Severe brain trauma to the fetus in a car accident: Literature review and a clinical case

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Abstract

Car accidents are the main cause of trauma during pregnancy. Even a non-severe accident is associated with a high risk of injury and unfavorable outcome for the fetus, especially in the event of placental abruption. Major agents leading to a trauma could also include safety belt and safety airbags. Blunt abdominal trauma during a car accident is associated with such type of intrauterine injury as fetal skull fractures and various intracranial hemorrhages. Despite a common viewpoint on relatively high death rates in this population, it is not infrequent that fetal trauma has a favorable outcome without any clinically significant neurological deficiency.

The paper presents an analysis of the main outcomes of intrauterine brain injury and associated factors. As an illustration, we describe a case of a car accident related brain injury to a fetus at 38 week of gestation, with skull fracture, brain contusion, and subarachnoidal, epidural and subdural, parenchymal and intraventricular hemorrhages induced by the safety belt, with the mother being virtually uninjured. After treatment, the patient was discharged from the hospital in a satisfactory state, without clinically significant neurological symptoms and signs. A 8-months follow-up of the infant showed some delay in brain maturation manifesting as benign epileptiform discharges of childhood and magnetic resonance imaging patterns.

It is highly likely, that the leading factors ensuring a favorable outcome of a intrauterine severe brain trauma (without fatal trauma to the mother and fetus) are as follows: correct obstetric strategy, late gestational age and absence of a massive parenchymal and/or intraventricular bleeding. After the short-term clinical recovery from a severe intrauterine brain trauma and in addition to it, proper follow-up of the child is essential because of a high risk of long-term cerebral and functional abnormalities, mostly paroxysmal, behavioral and cognitive.

About the authors

N. A. Vostrikov

The Center of Traumatology, Orthopedics and Neurosurgery

Author for correspondence.
Email: vostrikov_na@outlook.com
ORCID iD: 0000-0002-3141-3663

Nikolay A. Vostrikov - Postgraduate Student, Chair of Neurology, Neurosurgery and Neurorehabilitation; Neurosurgeon.

203-59 Moskovskaya ul., Kirov, 610050.

Tel.: +7 (901) 419 56 03.

Russian Federation

I. V. Ponomareva

Regional Clinical Hospital No. 3

Email: irina_victorovna@mail.ru
ORCID iD: 0000-0001-6499-3054

Irina V. Ponomareva - MD, PhD, Head of Department of Neurology No. 2, Polyclinic No. 2; Neurologist, Epileptologist.

287 Pobedy prospekt, Chelyabinsk, 454021.

Russian Federation

O. V. Cheremisinov

Kirov Regional Clinical Hospital

Email: ocheremisinov@gmail.com
ORCID iD: 0000-0002-2630-4091

Oleg V. Cheremisinov - MD, PhD, Radiologist, Department of Radiology.

42 Vorovskogo ul., Kirov, 610027.

Russian Federation

M. A. Sherman

Kirov State Medical University

Email: sherman@list.ru
ORCID iD: 0000-0001-5740-1022

Mikhail A. Sherman - MD, PhD, Associate Professor, Head of Chair of Neurology, Neurosurgery and Neurorehabilitation.

112 K. Marksa ul., Kirov, 610998.

Russian Federation

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Copyright (c) 2021 Vostrikov N.A., Ponomareva I.V., Cheremisinov O.V., Sherman M.A.

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