Kho Giat Seng, Abdullah Jafri Malin
Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Department of Neurosurgery, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia.
Malays J Med Sci. 2018 Sep;25(5):151-157. doi: 10.21315/mjms2018.25.5.14. Epub 2018 Oct 30.
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.
创伤性脑损伤是发展中国家非产科死亡的主要促成因素。约20%的孕产妇死亡与损伤直接相关。道路交通事故和家庭暴力是最常见的可能威胁孕产妇或胎儿生命的非致命性损伤，此类事件在每12次怀孕中就有1次发生。孕期严重创伤性脑损伤的治疗需要多学科团队协作。对怀孕创伤患者的管理需要考虑一些与怀孕相关的特定问题，比如孕产妇生理和解剖结构的改变。在羊水栓塞导致孕产妇心脏骤停的情况下，新生儿的存活与孕产妇心脏骤停后剖宫产的时机有关。此外，孕产妇心脏骤停后进行濒死剖宫产的决策很明确。如果在心肺功能受损15分钟之前进行手术，胎儿存活率为67%，在16 - 25分钟的时间段内则降至40%。孕期无论创伤性脑损伤是轻微还是严重，都与孕产妇不良结局相关。对普通人群来说被认为是轻微的损伤，对孕妇而言并非如此。因此，这些患者应接受密切监测，并且始终应采用多学科方法。
