Abstract
The purpose of this paper is to describe brain pathology in neonates after major traffic trauma in utero during the third trimester. Our patient cohort consisted of four neonates born by emergency cesarean section after car accident in the third trimester of pregnancy. The median gestational age (n=4) was 36 weeks (range: 30–38). Immediate post-natal and follow-up brain imaging consisted of cranial ultrasound (n=4), computed tomography (CT) (n=1) and post-mortem magnetic resonance imaging (MRI) (n=1). Pathology findings were correlated with the imaging findings (n=3). Cranial ultrasound demonstrated a huge subarachnoidal hemorrhage (n=1), subdural hematoma (n=1), brain edema with inversion of the diastolic flow (n=1) and severe ischemic changes (n=1). In one case, CT demonstrated the presence and extension of the subarachnoidal hemorrhage, a parietal fracture and a limited intraventricular hemorrhage. Cerebellar hemorrhage and a small cerebral frontal contusion were seen on post-mortem MRI in a child with a major subarachnoidal hemorrhage on ultrasound. None of these four children survived (three children died within 2 days and one child died after 1 month). Blunt abdominal trauma during pregnancy can cause fetal cranial injury. In our cases, skull fracture, intracranial hemorrhage and hypoxic-ischemic encephalopathy were encountered.
Similar content being viewed by others
References
Goldman SM (2000) Overview of emergency radiological management of the pregnant patient, especially the traumatized pregnant patient. Emerg Radiol 7:198–205
Corsi PR, Rasslan S, de Oliveira LB, Kronfly FS, Marinho VP (1999) Trauma in pregnant women: analysis of maternal and fetal mortality. Injury 30:239–243
Schiff MA, Holt VL, Daling JR (2002) Maternal and infant outcomes after injury during pregnancy in Washington state from 1989 to 1997. J Trauma 53:939–945
Ali J, Yeo A, Gana TJ, McLellan BA (1997) Predictors of fetal mortality in pregnant trauma patients. J Trauma 42:782–785
Goldman SM, Wagner LK (1999) Radiologic ABCs of maternal and fetal survival after trauma: when minutes may count. Radiographics 19:1349–1357
Shah KH, Simons RK, Holbrook T, Fortlage D, Winchell RJ, Hoyt DB (1998) Trauma in pregnancy: maternal and fetal outcomes. J Trauma 45:83–86
Henderson SO, Mallon WK (1998) Trauma in pregnancy. Emerg Med Clin N Am 16:209–228
Connolly AM, Katz VL, Bash KL, McMahon MJ, Hansen WF (1997) Trauma and pregnancy. Am J Perinatol 14:331–336
Siebenga J, Van Der Schoot JTM, Keeman JN (1999) Trauma tijdens de zwangerschap. Ned Tijdschr Geneeskd 143:1144–1148
Alley JR, Yahagi Y, Moncure MM, Strickler JC (2003) A case of in utero fetal brain trauma after motor vehicle collision. J Trauma 55:782–785
Shah AJ, Kilcline BA (2003) Trauma in pregnancy. Emerg Med Clin N Am 21:615–629
Esposito TJ (1994) Trauma during pregnancy. Emerg Med Clin N Am 12:167–199
Morris JA, Rosenbower TJ, Jurkovich GJ, Hoyt DB, Harviel D, Knudson M, Miller RS, Burch JM, Meredith JW, Ross SE, Jenkins JM, Bass JG (1996) Infant survival after cesarean section for trauma. Ann Surg 223:481–491
van Bel F (1997) Cerebral blood flow velocity waveform characteristics (Doppler ultrasound). In: Govaert P, de Vries LS (eds) An atlas of neonatal brain sonography. McKeith, London, pp 341–359
Matthews G, Hammersley B (1997) A case of maternal pelvic trauma following a road traffic accident, associated with fetal intracranial haemorrhage. J Accid Emerg Med 14:115–117
Demaerel P, Casteels I, Wilms G (2002) Cranial imaging in child abuse. Eur Radiol 12:849–857
Carty H (1997) Non-accidental injury: a review of the radiology. Eur Radiol 7:1365–1376
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Breysem, L., Cossey, V., Mussen, E. et al. Fetal trauma: brain imaging in four neonates. Eur Radiol 14, 1609–1614 (2004). https://doi.org/10.1007/s00330-004-2357-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-004-2357-6