1/27. Traumatic prenatal sigmoid perforation due to amniocentesis. A variety of fetal injuries, including those inflicted to the gastrointestinal tract by amniocentesis, have been reported before. This brief report describes the first documented case of sigmoid perforation owing to the common procedure of amniocentesis that manifested as abdominal distention at birth. A potential link between this complication and a recent increased incidence of "intrauterine spontaneous perforation" of the gastrointestinal tract has been mentioned. Practicing radiologists are encouraged to inquire directly about the history of amniocentesis in unexplained cases of intrauterine intestinal perforation. ( info) |
2/27. Investigations of crashes involving pregnant occupants. case reports of 16 crashes involving pregnant occupants are presented that illustrate the main conclusions of a crash-investigation program that includes 42 crashes investigated to date. Some unusual cases that are exceptions to the overall trends are also described. The study indicates a strong association between adverse fetal outcome and both crash severity and maternal injury. Proper restraint use, with and without airbag deployment, generally leads to acceptable fetal outcomes in lower severity crashes, while it does not affect fetal outcome in high-severity crashes. Compared to properly restrained pregnant occupants, improperly restrained occupants have a higher risk of adverse fetal outcome in lower severity crashes, which comprise the majority of all motor-vehicle collisions. ( info) |
3/27. Intrauterine stab leading to a radial nerve palsy. Penetrating injuries to the gravid uterus are rare. This report documents a fetus that sustained a complete radial nerve palsy (a hemopneumothorax) after a knife wound (complete nerve transection is suspected). Surgical exploration of the nerve was delayed because of respiratory distress. Six weeks later, when exploration was scheduled to be undertaken, some recovery was noted, and exploration was thus deferred. The injury recovered completely in the absence of formal repair. ( info) |
4/27. Fetal trauma: brain imaging in four neonates. 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. ( info) |
5/27. Fetal intracranial injuries in a preterm infant after maternal motor vehicle accident: a case report. OBJECTIVE: To present a case of fetal intracranial injuries in a preterm infant after maternal motor vehicle accident and to review the relevant literature. DESIGN: Case report. SETTING: Neonatal and pediatric intensive care unit of a children's hospital. PATIENT: Preterm infant (gestational age, 30-6/7 wks) with intracranial injuries after maternal motor vehicle accident. RESULTS: Whereas the mother had only a closed femur fracture, her infant sustained subdural, subarachnoid, and intracerebral hemorrhages in the left parietal and temporal lobes most likely attributable to direct fetal trauma. Massive fetomaternal hemorrhage may have led additionally to hypoxia-ischemia contributing indirectly to the injury. At the last follow-up visit (chronological age, 20 months; corrected age, 18 months), there was evidence of a persistent right-sided hemiparesis in an otherwise normally developed infant. CONCLUSIONS: Motor vehicle accidents during pregnancy can be associated with fetal mortality and significant morbidity, even in the absence of severe maternal injuries. Direct (hemorrhagic) and indirect (hypoxic-ischemic) intracranial injuries should be actively sought with appropriate imaging studies. ( info) |
6/27. Extensive brain injury in a premature infant following a relatively minor maternal motor vehicle accident with airbag deployment. Traumatic injury following a motor vehicle accident during pregnancy has an enormous potential for fetal injury and demise. With the advent of seat belts, shoulder restraints and airbags, and improved maternal survival, the most common cause of fetal loss is placental injury. However, the safety of airbag deployment during pregnancy and in particular during the latter stages, and the potential for fetal trauma remains unclear. We report a case of extensive neurological injury of a premature infant with minimal maternal trauma associated with deployment of an airbag following a minor motor vehicle accident. ( info) |
7/27. Neonatal renovascular hypertension due to prenatal traumatic retroperitoneal hematoma. This report describes severe hypertension in a 7-week-old male infant found to have renovascular disease from an organized hematoma due to prenatal trauma. As such, this case illustrates a novel acquired, congenital mechanism of renovascular hypertension. The importance of considering prenatal as well as postnatal etiologies of acquired renovascular hypertension in neonates is emphasized. Likewise, attention must be drawn to the classic presentation of congestive heart failure in a child with severe hypertension. ( info) |
8/27. paraplegia and congenital contractures as a consequence of intrauterine trauma. We present a newborn infant with paraplegia and contractures of the lower limbs, consistent with neurologic injury rather than malformation. The mother was involved in a severe motor vehicle accident during the sixth month of pregnancy. We propose that this infant's injuries are a result of that accident. ( info) |
9/27. skin dimpling as a delayed manifestation of traumatic amniocentesis. A 2-month-old infant girl was seen for marks on her abdomen. Born after a 39-week, 2-day normal twin gestation to a 37-year-old healthy multiparous mother, the prepartum history for "Baby B" was significant only for amniocentesis at 17 weeks' gestation, where three needle insertions were required for obtaining amniotic fluid from "Baby B." During amniocentesis, performed under ultrasound guidance by an experienced obstetrician, the amniocentesis needle was misplaced in the fetal abdomen in one of the failed attempts. No evident adverse sequelae were noted and the pregnancy proceeded without complication. As the baby gained weight, by 6 weeks of life two indentations appeared on the skin, becoming more pronounced as the baby became chubbier. Aside from this finding, the baby was otherwise healthy. Close examination revealed nontender skin-colored focal puckering on the right anterior lower abdomen and the right flank. No induration, fluid exudation, or fistulous opening was evident. At 13 months of age, the lesions remained stable and asymptomatic. ( info) |
10/27. Foetal kidney maldevelopment in maternal use of angiotensin ii type I receptor antagonists. We report renal lesions observed in a foetus exposed throughout pregnancy to angiotensin ii type I (AT 1) receptor antagonists. The mother suffered from essential hypertension and was treated with Cozaar (losartan 50 mg). autopsy examination of the foetus revealed severe renal lesions, including tubular dysgenesis, hypertrophy of the endothelial and medial cells lining the arterial and arteriolar walls, hyperplasia of the juxtaglomerular apparatus and poorly developed vasa recta. Similar lesions have already been observed in foetuses of women treated with angiotensin-converting enzyme antagonists and also in foetuses and neonates of animals undergoing experimental blockade of the renin-angiotensin system. The purpose of this report is to describe structural lesions observed in the kidneys, and, particularly, vascular lesions. Our results suggest that the use of AT 1 receptor antagonists during pregnancy may have a severe deleterious effect on kidney development in the foetus. ( info) |