///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

Motorcycle accident with brain trauma associated during the third trimester of pregnancy: case report.

Abstract Number: 232
Abstract Type: Case Report/Case Series

German Monsalve Mejia Anesthesiologist1 ; Alejandro Upegui Anesthesiologist2; Nelson Fonseca IAnesthesiologist ntensivist3; Maria Virginia Gonzalez Anesthesiologist4; Mauricio Vasco Anesthesiologist5

INTRODUCTION:

Trauma in pregnancy is currently a leading cause of non obstetric maternal death.

CASE REPORT:

A 26 year-old pregnant patient G3 A1, D1, C0, with 40 gestation weeks presented severe Brain Trauma Injury (BTI) as a passenger of a motorcycle without a helmet. At admission, Glasgow Coma Scale 6/15. BP 108/66, HR 88 per min, Sat 02: 85 %.Tracheal intubation were done with midazolam,succinylcholine and mechanical ventilation was initiated. Obstetric echography shows normal amniotic fluid and placental abruption were ruled out.Cervical spine Xray and pelvic Xray were normal. CT scan: cerebral edema, intraparenchimal contusion in left frontal zone with middle line deviation.Patient was transferred to the ICU where invasive monitoring was placed and vasopressor support initiated. OB found a patient cervical dilation 2 cms. OB decided to end pregnancy but controversy was generated on the best route of delivery. The taken decision was to induce labor monitoring intracranial pressure (ICP). An intraparenchimal catheter showed an initial ICP 18mmHg. Figure 1 shows laboring patient with ICP monitoring. Sedation, analgesia and oxitocin were initiated; ten hours later a healthy neonate was delivery with APGAR of 8/10 and 9/10 respectively.No increases of ICP were seen during labor or delivery. Cerebral perfusin pressure was 70 mmHg.The ICP increased in the first postpartum day, needing hypertonic saline 7.5%. She was extubated in the fifth postpartum day and transferred to a room on the 7 postpartum day without neurological deficit.

Discussion:

In TBI in the pregnant patient early aggressive maternal resuscitation is the main priority. General evaluation must ruled out placental abruption, uterine rupture and direct fetal trauma. If fetus is viable, decision must be taken whether delivery is or not appropriate. The rising of ICP due to uterine contractions is probable; in this case, patient had sedation, analgesia and monitoring of ICP. Mechanical ventilation must be done trying to keep a normal ETC02; if hyperventilation is required, it may cause uterine arteries vasoconstriction. Mannitol or hypertonic saline (HS) use in the pregnant patient is controversial; mannitol slowly accumulates in the fetus.Fetal hyperosmolality produces increase sodium concentration. There is no information about the use of HS in pregnant patients.

The TBI in pregnancy needs a multidisciplinary approach.

References:

1.Surg Clin N Am 88 (2008) 421-440.



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