Fetal intracranial injuries in a preterm infant after maternal motor vehicle accident: a case report
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Published on: November 20, 2015
Cornelia F Hagmann1, Thomas Schmitt-Mechelke, Jürg H Caduff
1Neonatal and Pediatric Intensive Care Unit, and the Department of Diagnostic Radiology, Children's Hospital of Lucerne, Switzerland.
Insights
Maternal motor vehicle accidents can cause fetal intracranial injuries, including hemorrhages and hypoxic-ischemic damage, even with mild maternal trauma. Prompt imaging is crucial for detecting these potentially severe fetal injuries.
Area of Science:
- Perinatology
- Neonatal Neurology
- Trauma Surgery
Background:
- Motor vehicle accidents (MVAs) during pregnancy pose risks to both mother and fetus.
- Fetal injuries from maternal trauma can range from mild to life-threatening.
Observation:
- A preterm infant (30-6/7 weeks gestation) sustained intracranial injuries following maternal MVA.
- The mother experienced a closed femur fracture, while the infant had subdural, subarachnoid, and intracerebral hemorrhages.
Findings:
- Injuries were localized to the left parietal and temporal lobes, likely from direct fetal trauma.
- Massive fetomaternal hemorrhage may have contributed to hypoxia-ischemia, exacerbating the injury.
- At 20 months corrected age, the infant exhibited right-sided hemiparesis but otherwise normal development.
Implications:
- MVAs during pregnancy necessitate vigilant assessment for fetal intracranial injuries, both hemorrhagic and hypoxic-ischemic.
- Even minor maternal injuries can be associated with significant fetal morbidity.
- Early diagnosis via imaging is critical for managing potential long-term neurological deficits.
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.
