An unexpected fetal outcome following a severe maternal motor vehicle accident

Maternal motor vehicle injury occurs commonly and can cause serious fetal injury. Optimum pregnancy management at the time of maternal presentation following trauma requires reliable methods of fetal assessment. In this report, we present a case in which currently accepted methods of fetal assessment initially failed to demonstrate catastrophic fetal brain injury following a maternal motor vehicle accident.

A 28-year-old primigravida woman at 27 weeks' gestation was in a pedestrian motor vehicle accident, suffering a closed head injury and multiple fractures. Initial fetal assessment included cardiotocographic monitoring for 24 hours fetal ultrasound, both of which were normal, as was a biophysical profile done on the fifth day after the accident. These were repeated at intervals, but definite evidence of fetal brain injury was not seen until unilateral ventricular dilatation was documented on ultrasound at 35 weeks' gestation. Postnatal imaging showed microcephaly, hydrocephalus ex vacuo, and multiple hemispheric hypodensities, likely representing post-traumatic hemorrhages with secondary infarction. At the age of 4 years, the child is cortically blind, epileptic, and quadriparetic.

This pregnancy outcome was unexpectedly poor despite the reassuring initial assessment. We caution that these methods may not provide accurate early fetal assessment, especially when fetal brain stem function is spared.