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Fetal Trauma
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5
Abstract
The fetus can sustain mechanical trauma during pregnancy or difcult delivery.
Approximately 2% of all live births in the
USA were exposed to intrauterine trauma
from motor vehicle accidents. Blunt fetal
trauma during pregnancy can result in (1)
fetal/neonatal death, (2) direct fetal injury, and
(3) deceleration injury. It can be detected during maternal imaging diagnostics, CTG monitoring, or delivery. It can also be the result of
childbirth trauma. It is imperative to detect
intrauterine trauma because, in many cases, it
indicates Cesarean delivery to minimize additional trauma during difcult or prolonged
vaginal delivery. The fetal outcome depends
on the underlying fetal, amniotic, and uterine
injuries. Penetrating fetal trauma accounts for
10% of all fetal trauma. With penetrating
trauma, primarily stab injuries in the second
half of pregnancy, maternal injuries are minimal due to the protective role of the pregnant
uterus. Consequently, fetal penetrating trauma
is common. With stabbing fetal trauma, mortality is minimal, with the potential for various
degrees of impairment. On the contrary, gunshot trauma has high fetal mortality from
direct fetal trauma or indirectly from severe
maternal bleeding.
5.1 Fetal Physiology
During the rst week, the conceptus has not yet
been implanted in the uterus, making it relatively
resistant to injury. Soon after, the embryo attaches
to the uterus via the anchoring villi. The placenta is
not as elastic as the myometrium, potentially leading to shear stresses and disruption of the villi with
force applied to the uterus. The fetus’s well-being
depends on the adequacy of the maternal blood
ow to the placenta, mainly derived from the uterine arteries. The uterine vascular bed is a low resistance system, not capable of further dilation and
devoid of autoregulation. Therefore, placental
blood ow varies directly with the net perfusion
pressure (uterine artery pressure-uterine venous
pressure) across the intervillous space and inversely
with uterine vascular resistance. In normal pregnancy, the fetus has a considerable functional
reserve to withstand uterine blood ow or oxygenation changes. In sheep, fetal oxygen consumption
does not decrease until oxygen delivery is reduced
by 50% [1]. Later in pregnancy, vital fetal organs
such as the brain and myocardium are further protected by the “diving reex,” which allows redistribution of fetal cardiac output during maternal
hypoxemia or compromised uterine perfusion. The
fetus’s response to these insults is limited and
seems to vary with gestational age. Decreased placental blood ow quickly leads to fetal distress.
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
G. Augustin, Acute Abdomen During Pregnancy, https://doi.org/10.1007/978-3-031-26021-6_5
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