trauma patients: a five-year institutional review. Am Surg. 2007, 73 (8): 824-827.PubMedGoogle Scholar
- Mirza FG, Devine PC, Gaddipati S: Trauma in pregnancy: a systematic approach. Am J Perinatol. 2010, 27 (7): 579-586. 10.1055/s-0030-1249358.PubMedView ArticleGoogle Scholar
- Tweddale CJ: Trauma during pregnancy. Crit Care Nurs Q. 2006, 29 (1): 53-67. 10.1097/00002727-200601000-00005.PubMedView ArticleGoogle Scholar
- Williams JK, McClain L, Rosemurgy AS, Colorado NM: Evaluation of blunt abdominal trauma in the third trimester of pregnancy: maternal and fetal considerations. Obstet Gynecol. 1990, 75 (1): 33-37.PubMedGoogle Scholar
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