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.
Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI 48109, USA.
Injury. 2022 Apr;53(4):1329-1344. doi: 10.1016/j.injury.2022.01.037. Epub 2022 Feb 5.
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.
孕期创伤是导致发病率和死亡率的主要非产科原因，占每 1000 例胎儿死亡的 5 例。孕期创伤直接导致的胎儿损伤较为罕见，关于如何优化损伤后胎儿结局的信息有限。早期识别和适当处理直接胎儿创伤可能会改善胎儿结局。目前没有指导胎儿损伤管理的指南。我们详细回顾了孕期钝性和穿透性损伤后直接胎儿损伤的处理和结局，并描述了一种针对受伤孕妇的初始处理方法，重点是评估胎儿损伤。我们确定了 45 例钝性创伤导致的直接胎儿损伤，21 例在新生儿期后存活，33 例穿透性创伤导致的直接胎儿损伤，24 例在新生儿期后存活。产前影像学在 19 例钝性创伤中发现了胎儿损伤，并在 6 例中用于确定子弹相对于胎儿的位置。这些报告被用来制定受伤胎儿的管理算法。
