Article information
Summary
We present the case of a patient who had a car accident in the 32nd week of pregnancy. Maternal injuries were minimal. Foetal heart rate patterns showed tachycardia and decreased modulation. Ultrasound scan was normal, with no sign of placental abruption. Twelve days after the accident a caesarean section was performed because of cardiotocograph alterations. A live infant was born. The baby died 12 days later from an ischaemic multicystic encephalopathy
Using a bibliographical review, we try to explain the mechanism of the foetal lesions, despite the apparently minimal maternal injury. Hypovolaemic shock, cava syndrome and maternal stress could be the cause of placental hypoperfusion. Placental abruption or fetoplacen-tary haemorrhage could be other possible causes
With these physiopathological data we review first aid treatment, which is quite often not used in pregnant women, and management in the specialist unit
Resumen
Presentamos el caso de una paciente que sufrióun accidente de automóvil en la vía pública en lasemana 32 de amenorrea, con lesiones maternasmínimas. El registro del ritmo cardíaco fetal erataquicárdico y poco oscilante. La ecografía eranormal, sin hematoma retroplacentario. Se realizóuna cesárea 12 días después del accidente por alteración del trazado cardiotocográfico, naciendo unniño vivo. El niño falleció a los 12 días de vidapor una encefalopatía multiquística de origen isquémico.
Ala vista de los datos de la bibliografía, se intentaexplicar el mecanismo de las lesiones fetales, a pesardel traumatismo aparentemente no grave de la madre. El shock hipovolémico, el síndrome cava y el estrés materno pueden ser el origen de una hipoperfusión placentaria. Un hematoma retroplacentario ouna hemorragia fetoplacentaria pueden ser otras causas posibles.
Apoyándonos en estos datos fisiopatológicos, recordamos la conducta para los primeros auxilios que,a menudo, no es habitual poner en práctica en mujeres embarazadas, y las medidas a tomar en un centroespecializado.
Full text is only aviable in PDF
Bibliografía
[2.]
R. Lewis, et al.
Traumatismos.
Tratamiento de las complicaciones clínicas del embarazo. 3.aed, pp. 1782-1789
[3.]
American College of Obstetrician and Gynecologist.
Trauma During Pregnancy,
[4.]
H. Schneider.
Trauma and pregnancy.
Arch Gynecol Obs-tet, pp. 54-59
[5.]
M. Baethman, T. Kahn, H.G. Lenard, T. Voit.
Fetal CNS damage after exposure to maternal trauma during pregnancy.
Acta Paediatr, 85 (1996), pp. 1331-1338
[6.]
P.F. Agran, D.E. Dunke, D.G. Winn, D. Kent.
Fetal death in motor vehicle accidents.
Ann Emerg Med, 16 (1987), pp. 1355-1358
[7.]
R. Bejar, R.W. Cohen, L. Gluck.
Hypoxic-ischemic and hemorrhagic brain injury in newborn.
Perinatol Neonatol, 6 (1982), pp. 69-74
[8.]
L.S. De Vries, V. Dubowitz, S. Lary.
Predictive value of cranial ultrasound in the newborn baby: A reappraisal.
Lancet, 1 (1985), pp. 137-139
[9.]
M.I. Levene, J.L. Williams, C.L. Fawer.
Ultrasound of the Infant Brain.
[10.]
J.J. Volpe.
Neurology of the Newborn. 2nd.
[11.]
J.J. Volpe.
Hemorragia intraventricular y lesión cerebral en prematuros. Neuropatología y patogenia. Clin Perinatol.México.
Interamericana, 16 (1989), pp. 395-422
[12.]
J.J. Volpe.
Hemorragia intraventricular y lesión cerebral en prematuros. Diagnóstico, pronóstico y prevención. Clin Perinatol. México.
Interamericana, 16 (1989), pp. 423-448
[13.]
B. Lamaire, B. Chave, M. Tescher.
Mort néonatale dans les suites d’un traumatisme in utero, en l’abscense de lesions maternelles.
Rev Fr Gynecol Obstet, 85 (1990), pp. 199-201
[15.]
R. Towery, T.P. English, D. Wisner.
Evaluation of pregnant women after bluntinjury.
J Trauma, 35 (1993), pp. 731-736
[16.]
M.A. Dahmus, B.M. Sibai.
Blunt abdominal trauma: are there any predictive factors for abruptio placentae or maternal-fetal distress?.
Am J Obstet Gynecol, 169 (1993), pp. 1054-1060
[17.]
T. Razafintsalama, J. Coiffic, A. Splete, O. Chevrant-Breton, P. Pladys, P. Poulain.
Encéphalopathie multikystique néo-natale après accident de la voie publique acec lesions ma-ternelles mineurs.
J Ginecol Obstet Biol Reprod, 28 (1999), pp. 483-487
[18.]
M.D. Pearlman, J.E. Tintinalli, R.P. Lorenz.
Blunt trauma during pregnancy.
NEngl J Med, 323 (1990), pp. 1609-1612
[19.]
F. Gardeil, S. Daly, M.J. Turner.
Uterine rupture in pregnancy reviewed.
Eur J Obstet Gynecol Reprod Biol, 56 (1994), pp. 107-112
[20.]
PN Jr Bretan, J.W. McAninch, M.P. Federle, RB Jr. Jeffrey.
Computerized tomographic staging of renal trauma: 85 consecutives cases.
J Urol, 136 (1986), pp. 561-565
[21.]
D.M. Sherer, J.S. Abramowicz, R. Babkowski.
Extensive fetal intrathoracic injuries sustained in a motor vehicle accident.
Am J Perinatol, 10 (1993), pp. 414-420
[22.]
M.H. Fries, GDV. Hankins.
Motor vehicle accidents associated with minimal maternal trauma but subsequent fetal demise.
Ann Emerg Med, 18 (1989), pp. 301-305
[23.]
J.K. Ribe, J.R. Teggatz, C.M. Harvey.
Blows to the maternal abdomen causing fetal demise: Report of three cases and a review of the literature.
J Forensic Sci, 35 (1993), pp. 1092-1096
[24.]
H.B. Sarnat, M.S. Sarnat.
Neonatal encephalopathy follo wing fetal distress: A clinical and electroencephalographic study.
Arch Neurol, 33 (1976), pp. 696-703
[25.]
C. Robertson, N. Finer.
Term infants with hypoxic-ischemic encephalopathy: Outcome at 3.5 years.
Dev Med Child Neurol, 33 (1976), pp. 473-479
[26.]
A. Hill, J.J. Volpe.
Asfixia perinatal: aspectos clínicos. Clin Perinatol. México.
Interamericana, 16 (1989), pp. 473-496
[27.]
F. Venditelli, C. Manciet-Labarchede, J.L. Tabaste, Y. Malinas.
Lesions traumatiques de l’utérus gravide et de son con tenu: aspects médico-légaux.
Rev Fr Gynecol Obstet, 89 (1994), pp. 393-400
[28.]
W.M. Crosby.
Trauma during pregnancy: maternal and fetal injury.
Obstet Gynecol Surv, 29 (1974), pp. 683-699
[29.]
Ch. Merger.
Aspects médico-légaux de la traumatologie en obstétrique.
Encycl Med Chir Obstétrique, pp. 5150-5210
[30.]
T.J. Esposito, D.R. Gens, L.G. Smith, R. Scorpio, T Trauma during pregnancy. Buchman.
A review of 79 cases.
Arch Surg, 126 (1991), pp. 1073-1078
[31.]
W.S. Hoff, L.F. D’Amelio, G.H. Tinkoff, J.F. Lucke, M. Rhodes, D.L. Diamond, et al.
Maternal predictors of fetal demise in trauma during pregnancy.
Surg Gynecol Obstet, 172 (1991), pp. 175-180
[32.]
R.J. Scorpio, T.J. Esposito, L.G. Smith, D.R. Gens.
Blunt trau ma during pregnancy: factors affecting fetal out come.
Trauma, 32 (1992), pp. 213-216
[33.]
M.E. Wolf, B.H. Alexander, F.P. Rivara, D.E. Hickok, R.V. Maier, P.M. Starzyk.
A retrospective cohort study of seatbelt use and pregnancy outcome after vehicle crash.
J Trauma, 34 (1993), pp. 116-119
[34.]
R.L. Burt.
Plasma non-esterified fatty acids in normal preg nancy and the puerperium.
Obstet Gynecol, 15 (1960), pp. 460-465
[35.]
W.A.W. Walters, W.G. MacGregor, M. Hills.
Cardiac output at rest during pregnancy and the puerperium.
Clin Sci, 30 (1966), pp. 1-7
[36.]
M.A. Akhtar, P.M. Mulawkar, H.R. Kulkarni.
Burns in preg nancy: Effect on maternal and fetal outcomes.
Burns, 20 (1994), pp. 351-356
[37.]
L.M. Sachs, M. Delioria-Papadopoulos.
Hemoglobin oxygen interactions.
Sem Perinatol, 8 (1984), pp. 168-173
[38.]
P.C. Peters, A.I. Sagalowsky.
Genitourinary trauma. In: Campbell MF, editor. Campbell’s Urology. Vol 3. 6th. ed.
pp. 2571-2593
[39.]
W.C. Mabie, T.G. Disessa, L.G. Crocker.
A longitudinal study of the cardiac output in normal human pregnancy.
Am Obstet Gynecol, 170 (1994), pp. 849-853
[40.]
R.B. Lee, J.H. Wudel, JA Jr. Morris.
Trauma in pregnancy.
Tenn Med Assoc, 83 (1990), pp. 74-76
[41.]
N. Vorys, J.C. Ullery, G.E. Hanusek.
The cardiac output changes in various positions in pregnancy.
Am J Obstet Gynecol, 82 (1961), pp. 1312-1316
[42.]
M.G. Kerr, D.B. Scott, E. Samuel.
Studies of the inferior vena cava in late pregnancy.
BMJ, 1 (1964), pp. 532-536
[43.]
M.D. Adams, K.A. Keegan.
Cambios fisiológicos durante el embarazo normal.
Tratamiento de las complicaciones clínicas del em barazo, pp. 28-46
[44.]
T.R. Easterling.
Fisiología cardiovascular durante el emba razo.
Tratamiento de las complicaciones clínicas del embarazo, pp. 1061-1066
[45.]
B.K. Howard, J.H. Goodson, W.F. Mengert.
Supine hypotensive syndrome in late pregnancy.
Obstet Gynecol, 1 (1953), pp. 371-377
[46.]
R.B. Lee, J.H. Wudel, JA Jr. Morris.
Trauma in pregnancy.
JTerm Med Assoc, 83 (1990), pp. 74-76
[47.]
D.G. Murdoch Eaton, Y. Ahmed, L.M. Dubowitz.
Maternal trauma and cerebral lesions in preterm infants. Case reports.
Br J Obstet Gynaecol, 98 (1991), pp. 1292-1294
[48.]
D.L. Farmer, N.S. Adzick, W.R. Crombleholme, T.M. Cromblehol-me.
Longgaker MT, Harrison MR. Fetal trauma: relation to material injury.
J Pediatr Surg, 25 (1990), pp. 711-714
[49.]
B.D. Lifschultz, E.R. Donoghue.
Fetal death following maternal trauma: two cases reports and a survey of the literature.
J Forensic Sci, 36 (1991), pp. 1740-1744
[50.]
M.D. Pearlman, J.E. Tintinalli.
Evaluation and treatment of the gravida and fetus following trauma during pregnancy.
Obstet Gynecol Clin North Am, 18 (1991), pp. 371-378
[51.]
R.G. Bickers, R.P. Wennberg.
Fetomaternal transfusion following trauma.
Obstet Gynecol, 61 (1983), pp. 258-264
[52.]
P.G. Rose, P.L. Strohm, F.R. Zuspam.
Fetomaternal hemorrhage following trauma.
Am J Obstet Gynecol, 153 (1985), pp. 844-849
[53.]
T.M. Goodwin, M.T. Breen.
Pregnancy outcome fetomater-nal hemorrhage after noncatastrophic trauma.
Am J Obstet Gynecol, 162 (1990), pp. 665-670
[54.]
M.D. Pearlman, J.E. Tintinalli, R.P. Lorenz.
A prospective controlled study of trauma during pregnancy.
Am J Obstet Gynecol, 182 (1990), pp. 1502-1507
[55.]
J.B. Miale.
Laboratory Medicine Hematology. 6th ed.
[56.]
W.L. Holcomb, E. Gunderson, R.H. Petrie.
Clinical use of the Klehauer Betke test.
J Perinat Med, 189 (1990), pp. 331-335
[57.]
D.L. Weaver, J.C. Barthold, B. Hamill.
Hereditary persistence of fetal hemoglobin presenting as fetal-maternal hemorrhage.
Am J Clin Pathol, 93 (1990), pp. 277-283
[58.]
A.R. Dupre, J.C. Morrinson, J.N. Martin.
Clinical application of the Kleihauer-Betke test.
J Reprod Med, 38 (1993), pp. 621-625
[60.]
S.S. Chang, M.C. Chang, J.A. Morris.
Trauma in pregnancy: the maternal-fetal relationship.
J Renn Med Assoc, 87 (1994), pp. 291-296
[61.]
J.P. Corsetti, C. Cox, J.F. Leary.
Comparison of quantitative acid-elution technique and flow cytometry for detecting fetomaternal hemorrhage.
Am Clin Lab Sci, 17 (1987), pp. 197-203
[62.]
T.J. Greenwalt, U.J. Dumaswala, M.M. Domino.
The quantitication of fetomaternal hemorrhage by an enzyme-linked antibody test with glutaraldehyde fixation.
Vox Sang, 63 (1992), pp. 268-272
[63.]
D. Rouse, C. Weiner.
Ongoing fetomaternal hemorrhage trated by serial fetal intravascular transfusions.
Obstet Gy-necol, 76 (1990), pp. 974-979
[64.]
G.J. Dowing, E. Vandeboom, J.A. Rhorpe.
Antepartum feto-maternal hemorrhage. Report of a case with the use of cor-docentesis in diagnosis and management.
J Reprod Med, 37 (1992), pp. 566-571
[65.]
D. Rothenberger, F.W. Quattlebaum, J.F. Perry.
Blunt maternal trauma: A review of 103 cases.
J Trauma, 18 (1978), pp. 173-177
[66.]
K.J. Williams, L. McClain, A.S. Rosemurgy.
Evaluation of blunt abdominal trauma in the third trimester of pregnancy: maternal and fetal considerations.
Obstet Gynecol, 75 (1990), pp. 73-77
[67.]
M. Elliot.
Vehicular accidents and pregnancy.
Aust N Z JObset Gynecol, 6 (1966), pp. 279-285
[68.]
W.M. Crosby, J.P. Costilloe.
Safety of lap-belt restraint for pregnant victims of automobile collisions.
N Enl J Med, 284 (1971), pp. 632-636
[69.]
R.J. Pepperell, E. Rubinstein, I.A. McIsaac.
Motor car accidents during pregnancy.
Med J Aust, 1 (1977), pp. 203-207
[70.]
P.A. Stafford, P.W. Biddinger, R.E. Zumwalt.
Lethal intraute-rine fetal trauma.
Am J Obstet Gynecol, 159 (1988), pp. 455-461
[72.]
ACOG Technical Bulletin.
Automobile passenger res-traings for children and pregnancy women.
ACOG, 151 (1991), pp. 1-10
[73.]
R.S. Kuhlmann, D.P. Cruikshank.
Traumatismos maternos durante el embarazo. Clin Obst Gin. México.
Interameri-cana, 37 (1994), pp. 249-265
[74.]
L.I. Cabero.
Patología quirúrgica, traumatismos y gestación.
Riesgo elevado obstétrico, pp. 409-420
[75.]
S.L. Clark, D.B. Cotton, W. Lee.
Central hemodynamic assessment of normal term pregnancy.
Am J Obstet Gynecol, 161 (1989), pp. 1439-1444
[76.]
H.J. Buchsbaum.
Accidental injury during pregnancy.
Con-temp OB/GYN, 200 (1982), pp. 27-33
[77.]
M. Bowman, W. Giles, S. Deane.
Trauma during pregnancy: a review of management.
Aust N Z J Obstet Gynaecol, 29 (1989), pp. 389-393
[78.]
W.M. Crosby, A.I. King, L.C. Stout.
Fetal survival following impact: Improvement with shoulder harness restraint.
Am J Obstet Gynecol, 112 (1972), pp. 1101-1105
[79.]
for Disease Control. Centers.
Public health focus.
Impact of safety-belt use on motor-vehicle injuries and costs – Iowa, 1987-88. MMWR, 42 (1993), pp. 704-709
[81.]
D.C. Astarita, B. Feldman.
SEAT belt placement resulting in uterine rupture.
J Trauma, 42 (1997), pp. 738-741
[82.]
C.J. Sims, C.H. Boordman, S.J. Fuller.
Air bag deployment following a motor vehicle accident in pregnancy.
Obstet Gy-necol, 175 (1996), pp. 977-982
[83.]
M.D. Pearlman, D. Viano.
Automobile crash simulation with the first pregnant crash test dummy.
Am J Obstet Gy-necol, 175 (1996), pp. 977-982
[84.]
American College of Obstetricians and Gynecologists.
Automobile Passenger Restraints for Children and Pregnant Women.
[85.]
US Department of Transportation. National Highway Traffic Safety Administration..
Nineteen-City Survey of Restraint Use.
[86.]
A.W. Brann, R.E. Myers.
Central nervous system findings in the newborn monkey following severe in utero partial asphyxia.
Neurology, 25 (1975), pp. 327-331
[87.]
R.E. Myers.
Four patterns of perinatal brain damage and the conditions of coccurrence in primates.
Adv Neurol, 10 (1975), pp. 223-227
[88.]
R.E. Myers.
Experimental models of perinatal brain damage: Relevance to human pathology.
In-trauterine asphyxia and the developing fetal brain, pp. 37-52
[89.]
J.M. Freeman.
Prenatal and perinatal factors associated with brain disorders.
pp. 85-1149
[90.]
K.B. Nelson, J.H. Ellenberg.
Antecedents of cerebral palsy: Multivariate analysis of risk.
N Engl J Med, 315 (1986), pp. 81-84
[91.]
J.M. Freeman, K.B. Nelson.
Intrapartum asphyxia and cerebral palsy.
Pediatrics, 82 (1988), pp. 240-245
[92.]
J. Tumbri, Z. Prese cki.
Ecografía neonatal en el diagnóstico precoz del daño cerebral.
Ecografía en medicina materno-fetal, pp. 867-883
[93.]
R.M. Kliegman.
Hypoxia-ischaemia (asphyxia.
Textbook of pedaitrics, pp. 469-471
[94.]
C. Palme, A. Ericsson.
What happened to asphyxic Swedish neonates in 1985 [abstract].
Join Meeting of Neonatal, pp. 145
[95.]
G.A. Taylor.
Effect on germinal matrix hemorrhage on terminal vein position and patency.
Pediatr Radiol, 25 (1995), pp. 37-40
[96.]
V. Mejaski-Bosnjak.
Neurorazvojno pracenje perinatalno ugrozene djece s ventrikulomegalijom.
[97.]
A. Hill.
Valoración del feto: importancia respecto a la lesión cerebral. Clin Perinatol.
México: Interamericana, 16 (1989), pp. 449-471
[98.]
H.C. Lou, N.A. Lasson, B. Hansen.
Impaired autoregulation of cerebral blood flow in the distressed newborn infant.
J Pediatr, 94 (1979), pp. 118-122
[99.]
J.J. Volpe, A. Hill.
Neurologic disorders.
Neonatology.pathophysiology and management of the newborn, pp. 1092-1102
[100.]
Z. Prese ki.
Hipoksijsko-ischemijska encefalopatija novo-rodjenceta.
Pedijatrija, pp. 205-219
[101.]
A. Legido.
Fisiopatología de la Encefalopatía Hipóxico-is-quémica Perinatal.
Acta Neuropediatr, 1 (1994), pp. 96-109
[102.]
Z.M. Sfaello.
Encefalopatía hipóxico-isquémica.
Neurología pediátrica, pp. 173-182
[103.]
A. Hill, J.J. Volpe.
Hypoxic-ischemic encephalopathy in the newborn.
Principles and practice, pp. 489-507
[104.]
J.J. Volpe, A. Oka, M. Belliveau, P.R. Rosenberg.
Glutamate is highly toxic to differentiating oligoendroglia [abstract].
Ann Neurol, 32 (1992), pp. 245
[105.]
J.J. Volpe, A. Oka, P.R. Rosenberg, J. Lini.
Glutamate toxicity to oligodendrologia is maturation dependent and related to a brief window of vulnerability to oxidate stress [abstract].
Ann Neurol, 34 (1993), pp. 442
[106.]
J.J. Volpe.
Perinatal hypoxic-ischemic brain injury: and overview.
Fetal and prinatal neurology, pp. 232-252
[107.]
R.E. Myers.
Four patterns of perinatal brain demage and their conditions of occurrence in primates.
Ann Neurol, 10 (1975), pp. 223-226
[108.]
J. Natsume, N. Kazuyoshi, F. Kuniyoshi, H. Fumio, H. Yoshio.
Clinical, neurophysiologic and neuropathological type C (Myers.
Pediatric Neurol, 1 (1995), pp. 61-64
[109.]
S. Burja.
Ultrazvuk u dijagnostici hipoksickno-ischemicnih ostecenja mozga neodonoscadi.
Ultrazyuk u dijagnosti-ci rango ostecenja mozga, pp. 78-89
[110.]
JCL. Laroche.
Developmental Pathology of the Neonate.
[111.]
M.I. Levene.
Sequelae of periventricular hemorrhage.
pp. 62-75
[112.]
N. Lukinovic.
Uloga ultrazvuka u proucavanju zazrijevanja mozga I otkrivanju patoloskih intrakanijalnih procesa.
Ultrazvuk u Klinickoj Medicini, (1989), pp. 313-332
[113.]
L.R. Ment, B. Vohr, W. Oh.
Neurodevelopmental outcome at 36 months’ corrected age of preterm infants in the Multi-center Indomethacin Intraventricular Haemorrhage Pre-veintion Trial.
Pediatrics, 98 (1996), pp. 714-718
[114.]
O. Flodmark, E.H. Rolland, A. Hill.
Periventricular leuko-malacia: Radiologic diagnosis.
Radiology, 162 (1987), pp. 119-124
[115.]
B. Koprcina, J. Tumbri, H. Subasic, I. Janiska, T. Hafner, B. Miskovic.
Neonatal ultrasound findings in newborns with abnormal fetal Doppler measurements.
Modern methods of the assessment of fertal and neonatal brain, pp. 202-206
[116.]
K.H. Rosenberg, R.S. Levine, K.S. Stitz, D.R. Smith.
Real-time ultrasound evaluation in infants with bacterial meningitis.
J Ecographe Med Ultrasound, 6 (1985), pp. 177-182
[117.]
S. Takashima, D.L. Armstrong, L.E. Becker.
Subcortical leu-komalacia. Relationship to development of the cerebral sulcus and its vascular supply.
Arch Neurol, 35 (1978), pp. 470-472
[118.]
D.E. Levy, J.B. Brierley, D.G. Silverman, F. Plum.
Briel hypo-xia-ischemia initially demages cerebral neurons.
Arch Neurol, 32 (1975), pp. 450-455
Copyright © 2002. Elsevier España, S.L.. Todos los derechos reservados
