Recognition and management of traumatic fetal injuries

Sarah C Stokes; Nathan S Rubalcava; Christina M Theodorou; Manisha B Bhatia; Brian W Gray; Payam Saadai; Rachel M Russo; Amelia McLennan; Dana C Bichianu; Mary T Austin; Ahmed I Marwan; Fuad Alkhoury; APSA Fetal Diagnosis and Therapy Committee

doi:10.1016/j.injury.2022.01.037

Recognition and management of traumatic fetal injuries

Injury. 2022 Apr;53(4):1329-1344. doi: 10.1016/j.injury.2022.01.037. Epub 2022 Feb 5.

Affiliations

¹ 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. Electronic address: scstokes@ucdavis.edu.
² Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI 48109, USA.
³ 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.
⁴ Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
⁵ Division of Trauma/Critical Care, Department of Surgery, University of California, Davis Medical Center, Sacramento, CA 95817, USA.
⁶ Department of Obstetrics and Gynecology, University of California Davis Medical Center, Sacramento, 95817, USA.
⁷ Neonatology, Department of Child Health, University of Missouri, School of Medicine, Women's and Children's Hospital, Columbia, MO 65201, USA.
⁸ Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston TX 77030, United States.
⁹ 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.
¹⁰ Division of Pediatric Surgery, University of Columbia School of Medicine, Columbia, MO, USA.

PMID: 35144809
DOI: 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: Fetal injury; Fetal trauma; Trauma during pregnancy.

Publication types

Review

MeSH terms

Female
Fetal Death
Fetus
Humans
Infant, Newborn
Pregnancy
Pregnancy Complications*
Retrospective Studies
Wounds, Nonpenetrating* / diagnostic imaging
Wounds, Nonpenetrating* / therapy
Wounds, Penetrating* / diagnostic imaging
Wounds, Penetrating* / therapy