Traumatic Brain Injury in Pregnancy: A Single Level I Trauma Center Experience

Traumatic brain injury (TBI) is less common in pregnancy than in the general population; however, it poses significant challenges in diagnosis and management. These include the potential teratogenicity of medications, radiation exposure from imaging modalities, physiological changes associated with pregnancy, and obstetric complications that may arise. Although there are general guidelines for trauma in the obstetric patient, they are not specific to TBI, and most recommendations are based on low-level evidence or institutional experiences. We conducted a retrospective review of the hospital trauma registry over a 10-year period. We included all the patients admitted to our neurosurgical intensive care unit for TBI and confirmed pregnancy. The data was obtained through a chart review. Among 2,027 TBI admissions, four patients were pregnant. Of these four patients, two underwent external ventricular drain placement; one required a decompressive craniectomy. Two patients delivered viable infants via cesarean section. Two patients were discharged home, and one to a personal care home. One patient was pronounced brain dead. Our data confirmed the rarity of pregnancy in TBI. Even though this represents an infrequent clinical scenario, the complications and treatment can be challenging for clinicians. Therefore, pooled data from other level I trauma centers should be studied to formulate appropriate therapeutic directions, and the inclusion of this population in medical societies' guidelines is necessary.