Download PDF
Indian Journal of Neurotrauma 2014; 11(02): 162-165
DOI: 10.1016/j.ijnt.2013.10.004
Case Report
Thieme Medical and Scientific Publishers Private Ltd.

Decompressive craniectomy in term pregnancy with combined caesarean section for traumatic brain injury

Pankaj Dawar
a   Senior Resident, Department of Neurosurgery, All India Institute of Medical Sciences and Associated Jai Prakash Narayan Apex Trauma Centre, New Delhi, India
,
M.S. Aradhana Kalra
b   Senior Resident, Department of Obstetrics and Gynecology, Deen Dayal Upadhyay Hospital, New Delhi, India
,
Deepak Agrawal
c   Associate Professor, Department of Neurosurgery, All India Institute of Medical Sciences and Associated Jai Prakash Narayan Apex Trauma Centre, New Delhi, India
,
Bhawani S. Sharma
d   Professor and Head of Department, Department of Neurosurgery, All India Institute of Medical Sciences and Associated Jai Prakash Narayan Apex Trauma Centre, New Delhi, India
› Author Affiliations
Subject Editor:
Further Information

Publication History

17 February 2013

23 October 2013

Publication Date:
06 April 2017 (online)

  PDF Download  Permissions and Reprints

Abstract

Over the years the maternal mortality depending on the obstetric causes has reduced whereas there is a relative increase in maternal mortality and morbidity due to non-obstetric causes. Trauma during pregnancy, including head injury, is one of the leading causes of incidental maternal death and morbidity, and complicates 6%–7% of all pregnancies. Furthermore it predisposes two lives at risk and creates unique diagnostic and therapeutic challenges. Because of the physiological hormonal, hemodynamic and anatomical changes associated with pregnancy, certain standard neurosurgical practices may be challenged. We present a case of woman with term pregnancy who sustained moderate head injury requiring urgent caesarean section for pregnancy and decompressive craniectomy in the same sitting in Operation Theater. Issues like screening of mother and feto-maternal monitoring; physiological changes during pregnancy, choice of anaesthesia, intraoperative concerns and fetal monitoring, timing of delivery are discussed with review of pertinent literature.

Keywords

Caesarean section - Pregnancy - Head injury - Decompressive craniectomy - Maternal death
 

  • References

  • 1 Aitokallio-Tallberg A., Halmesmäki E.. Motor vehicle accident during the second or third trimester of pregnancy. Acta Obstet Gynecol Scand 1997; 76: 313-317
    CrossrefPubMedGoogle Scholar
  • 2 Shah A.J., Kilcline B.A.. Trauma in pregnancy. Emerg Med Clin North Am 2003; 21: 615-629
    CrossrefPubMedGoogle Scholar
  • 3 Cirak B., Kiymaz N., Kerman M., Tahta K.. Neurosurgical procedures in pregnancy. Acta Cir Bras 2003; 18: 01-13
    PubMedGoogle Scholar
  • 4 Kuczkowski K.M.. Trauma in pregnancy. Perioperative anesthetic considerations for the head-injured pregnant trauma victim. Anaesthesist 2004; 53: 180-181
    CrossrefPubMedGoogle Scholar
  • 5 Lippmann S., Bordador B., Shaltout T.. Detection of unknown early pregnancy. A matter of safety. Postgrad Med 1988; 83: 129-131 135
    CrossrefPubMedGoogle Scholar
  • 6 Goldman S.M., Wagner L.K.. Radiologic ABCs of maternal and fetal survival after trauma: when minutes may count. Radiographics 1999; 19: 1349-1357
    CrossrefPubMedGoogle Scholar
  • 7 Morris Jr. J.A., Rosenbower T.J., Jurkovich G.J.. et al Infant survival after cesarean section for trauma. Ann Surg 1996; 223: 481-491
    CrossrefPubMedGoogle Scholar
  • 8 Schiff M.A., Holt V.L.. The injury severity score in pregnant trauma patients: predicting placental abruption and fetal death. J Trauma 2002; 53: 946-949
    CrossrefPubMedGoogle Scholar
  • 9 Kettel L.M., Branch D.W., Scott J.R.. Occult placental abruption after maternal trauma. Obstet Gynecol 1988; 71: 449-453
    PubMedGoogle Scholar
  • 10 Thomas J.S., Koh S.H., Cooper G.M.. Haemodynamic effects of oxytocin given as i.v. bolus or infusion on women undergoing Caesarean section. Br J Anaesth 2007; 98: 116-119
    CrossrefPubMedGoogle Scholar
  • 11 Kuczkowski K.M., Fouhy S.A., Greenberg M., Benumof J.L.. Trauma in pregnancy: anaesthetic management of the pregnant trauma victim with unstable cervical spine. Anaesthesia 2003; 58: 822
    PubMedGoogle Scholar