When Your 37 Weeks Pregnant if You Get Smacked in the Stomach Can It Hurt the Baby

BMC Res Notes. 2013; 6: 517.

Blunt abdominal trauma to a pregnant woman resulting in a kid with hemiplegic spastic cognitive palsy and permanent eye damage

Elmuntasir Taha

¹National Ribat University, Khartoum, Sudan

Khalid Nasralla

¹National Ribat University, Khartoum, Sudan

AbdulRahman Khalid

¹National Ribat University, Khartoum, Sudan

AbdelAziem A Ali

²Department of Obstetrics and Gynecology, Faculty of Medicine, Kassala University, P.O. Box 496, Kassala, Sudan

Received 2013 Feb viii; Accepted 2013 Oct 22.

Abstract

Groundwork

In today'south life trauma is a common and important complication of pregnancy and remains one of the major contributors to maternal and fetal morbidity and mortality.

Instance presentation

The authors reported a example of iv years old child with hemiplegic spastic cerebral palsy and permanent left centre impairment due to antenatal trauma. He was an off spring to a 33 years sometime woman gravida half dozen para v from western Sudan, who sustained a domestic blunt abdominal trauma during her routine daily activities. The abdominal trauma occurred during the tertiary trimester at 36^th calendar week gestation of the pregnancy when the female parent hitting herself by the woody function of an axe not intentionally.

Conclusions

The findings from this case conclude that relatively minor trauma tin can have significant agin furnishings on the fetus and can be devastating.

Keywords: Trauma, Pregnancy, Middle, Cognitive palsy, Sudan

Background

In today's life trauma is a common and important complication of pregnancy and remains one of the major contributors to maternal and fetal morbidity and mortality [one,2]. Even minor maternal trauma can pb to serious complications include maternal injury, death, daze, internal hemorrhage, intrauterine fetal demise, directly fetal injury, abruptio placentae, and uterine rupture [1-4]. The leading causes of obstetric trauma are motor vehicle accidents, falls, assaults, and gunshots, and ensuing injuries are classified as edgeless abdominal trauma, pelvic fractures, or penetrating trauma [1-half dozen]. The causes are different with dissimilar life styles and dissimilar socio-economical and cultural groundwork. We aimed in this case report to highlight the consequence of blunt abdominal trauma on the obstetric outcome later on we obtained a written consent from the patient for publication of this case written report and any accompanied images.

Case presentation

We present a case of 4 years old kid with hemiplegic spastic cerebral palsy and permanent left eye damage due to antenatal trauma. He was an off leap to a 33 years old woman gravida half-dozen para 5, from western Sudan without consanguinity betwixt his parents. The female parent sustained a domestic blunt abdominal trauma during her routine daily activities in the year 2009. The intestinal trauma occurred during the tertiary trimester at 36^th calendar week gestation, of the pregnancy when the mother hit herself past the woody function of an axe non intentionally. Her pregnancy was uneventful and she had no whatever significant past medical or obstetrical history. At the time of trauma there was an aberrant fetal motion. Intestinal examination at that fourth dimension was unremarkable except for a bruise at the trauma site equally stated by the referring doctor. Shortly she experienced abdominal pain and vaginal haemorrhage which necessitated 2 units of blood transfusion in the nearby rural hospital. Four hours later the patient adult uterine contraction which progressed steadily and resulted in vaginal commitment after 10 hours from her admission. She delivered a boy of 2650 gm with an afflicted left eye and the treating doctor referred her to a tertiary hospital on the 2d mean solar day without recorded data on intrapartum monitoring, neonatal resuscitation and\or Apgar score. At fourth dimension of presentation the child was irritable with signs of cerebral irritation, his left eye was totally damaged and in improver there was paucity of motion on the correct side. The babe was admitted and received the advisable handling so booked for regular follow up to appraise the development of his milestone. During the follow upwards there was global retardation of his milestones. The child ended with right sided hemiplegic spastic cerebral palsy and epilepsy in addition to his eye problem and according to the Growth Motor Role Nomenclature System (GMFCS) the disease was type 4 yet the IQ according to the Wechsler Intelligence Calibration for children-Revised (WISC-R) was not applicable because the child age < half-dozen years sometime. The kid was fully investigated, initial CT scan showed brain edema which followed by MRI after belch which show cerebral atrophy. His centre was managed conservatively and planed for eye inoculation and bogus centre, while multi-disciplinary approached including physiotherapy for his hemiplegia was started (Figures ​ ane and ​ 2).

Showing the left eye harm (a child of 4 years one-time).

Showing the right sided hemiplegia (a child of 4 years former).

Conclusions

We report a rare case of cerebral palsy as a result of intestinal trauma during the third trimester to highlight the effect of blunt trauma on pregnancy. The effect of trauma on pregnancy depends on the gestational age of the fetus, the type and severity of the trauma, and the extent of disruption of normal uterine and fetal physiology. Trauma occurring during the second and third trimester has different clinical consequences than during the first trimester. Get-go trimester, pocket-size trauma is not threatening to the pregnancy [1-six]. During the second and third trimester, even relatively pocket-sized trauma can accept significant adverse furnishings on the fetus. Such adverse effects include placental abruption, preterm labor, uterine rupture, and direct fetal injury. In this case, regular uterine contractions began shortly later the trauma (within four hours), progressed steadily and resulted in delivery. Premature rupture of the fetal membranes tin can also occur, within the first 4 hours of injury and ordinarily consequence in a premature commitment. Direct fetal injury may occur, resulting in contusions, fractures or fetal death. Uterine rupture tin occur and usually result in the loss of the fetus [7]. Middle damage which occurred in our case mayhap might exist related to the fetal position at time of trauma and the amount of liquor that represent an insulator and could absorb the edgeless trauma, while cognitive palsy could exist explained past the fetal head injury subsequently the abdominal trauma. The effect of trauma on the meaning adult female and unborn fetus can be devastating. The major causes of maternal injury are edgeless trauma, penetrating trauma, burns, falls, and assaults [viii]. With the agile life-fashion of today's pregnant women, the effects of trauma have get an important obstetric business organization. A protocol was developed to monitor pregnancies complicated by major blunt abdominal trauma in the 3rd trimester, looking specifically for delayed placental and/or fetal problems. In a series of the 84 pregnancies studied, the most serious complication was placental abruption. Although abruption occurred in only two cases, one case was associated with a ruptured uterus and fetal decease. There were no cases of delayed abruption or delayed fetal compromise. The nearly common complication was preterm labor, occurring in 28% of cases when the traumatic insult happened before 37 weeks' gestation. Of these 17 patients, fifteen were successfully treated with tocolysis. There were no cases of direct fetal injury or Rhesus-isoimmunization. A revised protocol is recommended for limited outpatient ascertainment with non stress testing and screening ultrasonography to rule out preterm labor and placental abruption and to document fetal well-existence [ix]. The survival of the fetus afterward trauma depends on the mother's condition in regard to respiratory passage, oxygenation, and hypovolemia [x]. Thus in determination, the findings from this example confirmed that relatively minor trauma tin have meaning adverse furnishings on the fetus and can be devastating.

Consent

Written informed consent was obtained from the mother for publication for this case written report and whatsoever accompanying images. A copy of the written consent is available for review by the series editor of this journal.

Competing interests

The authors declare that they have no competing interest.

Authors' contribution

TE reported the case, participated in drafting of the manuscript and managed the case. NK and KA participated in drafting of the manuscript and literature review, AAA coordinated the case report and participated in the drafting of the manuscript.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878962/

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