Файловый архив студентов. Файловый архив студентов.
1327 вузов, 5482 предметов.
/ Регистрация
FAQ Обратная связь Вопросы и предложения
Добавил:
kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Ростовский Государственный Медицинский Университет
Предмет:
Медицина общая
Файл:

Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 220 - файл

.pdf
Скачиваний:
0
Добавлен:
28.08.2026
Размер:
86 Мб
Скачать
☆
138
https://t.me/medicina_free
Fig. 5.22 The lethal penetrating hole in the fetal face and an exit hole in the fetal thorax. (Rreproduced from [155] under the CC Attribution License). Entry and exit wounds on the uterus of the same patients are presented in Fig. 25.44
brain injury without external marks of intrauter­ine fetal head injury. It is commonly the result of severe head injury detected at emergent CS.
5.3.4 Diagnosis
5 Fetal Trauma
Fetal injuries due to maternal penetrating abdom­inal trauma are diagnosed (1) preoperatively, when there is an indication for maternal diagnos­tic imaging with ndings of potential fetal inju­ries or with abnormal CTG ndings, (2) during maternal abdominal exploration for maternal injuries with conrmed uterine injury, (3) clini­cally, immediately after delivery, and (4) with delayed newborn or child presentation.
5.3.4.1 Preoperative Diagnosis
Two scenarios for the diagnosis of preoperative fetal injuries exist. First, fetal injuries can be expected with CTG signs of fetal distress without an indication for maternal abdominal exploration. Second, fetal injuries can be detected on maternal imaging diagnostics on plain X-rays, transabdom­inal US [153], or abdominal CT.Imaging preop­erative fetal injuries is more challenging with stabbing because there are fewer fetal deforma­tions and less possibility of retained foreign bod­ies visible on diagnostic imaging.
Fig. 5.23 Fatal penetrating stab wound to the lower thorax in a pale fetus. The wound is similar to the one in Fig.5.22. Sometimes, it is difcult to conclude whether maternal hypotension of fetal injury is the cause of fetal death. A fetal autopsy is not described. (Reproduced with permis­sion from [156] under the CC BY 4.0 Attribution License)
5.3.4.2 Intraoperative Diagnosis
Most fetal injuries are detected during the explo­ration of maternal intra-abdominal wounds, such as an abdominal gunshot wound, and most stab wounds indicate maternal abdominal explora­tion. A uterine wound carries a high probability of fetal injury, and CS should be considered in a viable fetus (see Sect. 25.4.4).
ab
5.3 Penetrating Fetal Trauma
https://t.me/medicina_free
139
a
b
Fig. 5.24 The rst presentation of a 3-year-old child. (a) The bulging on the skin in the right temporal region; (b) A thin skin scar in the right temporal region [152]
5.3.4.3 Postdelivery Diagnosis
Even if the wounds seem supercial, primarily if projectiles are not found, focused plain X-rays, or babygram can show retained metal parts/bul­lets (Fig. 5.25) in the fetus [157] or fractures from projectile energy transmission. Therefore, a plain X-ray is recommended for gunshot wounds. For head injuries, brain US or head CT denes the extent of bleeding and retained foreign bodies [153, 158].
5.3.4.4 Delayed Diagnosis
Delayed presentation, even after many years, can be noted as progressive deformities or enlarging lumps caused by retained foreign bodies [159], bony (Fig.5.26), or internal defects as in the form of diaphragmatic hernia [160]. Also, fetal neuro­logic impairment should raise suspicion of a post-traumatic cause from intrauterine fetal injury [154].
Metal bodies are seen on plain X-rays (Fig.5.27). As in blunt trauma, a specic condi­tion is growing skull fracture. Growing skull
Fig. 5.25 (a) Frontal and (b) lateral, plain abdominal X-rays of the abdomen showing the radiopaque bullet in the right thigh. (Reproduced with permission from [150] under the CC BY)
140
ab
ab
https://t.me/medicina_free
5 Fetal Trauma
Fig. 5.26 A 2.5-year-old abandoned child with a pulsat­ing bulge in the right temporal region. Knife stab wound to the maternal abdomen at 30weeks of pregnancy. (a) A 3D CT scan reveals a large right temporal bone defect; (b)
MRI showing herniation of the cicatricial cerebral tissue through the skull defect and a mild “blow out” of the homolateral temporal ventricular horn [152]
Fig. 5.27 Chest X-ray (posteroanterior and right lateral) revealing radiopaque shadow (bullet) in a 10-year-old boy without signs of a postnatal gunshot injury. There were no
scars on the skin. (Reproduced with permission from [159] under the CC Attribution License)
5.3 Penetrating Fetal Trauma
https://t.me/medicina_free
141
fracture requires severe head injury to result in a skull fracture, a tear in the dura mater, or brain injury. The outward driving force, such as a nor­mally growing brain, is the mechanism underly­ing the formation of the growing fracture [161]. These elements explain why most growing frac­tures occur in very young children or intrauterine fetal head injuries [152].
5.3.5 Treatment
5.3.5.1 Obstetric Management
With a live fetus, risks of prematurity must be weighed against the benets of delivery for and treatment of the suspected fetal injury. Indications for emergent CS in an alive and viable fetus are:
• radiologic signs of penetrating head injury or visible intracranial foreign bodies,
• radiologic signs of thoracoabdominal injury or visible intracranial foreign bodies,
• CTG abnormalities.
5.3.5.2 General Wound Treatment
Due to a small number of cases, there are no rm recommendations for specic penetrating fetal injuries.
Principles of stab or gunshot wound to the delivered viable fetus should follow neona­tal and pediatric surgery principles.
tem’s progressive maturation and the placenta’s increased permeability during the last months of pregnancy. Vaccine effectiveness of ≥2 properly timed doses of tetanus toxoid given to pregnant women against neonatal tetanus mortality is 94% [163]. Transplacental immunization circumvents the necessity for immunization in early neonatal life (up to 13months) [164]. Guidelines about vac­cination or prophylaxis for emergent CS shortly after immunization do not exist. There is no evi­dence of adverse fetal effects from vaccinating pregnant women with an inactivated virus, bacte­rial vaccine, or toxoid. A growing body of robust data demonstrates the safety of such use [165].
Prophylactic Antibiotics
In most cases, antibiotics are not even mentioned. As in nonpregnant population broad-spectrum antibiotics, FDA class B, eventually, class C should be administered to the mother. With the continuation of pregnancy, transplacental antibi­otic transfer protects a fetus. There are no recom­mendations on fetal antibiotic prophylaxis if emergent CS is performed at the time of injury.
5.3.5.3 Subcutaneous andLimb Injury
Tangential skin injuries resulting from stab and gunshot wounds (Fig.5.20a) need only debride­ment and dressings. For the deeper penetration into the limbs (Figs. 5.20b and 5.28) with the
Since infants have been born alive with soft
tissue and visceral injuries, the hazards of prema­turity must be weighed against the potential ben­ets of operation to the injured premature infant delivered by CS.When fetal weight approaches 2,500g, these hazards are greatly diminished.
Tetanus Vaccinations/Prophylaxis
For maternal prophylaxis, see Sect. 25.4.4.1. To avoid generalized neonatal tetanus, maternal vac­cination during the last trimester (not earlier) of pregnancy induces intrauterine active fetal immu­nization [162]. This is due to the fetal immune sys-
Fig. 5.28 Bullet entrance hole in a fetus treated conser­vatively. Post-injury plain X-ray did not reveal metal parts, but the newborn was lost in follow-up. (Reproduced with permission from [166])
142
https://t.me/medicina_free
5 Fetal Trauma
possibility of injury of important structures (nerves, blood vessels, bones, tendons, joints), no clear guidelines exist [166]. However, explora­tion is recommended except in puncture wounds without signs of compartment or signicant edema. The neurovascular decit is an absolute indication for exploration. The radiologic exami­nation is necessary to dene retained metal parts with only the entrance wound on limbs.
5.3.5.4 Head Injury
Neuroprotection
One of the unsolved issues is post-traumatic neu­roprotection. Many potential targets for neuro­protection—antagonists of the NMDA receptors for glutamate, magnesium sulfate, and tianeptine block the effects of inammatory cytokines, NSAIDs, and growth factors—are effective in animals and invitro experiments. However, there is no rm data on humans [167].
Brain Surgery
Several authors recommend postponed removal of projectiles when the newborn does not show (1) signicant neurologic decits, (2) intracranial bleeding, (3) increased intracranial pressure, or (4) infective complications mandating explora­tion [153, 168]. Repeated US or CT examinations should be used to monitor fetal course noninva­sively. The possible adverse effect could be lead poisoning with the potential of a child’s failure to thrive [169]. Some authors claim it is only pres­ent when the bullet is included in the circulating uids like synovial [170] or cerebrospinal [171,
172]. If any of the conditions above are present,
immediate exploration is mandatory [158].
5.3.5.5 Thoracoabdominal Injury
In hemodynamically unstable fetuses, surgical exploration is mandatory.
In the stable fetus, gunshot wounds to the tho­rax or abdomen indicate thoracotomy or laparot­omy, while stab wounds could be managed nonoperatively. Peripheral thoracic gunshot wounds could be treated with a chest tube. The risk of delayed complications includes a dia­phragmatic hernia [160]. Wound exploration is mandatory [173]. Further exploration is recom­mended with the pleural or peritoneal injury due to a high possibility of organ injury when the dagger to fetal body ratio is considered [174]. Further procedures depend on the injury type and principles that follow pediatric surgery principles (closure of pleural, peritoneal, diaphragmatic, bowel injuries/defects, and bleeding control) (Fig.5.29).
Absorbable sutures are used to repair minor lacerations in the lungs or bowel (Fig.5.29).
After bowel resections or simple sutures, breastfeeding can start on postoperative day 2 if the newborn is stabilized without mechanical ventilation [174].
5.3.6 Prognosis
The fetus has a worse prognosis than the mother, with an injury rate of 59–80% and a perinatal mortality rate of 40–71% [92, 175, 176]. The
In stable newborns with noncomplicated penetrating intracranial injury, when all issues related to prematurity are solved, the idea to postpone the operation at around 1year of age minimizes the risk of further brain injury, with a potential of lead poi­soning. The infant’s age for safe projectile removal depends on the localization of the projectile and the infant’s condition.
Fig. 5.29 Lung laceration from the gunshot wound repaired with primary suture. (Reproduced with permis­sion from [174] under the CC BY Attribution License)
5.3 Penetrating Fetal Trauma
https://t.me/medicina_free
143
perinatal mortality during 1957–1967 was 71% [23], unchanged from 1845–1964 [177]. After 1967, there was a decrease to 59% [23]. From 1845 to 1954, fetal mortality of viable fetuses was 55% [178]. In the same period, the fetal mor­tality among those with vaginal deliveries was 66%; among those who had abdominal deliver­ies, 46%. Perinatal mortality of viable fetuses up to 1972 was 59% [179].
Fetal trauma after stabbing injuries to the uter­ine cavity occurred in approximately 50%, with fetal survival of 80% [180–182]. All parts of the fetal body are equally affected.
Factors that have an impact on fetal outcome are (1) fetal factors, in addition to (2) maternal factors (placental injury, placental abruption, dis­seminated intravascular coagulation, and maternal hypovolemia), and (3) availability of tertiary centers for high-risk neonates. Fetal fac­tors that have an impact on fetal outcome are:
• the second trimester of pregnancy,
• multiple > single wounds,
• gunshot > stabbing wounds,
• thoracoabdominal wounds.
Pregnancy loss was signicantly greater in women in the second trimester than in the rst trimester. The second trimester represents the most vulnerable period for all types of fetal trauma because the gravid uterus ascends out of the bony pelvis in the cephalad direction to reach the level of the umbilicus by 24weeks; here, the gravid uterus may sustain a direct traumatic injury. In the third trimester, the fetus is well pro­tected by the thickened uterine wall and the amniotic uid [120]. However, in both gunshot and stab wounds, the fetus presents a larger target as the pregnancy progresses and is more likely to sustain an injury [14, 183–186].
Fetal morbidity depends on the gestational age, location, and extent of injured structures and organs. However, functional impairment is mostly lesser [160, 173], except for head injuries (see 5.3.6.1), than in children and adults.
With gunshot wounds, fetal injuries range from 60 to 90%, and overall perinatal mortality is up to 70% [14, 179, 184, 187]. A signicant por­tion of fetal death in stabbing and gunshot wounds is due to immaturity from ill-timed deliv­ery. Until 1977, fetal mortality was 78% if intra­uterine gunshot wounding occurred preterm, but only 40% for injuries at term [188].
Several decades ago, after stabbing injuries to the uterine cavity, fetal trauma occurred in 93%, with fetal mortality of 47% [186]. Recent fetal mortality decreased to 27.3% [180].
5.3.6.1 Penetrating Head Injury
Intrauterine penetrating fetal head injury has a high mortality [158]. With maternal abdominal stab wounds, the fetal head is injured in 10% of cases [152]. Many survived newborns have neu­rologic deciencies. The incidence and the extent of neurologic decit depend on the factors listed in the following tables (Tables 5.4 and 5.5):
As for fetal mortality, gunshot wounds carry a much higher rate of a post-injury neurologic de­cit than fetal head stab injuries. Despite attenua­tion from the uterine wall and amniotic uid, projectiles from explosive weapons transmit more energy to the surrounding tissues. An addi­tional consequence is a higher risk of surround­ing necrosis and infective complications necessitating further conservative and surgical therapy, mainly debridement, and abscess drain­age. In cases of fetal cerebral ischemia, reperfu­sion injury also contributes to brain damage. Prematurity and preterm delivery could also con­tribute to neurocognitive development [153]. Also, additional general anesthesia in neonates
Table 5.5 Factors contributing to the neurologic decit after fetal penetrating head injuries
Related to head injury Unrelated to head injury Type of wound/weapon Maternal hemorrhage or
septic shock Extent of primary brain damage Severity of primary brain damage Secondary brain damage Prematurity Number of operations/ general anesthesia
Fetal hemorrhage/hypoxia
Socioeconomic factors
Lead toxicity
144
https://t.me/medicina_free
5 Fetal Trauma
contributes to cognitive impairment. Maternal hemorrhagic or septic shock also contributes to worse outcome, primarily if associated with pla­cental abruption, placental tear, or disseminated intravascular coagulation. Retroplacental bleed­ing can lead to feto-maternal transfusion, fetal anemia, hypovolemia, and hypoxia (see Sect.
25.3.6).
The degree and dynamics of neurologic de-
ciencies are challenging for prognosis due to a small number of patients. However, all survived fetuses developed hydrocephalus, seizures, and intellectual or cognitive disabilities. Children <5years at the time of injury had more intellec­tual impairment than children with similar inju­ries later. Socioeconomic factors are also important. Long-term functional therapy inu­ences long-term neurodevelopmental outcomes as for any other type of injury, while it is of utmost importance for a head injury.
5.3.6.2 Penetrating Thoracoabdominal
Injury
Fetal thoracoabdominal gunshot wounds 40years ago had a mortality rate of ≈100% [188, 189], while current mortality is 50% [156].
5.3.6.3 Perimortem Cesarean Section
The outcome of postmortem CS for all causes was poor until recently. In the German duchy Kurhessen in 1848, there were 107 cases with no survivors [190]. In 1864, in 147 cases at the Berlin Obstetrical Society, only three infants sur­vived [191]. Katz etal. reviewed the literature from 1879 through 1985 and reported 269 cases with 188 infant survivors with probable underre­porting of unsuccessful cases [190]. Katz etal. associated infant survival with the time interval between maternal death and delivery. In their review of cases from 1900 to 1985, there were 61 cases with neonatal survival and known time intervals. Fifty-seven (93%) were born within 15min, and only two had neurological damage, one mild and one severe. Seventy percent of the survivors were born within 5min [190]. There are cases with live infants with postmortem CS between 7 and 22min after documented maternal cardiac arrest. Follow-up of infants demonstrated
no evidence of neurologic damage [191, 192]. Strong etal., in 1989, reported that about half of the perimortem CS in the literature had produced live infants. However, the incidence of neurologi­cal sequel increases with increasing delays to delivery. The long-term survival rate for healthy infants was 15% [193].
Of infants delivered by this method in general, approximately 15% survive and are discharged from the hospital in good condition [194–196]. The survival of these infants depends on how soon they are extracted, their maturity, the duration and nature of the mother’s illness, the performance of postmortem maternal CPR, and the availability of neonatal intensive care [197]. Although recent reviews conclude that despite reports of 30years supporting perimortem CS, they fail to prove that it improves maternal and neonatal outcomes [198]. Of the 330 reported cases of postmortem CS during the eighteenth century, only 7 living children recovered. Then, in 1916, fetal survival of 42.3% was published [199].
If the mother is stabilized, but the extent of maternal injuries precludes maternal salvage, there is another option except for perimortem CS.Improved life support for premature infants and their mothers who sustained fatal injury increased the possibility of successful pregnancy outcomes. This is primarily applicable for mater­nal injury resulting in brain death. Mother is maintained on life support systems until the fetus reaches maturity [200].
References
1. Wilkening GRM.Fetal oxygen uptake, oxygenation, and acid-base balance as a function of uterine blood ow. Am J Phys. 1983;244:H749–55.
2. Wardrop BMCH.The roles and vital importance of placental blood to the newborn infant. J Perinat Med. 1995;23:139–43.
3. Sebring HFEP.Fetomaternal hemorrhage: incidence, risk factors, time of occurrence, and clinical effects. Transfusion (Paris). 1990;30:344–57.
4. Biankin SM, Graf NSSA. Autopsy ndings in a series of ve cases of fetomaternal haemorrhages. Pathology. 2003;35:319–24.
5. Weiss HB, Strotmeyer S. Characteristics of preg­nant women in motor vehicle crashes. Inj Prev. 2002;8(3):207–10.
References
https://t.me/medicina_free
145
6. Schiff V, Daling JMH.Pregnancy-associated injury hospitalizations: maternal and fetal outcomes. Paediatr Perinat Epidemiol. 2001;15:A29.
7. Theurer IHDK. Traumatic fetal death without uterine injury. Report of a case. Obstet Gynecol. 1963;21:477–80.
8. Joseph JR, Smith BW, Garton HJL.Blunt prenatal trauma resulting in fetal epidural or subdural hema­toma: case report and systematic review of the litera­ture. J Neurosurg Pediatr. 2017;19:32–7.
9. Morgan JA, Marcus PS.Prenatal diagnosis and man­agement of intrauterine fracture. Obstet Gynecol Surv. 2010;65(4):249.
10. Alexander CHED.Intrauterine fracture of the infant skull. J Neurosurg. 1969;30:446–54.
11. Thompson EM. Non-invasive prenatal diagno­sis of osteogenesis imperfecta. Am J Med Genet. 1993;45(2):201.
12. Bar-Yosef O, Polak-Charcon S, Hoffman C, Feldman ZP, Frydman M, Kuint J. Multiple con­genital skull fractures as a presentation of Ehlers­Danlos syndrome type VIIC.Am J Med Genet A. 2008;146A(23):3054.
13. Pearlman JE, Lorenz RPMT.Blunt trauma during pregnancy. N Engl J Med. 1990;323:1609–13.
14. van Hook J.Trauma in pregnancy (obstetric emer­gencies). Clin Obstet Gynecol. 2002;45:414–24.
15. Stafford PA, Biddinger PW, Zumwalt RE. Lethal intrauterine fetal trauma. Am J Obstet Gynecol. 1988;159(2):485–9.
16. Pape HC, Pohlemann T, Gansslen A, Simon R, Koch C, Tscherne H.Pelvic fractures in pregnant multiple trauma patients. J Orthop Trauma. 2000;14(4):238–44.
17. Henderson S, WK M. Trauma during pregnancy. Emerg Med Clin North Am. 1998;16:209–28.
18. Connolly VL, Bash KL, et al. Trauma and preg­nancy. Am J Perinatol. 1997;14:331–6.
19. Chaturvedi A, Chaturvedi A, Stanescu AL, Blickman JG, Meyers SP. Mechanical birth-related trauma to the neonate: an imaging perspective. Insights Imaging. 2018;9:103–18.
20. Elliott M.Vehicular accidents and pregnancy. Aust N Z J Obstet Gynaecol. 1966;6:279–86.
21. Parkinson E.Perinatal loss due to external trauma to the uterus. Am J Obstet Gynecol. 1964;90:30–3.
22. JT MD, Weitz R, Sher PK.Intrauterine chronic sub­dural haematoma. Arch Neurol. 1977;34:777–8.
23. Buchbaum H.Accidental injury complicating preg­nancy. Am J Obstet Gynecol. 1968;102:752–69.
24. Taha E, Nasralla K, Khalid A, Ali AA.Blunt abdom­inal trauma to a pregnant woman resulting in a child with hemiplegic spastic cerebral palsy and perma­nent eye damage. BMC Res Notes. 2013;6:517.
25. Kissinger DP, Rozycki GS, Morris JA Jr, Knudson MM, Copes WS, Bass SM, etal. Trauma in preg­nancy. Predicting pregnancy outcome. Arch Surg. 1991;126(9):1079–86.
26. Scorpio TJ, Smith LG, Gens DRRE.Blunt trauma during pregnancy: factors affecting fetal outcome. J Trauma. 1992;32:213–6.
27. Givon U, Sherr-Lurie N, Schindler A, Blankstein A, Ganel A.Treatment of femoral fractures in neonates. Isr Med Assoc J. 2007;9(1):28–9.
28. Cebesoy FB, Cebesoy O, Incebiyik A. Bilateral femur fracture in a newborn: an extreme compli­cation of cesarean delivery. Arch Gynecol Obstet. 2009;279(1):73–4.
29. Yu M, Xu D, Zhang A, Shen J.Spontaneous fetal femoral fracture: a case report and literature review. J Int Med Res. 2018;46:1282–7.
30. Rothenberger DA, Horrigan TP, Sturm JT.Neonatal death following in utero traumatic splenic rupture. J Pediatr Surg. 1981;16:754–5.
31. Connor JEC. In utero traumatic intraabdominal deceleration injury to the fetus—a case report. Am J Obstet Gynecol. 1976;125:567–9.
32. Reginald JN, Hughes JH, Kaler SPSA.Splenic rup­ture in utero following a road trafc accident. Case report. Br J Obstet Gynaecol. 1991;98:318–9.
33. Brown JK, Minns RA.Non-accidental head injury, with particular reference to whiplash shaking injury and medico-legal aspects. Dev Med Child Neurol. 1993;35:849–69.
34. Stephens R, Richardson A, Lewin J. Bilateral sub­dural hematomas in a newborn infant. Pediatrics. 1997;99(4):619.
35. Ford RM, Picker RH. Fetal head injury follow­ing motor vehicle accident; an unusual case of intrauterine death. Aust N Z J Obstet Gynaecol. 1989;29:72–3.
36. Litmanovitz I, Doln T, Arnon S, Fleser C, Rathouse V, Feigin M, etal. Fetal intrathoracic injuries follow­ing mild maternal motor vehicle accident. J Perinat
37. Hayes B, Ryan S, Stephenson JBP, King MD.Cerebral palsy after maternal trauma in preg­nancy. Dev Med Child Neurol. 2007;49(9):700.
38. Myers RE.Production of fetal asphyxia by mater­nal psychological stress. Pavlov J Biol Sci. 1977;12(1):51.
39. Larroche JC.Fetal encephalopathies of circulatory origin. Neonatology. 1986;50(2):61.
40. Jain R, Bielski RJ.Fracture of lower femoral epiphy­sis in an infant at birth: a rare obstetrical injury. J Perinatol. 2001;21(8):550.
41. Papp S, Dhaliwal G, Davies G, Borschneck D.Fetal femur fracture and external cephalic version. Obstet Gynecol. 2004;104(5 Pt 2):1154.
42. Alexander JM, Leveno KJ, Hauth J, Landon MB, Thom E, Spong CY, etal. Fetal injury associated with cesarean delivery. Obstet Gynecol. 2006;108(4):885.
43. Eliahou R, Simanovsky N, Hiller N, Simanovsky N.Fracture-separation of the distal femoral epiph­ysis in a premature neonate. J Ultrasound Med. 2006;25(12):1603.
146
https://t.me/medicina_free
5 Fetal Trauma
44. Ikram S, Kaiser J, Walker R, editors. Egyptian bioar­chaeology. Humans, animals, and the environment. Leiden: Sidestone Press; 2015.
45. Rowe TF, Lafayette S, Cox S.An unusual fetal com­plication of traumatic uterine rupture. J Emerg Med. 1996;14:173–6.
46. Weir LF, Pierce BT, Vazquez JO. Complete fetal transection after a motor vehicle collision. Obstet Gynecol. 2008;111:530–2.
47. Farmer DL, Adzick NS, Crombleholme WR, Crombleholme TM, Longaker MT, Harrison MR. Fetal trauma: relation to maternal injury. J Pediatr Surg. 1990;25:711–4.
48. Matsushita H, Harada A, Sato T, Kurabayashi T.Fetal intracranial injuries following motor vehicle accidents with airbag deployment. J Obstet Gynaecol Res. 2014;40(2):599.
49. Yamasato K, Kurata N, Towner D.Delayed appear­ance of a traumatic fetal intracranial hemorrhage. Case Rep Obstet Gynecol. 2018;2018:1465034.
50. Härtl R, Ko K.In utero skull fracture: case report. J Trauma. 1996;41(3):549.
51. Miller T. Intrauterine diagnosis of fetal disease by x-ray. J Natl Med Assoc. 1978;70:875–6.
52. Doray B, Favre R, Viville B, Langer B, Dreyfus M, Stoll C.Prenatal sonographic diagnosis of skel­etal dysplasias. A report of 47 cases. Ann Genet. 2000;43(3-4):163.
53. Parilla BV, Leeth EA, Kambich MP, Chilis P, SN MG. Antenatal detection of skeletal dysplasias. J Ultrasound Med. 2003;22(3):255.
54. Ruano R, Molho M, Roume J, Ville Y. Prenatal diagnosis of fetal skeletal dysplasias by combin­ing two-dimensional and three-dimensional ultra­sound and intrauterine three-dimensional helical computer tomography. Ultrasound Obstet Gynecol. 2004;24:134–40.
55. Krakow D, Williams J, Poehl M, Rimoin DL, Platt LD.Use of three-dimensional ultrasound imaging in the diagnosis of prenatal-onset skeletal dysplasias. Ultrasound Obstet Gynecol. 2003;21:467–72.
56. Nishida N, Ina S, Hata Y, Nakanishi Y, Ishizawa S, Futatani T. Fetal closed head injuries follow­ing maternal motor vehicle accident: a clinico­pathologic case report. Medicine (Baltimore). 2018;97(44):e13133.
57. Shah KH, Simons RK, Holbrook T, Fortlage D, Winchell RJ, Hoyt DB.Trauma in pregnancy: mater­nal and fetal outcomes. J Trauma. 1998;45(1):83–6.
58. Arioz DT, Koken GN, Koken R, Kose KC, Cevrioglu AS. Isolated intrauterine femoral fracture in an otherwise normal fetus. J Obstet Gynaecol Res. 2008;34:92–4.
59. Bulas DI, Stern HJ, Rosenbaum KN, Fonda JA, Glass RBJ, Tifft C. Variable prenatal appearance of osteogenesis imperfecta. J Ultrasound Med. 1994;13(6):419.
60. Pauli RM, Modaff P, Sipes SL, Whyte MP. Mild hypophosphatasia mimicking severe osteogenesis
imperfecta in utero: bent but not broken. Am J Med Genet. 1999;86(5):434.
61. Dornan AJH.Where are we with Doppler? BJOG. 1994;101:190–1.
62. Sadro CT, Zins AM, Debiec K, Robinson J. Case report: lethal fetal head injury and placental abrup­tion in a pregnant trauma patient. Emerg Radiol. 2012;19:175–80.
63. Yeung KW, Wang CC.Blunt abdominal trauma in a pregnant patient: evaluation with computed tomog­raphy. Chin J Radiol. 2015;40:57–60.
64. Tattoli L, di Vella G, Solarino B.A case of intrauter­ine lethal fetal injury after attempted suicide of the mother. Forensic Sci Int. 2017;280:e1–5.
65. Nemec SF, Nemec U, Brugger PC, Bettelheim D, Rotmensch S, Graham JM, et al. MR imaging of the fetal musculoskeletal system. Prenat Diagn. 2012;32(3):205.
66. Gorincour G, Chaumoitre K, Bourliere-Najean B, Bretelle F, Sigaudy S, D’Ercole C, etal. Fetal skel­etal computed tomography: when? How? Why? Diagn Interv Imaging. 2014;95(11):1045.
67. Breysem L, Cossey V, Mussen E, Demaerel P, van de Voorde W, Smet M. Fetal trauma: brain imaging in four neonates. Eur Radiol. 2004;14(9):1609.
68. Corsi PR, Rasslan S, de Oliveira LB, Krony FS, Marinho VP. Trauma in pregnant women: analysis of maternal and fetal mortality. Injury. 1999;30(4):239.
69. Matsubara S, Izumi A, Nagai T, Kikkawa I, Suzuki M.Femur fracture during abdominal breech deliv­ery. Arch Gynecol Obstet. 2008;278:195–7.
70. Mailath-Pokorny M, Timor-Tritsch IE, Monteagudo A, Mittal K, Konno F, Santos R.Prenatal diagnosis of unilateral proximal femoral focal deciency at 19 weeks’ gestation: case report and review of the lit­erature. Ultrasound Obstet Gynecol. 2011;38:594–7.
71. Lin TH, Chung CH, Shih JC, Lin CH, Lee CN, Su YN. Prenatal diagnosis of proximal femoral focal deciency: a case report and literature review. Taiwan J Obstet Gynecol. 2013;52:267–9.
72. Uhde C.No title. Monatsschr f Geburtsh u Gynäkol. 1856;8:22.
73. Smith R. Intrauterine fractures. Surg Gynecol Obstet. 1913;17:346.
74. Aw D. Trauma and interuption of pregnancy. Tex State J Med. 1948;44:520–4.
75. Pearsall AW, Larkin JJ, Raasch W. Intrauterine femur fracture. Orthopedics. 1992;15(8):947.
76. Senanayake H, Anandakumar C, de Silva MVC.Mid-trimester fracture of femur in a normal fetus. J Obstet Gynaecol Res. 2003;29(3):186.
77. Stone CA.Unravelling the secrets of foetal wound healing: an insight into fracture repair in the mouse foetus and perspectives for clinical application. Br J Plast Surg. 2000;53(4):337.
78. Ris PMWP.A histological study of fracture healing within the uterus of the rabbit. Clin Orthop Relat Res. 1972;87:318–21.
References
https://t.me/medicina_free
147
79. Mirabella T, Gentili C, Daga A, Cancedda R.Amniotic uid stem cells in a bone microenviron­ment: driving host angiogenic response. Stem Cell Res. 2013;11(1):540.
80. Schmidt W, Kubli F, Cseh I, Kara K.Maternal per­ception of fetal movements and real-time ultrasound ndings. J Perinat Med. 1984;12(6):313.
81. Goldstein JA, Posnick JC, Wells MD, Slate K, Thorner PS.An assessment of postnatal growth after in utero long bone osteotomy with xation. Plast Reconstr Surg. 1994;94(1):160.
82. Slate KR, Posnick JC, Wells MD, Goldstein JA, Keeley FW, Thorner PS, etal. Fetal tibial bone heal­ing in utero: the effects of miniplate xation. Plast Reconstr Surg. 1993;92(5):874.
83. Wells MD, Posnick JC, Goldstein J, Kendrick Slate R, Keeley FW, Thorner PS. Fetal bone gap healing in utero. J Oral Maxillofac Surg. 1993;51(11):1235.
84. Scheier M, Peter M, Hager C, Lang T, Barvinek A, Marth C.Spontaneous isolated midtrimester fracture of tibia and bula in a normal fetus with in utero healing and good long-term outcome. Fetal Diagn Ther. 2010;28(1):58.
85. Götherström C, Westgren M, Shaw SWS, Åström E, Biswas A, Byers PH, etal. Pre- and postnatal trans­plantation of fetal mesenchymal stem cells in osteo­genesis imperfecta: a two-center experience. Stem Cells Transl Med. 2014;3(2):255.
86. le Blanc K, Götherström C, Ringdén O, Hassan M, McMahon R, Horwitz E, etal. Fetal mesenchymal stem-cell engraftment in bone after in utero trans­plantation in a patient with severe osteogenesis imperfecta. Transplantation. 2005;79(11):1607.
87. Hayashi T, Hashimoto T, Fukuda S, Ohshima Y, Moritaka K.Neonatal subdural hematoma secondary to birth injury—clinical analysis of 48 survivors. Child’s Nerv Syst. 1987;3(1):23–9.
88. Nadas S, Reinberg O. Obstetric fractures. Eur J Pediatr Surg. 1992;2(3):165.
89. Ragunathan K, Thorn J. Management of grade V splenic injury with splenic artery embolization in pregnancy: a case report. Case Rep Womens Health. 2022;34:e00391.
90. Vivian-Taylor CL, Chen JS, Ford JBJR.Motor vehi­cle accidents during pregnancy: a population-based study. BJOG. 2012;119:499–503.
91. Melamed N, Aviram A, Silver M, Peled Y, Wiznitzer A, Glezerman M, et al. Pregnancy course and outcome following blunt trauma. J Matern Fetal Neonatal Med. 2012;25(9):1612–7.
92. Petrone P, Talving P, Browder T, Teixeira PG, Fisher O, Lozornio A, etal. Abdominal injuries in preg­nancy: a 155-month study at two level 1 trauma cen­ters. Injury. 2011;42(1):47–9.
93. Esposito DR, Smith LG, et al. Trauma dur­ing pregnancy. A review of 79 cases. Arch Surg. 1991;126:1073–8.
94. Baerga-Varela SP, Bannon MP, etal. Trauma in preg­nancy. Mayo Clin Proc. 2000;75:1243–8.
95. Miller JF, Williamson E, Glue J, Gordon YB, Grudzinskas JG, Sykes A. Fetal loss after implantation. A prospective study. Lancet. 1980;2(8194):554–6.
96. Whittaker PG, Taylor A, Lind T. Unsuspected pregnancy loss in healthy Women. Lancet. 1983;321(8334):1126.
97. Simpson JL, Mills JL, Holmes LB, Ober CL, Aarons J, Jovanovic L, etal. Low fetal loss rates after ultrasound- proved viability in early pregnancy. JAMA. 1987;258(18):2555–7.
98. Stabile I, Campbell S, Grudzinskas JG.Ultrasonic assessment of complications during rst trimester of pregnancy. Lancet. 1987;330(8570):1237–40.
99. Timberlake NE Jr. Trauma in pregnancy: a 10-year perspective. Am Surg. 1989;55:151–3.
100. Crosby JPWC.Safety of lap-belt restraint for preg­nant victims of automobile collisions. N Engl J Med. 1971;284:632–6.
101. Rothenberger D, Quattlebaum FW, Perry JFJ, Zabel J, Fischer RP. Blunt maternal trauma: a review of 103 cases. J Trauma. 1978;18(3):173–9.
102. Aboutanos MB, Aboutanos SZ, Dompkowski D, Duane TM, Malhotra AK, Ivatury RR.Signicance of motor vehicle crashes and pelvic injury on fetal mortality: a ve-year institutional review. J Trauma. 2008;65(3):616.
103. Weiss HB, Songer TJ, Fabio A.Fetal deaths related to maternal injury. JAMA. 2001;286(15):1863–8.
104. Guth AA, Pachter HL.Domestic violence and the trauma surgeon. Am J Surg. 2000;179:134–40.
105. Goodwin H, Holmes JF, Wisner DH. Abdominal ultrasound examination in pregnant blunt trauma patients. J Trauma. 2001;50(4):689–93; discussion
694.
106. Grossman NB.Blunt trauma in pregnancy. Am Fam Physician. 2004;70:1303.
107. ACOG educational bulletin. Obstetric aspects of trauma management. Number 251, September 1998. Int J Gynaecol Obstet. 1999;64:87–94.
108. Weiss HB. The epidemiology of traumatic injury­related fetal mortality in Pennsylvania, 1995-1997: the role of motor vehicle crashes. Accid Anal Prev. 2001;33(4):449.
109. Pearlman M. Motor vehicle crashes, pregnancy loss and preterm labor. Int J Gynaecol Obstet. 1997;57:127–32.
110. Mirza FG, Devine PC, Gaddipati S. Trauma in pregnancy: a systematic approach. Am J Perinatol. 2010;27:579–86.
111. Fingerhut JL, Baker SP, etal. Injury mortality among children and teenagers in the United States, 1993. Inj Prev. 1996;2:93–4.
112. Curet CR, Demarest GB, et al. Predictors of out­come in trauma during pregnancy: identication of patients who can be monitored for less than 6 hours. J Trauma. 2000;49:18–24.
113. Rogers GS, Osler TM, et al. A multiinstitutional study of factors associated with fetal death in injured pregnant patients. Arch Surg. 1999;134:1274–7.
Соседние файлы в папке @xirurgi_2025
Помощь Обратная связь Вопросы и предложения Пользовательское соглашение Политика конфиденциальности