Lowdermilk C, Gavant M L, Qaisi W, West O C, Goldman S M
Department of Radiology, University of Tennessee, Memphis College of Medicine 38163, USA.
Radiographics. 1999 Oct;19 Spec No:S243-55; discussion S256-8. doi: 10.1148/radiographics.19.suppl_1.g99oc28s243.
Pregnant patients who sustain severe blunt trauma are infrequently encountered in most practices. However, detection of internal injuries including those to the gravid uterus is essential since maternal disability or fetal loss are physical and psychologic catastrophes that have long-term effects on the mother and her family. Computed tomography (CT) is commonly used to detect blunt traumatic injuries and can play an important role in the screening of the injured pregnant woman. The normal gravid uterus and physiologic changes of pregnancy can confound CT interpretation. Inhomogeneous enhancement of placental cotyledons, hydronephrosis, and enlarged ovarian veins are normal findings. Avascular regions in the placenta indicate infarction or abruption with impending fetal demise. Although CT can demonstrate uterine rupture and retroperitoneal hemorrhage, direct detection of fetal injuries is rare. Fetal demise is more common when maternal injuries include trauma to the uterus. Although screening ultrasonography can depict fetal distress, use of screening CT allows a concurrent evaluation of multiple areas in the pregnant trauma patient including the uterus. CT is a useful diagnostic tool in the triage of the critically injured pregnant woman.
在大多数医疗实践中，遭遇严重钝性创伤的孕妇并不常见。然而，检测包括妊娠子宫在内的内部损伤至关重要，因为母体残疾或胎儿丢失是对母亲及其家庭具有长期影响的身体和心理灾难。计算机断层扫描（CT）常用于检测钝性创伤，在受伤孕妇的筛查中可发挥重要作用。妊娠子宫的正常情况及妊娠的生理变化会使CT解读变得复杂。胎盘小叶不均匀强化、肾积水和卵巢静脉增粗是正常表现。胎盘中的无血管区域提示梗死或胎盘早剥，胎儿即将死亡。虽然CT可显示子宫破裂和腹膜后出血，但直接检测到胎儿损伤的情况很少见。当母体损伤包括子宫创伤时，胎儿死亡更为常见。虽然筛查超声可显示胎儿窘迫，但使用筛查CT可同时评估受伤孕妇的多个部位，包括子宫。CT是危重伤势孕妇分诊中的一种有用诊断工具。
