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CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(02): 249-257
DOI: 10.4103/ajns.AJNS_243_20
Original Article

Algorithm of traumatic brain injury in pregnancy (Perspective on neurosurgery)

Ditto Darlan
1   Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Surabaya
2   Faculty of Medicine, Universitas Airlangga, Surabaya
,
Galan Prasetya
1   Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Surabaya
2   Faculty of Medicine, Universitas Airlangga, Surabaya
,
Arif Ismail
1   Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Surabaya
2   Faculty of Medicine, Universitas Airlangga, Surabaya
,
Aditya Pradana
1   Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Surabaya
2   Faculty of Medicine, Universitas Airlangga, Surabaya
,
Joandre Fauza
1   Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Surabaya
2   Faculty of Medicine, Universitas Airlangga, Surabaya
,
Ahmad Dariansyah
1   Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Surabaya
2   Faculty of Medicine, Universitas Airlangga, Surabaya
,
Gigih Wardana
1   Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Surabaya
2   Faculty of Medicine, Universitas Airlangga, Surabaya
,
Tedy Apriawan
1   Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Surabaya
,
Abdul Bajamal
1   Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Surabaya
2   Faculty of Medicine, Universitas Airlangga, Surabaya
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Background: The maternal deaths due to obstetrical cases declined, but the maternal deaths that caused by nonobstetrical cases still increase. The study reported that traumatic cases in pregnancy are the highest causes of mortality in pregnancy (nonobstetrical cases) in the United States. Another study reported that 1 in 12 pregnant women that experienced traumatic accident and as many as 9.1% of the trauma cases were caused by traumatic brain injury (TBI). The female sex hormone has an important role that regulates the hemodynamic condition. Anatomical and physiological changes during pregnancy make the examination, diagnosis, and treatment of TBI different from non-pregnant cases. Therefore, it is very important to lead the algorithm for each institution based on their own resources. Case Series: A 37-year-old woman with a history of loss of consciousness after traffic accident. She rode a motorbike then hit the car. She was referred at 18 weeks' gestation. Glasgow Coma Scale (GCS) E1V1M4, isochoric of the pupil, reactive to the light reflex, and right-sided hemiparesis. The non-contrast head computed tomography (CT) scan revealed subdural hematoma (SDH) in the left frontal-temporal-parietal region, SDH of the tentorial region, burst lobe intracerebral hemorrhage, and cerebral edema. There was not a fetal distress condition. The next case, a 31 years old woman, in 26 weeks gestation, had a history of unconscious after motorcycle accident then she fell from the height down to the field about 3 m. GCS E1V1M3, isochoric of the pupil, but the pupil reflex decreased. Noncontrast CT scan revealed multiple contusion, subarachnoid hemorrhage, and cerebral edema. She had a good fetal condition. Discussion: We proposed the algorithm of TBI in pregnancy that we already used in our hospital. The main principle of the initial management must be resuscitating the mother and that also the maternal resuscitation. The primary and secondary survey is always prominent of the initial treatment. Conclusion: The clinical decision depends on the condition of the fetal, the surgical lesion of the intracranial, and also the resources of the neonatal intensive care unit in our hospital.

Key-words:

Timing of surgery - traumatic brain injury - traumatic brain injury in pregnancy

Financial support and sponsorship

Nil.




Publication History

Received: 21 May 2020

Accepted: 28 December 2020

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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