Management of Severe Traumatic Brain Injury in Pregnancy: A Body with Two Lives.

Giat Seng Kho,Jafri Malin Abdullah

doi:10.21315/mjms2018.25.5.14

Abstract

Traumatic brain injury is the major contributing factor in non-obstetric mortality in developing countries. Approximately 20% of maternal mortality is directly correlated to injuries. Road traffic accidents and domestic violence are the most common nonlethal injuries that can threaten either the maternal or foetal life, and such events occur in one out of every 12 pregnancies. The treatment of severe traumatic brain injury in pregnancy requires a multidisciplinary team approach. The management of a pregnant trauma patient warrants consideration of several issues specific to pregnancy, such as the alterations in the maternal physiology and anatomy. In the case of maternal cardiac arrest with amniotic fluid embolism, intact neonatal survival is linked with the timing of caesarean section after maternal cardiac arrest. Moreover, the decision for perimortem caesarean section is clear after maternal cardiac arrest. The foetal survival rate is 67% if the operation is done before 15 min of cardiopulmonary compromise has occurred, and it drops to 40% at the duration range of 16–25 min. Whether minor or severe, traumatic brain injury during pregnancy is associated with unfavourable maternal outcomes. Injuries considered minor for the general population are not minor for pregnant women. Therefore, these patients should be intensively monitored, and multidisciplinary approaches should always be involved.

Highlights

Traumatic brain injury is the major contributing factor in non-obstetric mortality in developing countries
The physiological adaptations that occur as pregnancy progresses warrant several specific considerations in the management of severe traumatic brain injury in pregnant patients
This review focusses on the evidence-based management of severe traumatic brain injury in pregnancy, from pre-hospital to post-operative care

Summary

Introduction

Traumatic brain injury is the major contributing factor in non-obstetric mortality in developing countries. In cases of major trauma, the assessment, stabilisation and care of the pregnant women is the first priority; if the foetus is viable (≥ 23 weeks), foetal heart rate auscultation and foetal monitoring can be initiated, and an obstetrical consultation should be obtained as soon as is feasible (II-3B) [3]. In pregnant women with a viable foetus (≥ 23 weeks) and suspected uterine contractions, placental abruption or traumatic uterine rupture, urgent obstetrical consultation is recommended (II-3B) [3]. Diagnostic imaging in injured pregnant women is always delayed in view of reluctance to expose the foetus to ionising radiation This discomfort should be avoided in critical decision making, and the risk of teratogenic potential should be well understood. Any pregnancy is considered viable after 23 weeks of gestation in view of the low survival rate of the foetus and approximately 61% foetal loss in women with major injuries before this time. With the prone position, the placental perfusion may be increased, as reported in Nakai et al [22]

Conclusion

Conflicts of Interest

Findings

13. Stone IK