High Risk Pregnancy (Report of a shotgun case)

Document Type : Case report

Authors

1 B.S. of Anesthesia, Khatam-al-Anbia Hospital, Zahedan University of Medical Science, Zahedan, Iran.

2 Instructor, Department of Anesthesia, Faculty of Paramedicine, Zahedan University of Medical Science, Zahedan, Iran.

3 Medical student, Student Research Committee, Faculty of Medicine, Zahedan University of Medical Science, Zahedan, Iran.

4 Assistant Professor, Department of Anesthesia, Faculty of Medicine, Zahedan University of Medical Science, Zahedan, Iran.

Abstract

Introduction: Trauma is considered as one of the important factors of high risk pregnancies. Trauma is the most important cause of mortality among pregnant women and then fetus. The death caused by trauma during pregnancy is preventable; therefore knowledge regarding the immune principles of treating a pregnant mother is necessary. In this report, a beaten pregnant woman by shotgun is presented which in spite of a high risk pregnancy and longtime anesthesia, the mother and fetus condition return stable by proper and timely management of gynecologist and anesthesiologist,.
Case presentation: The case is a 38 year-old women with gestational age of 32 weeks that a bullet was shot to her jaw and was ejected from the other side in Nov 2016. The bullet was also hit the shoulder area and the patient was intubated following shortness of breath. Three days later, the patient undergone general anesthesia with the presence of a gynecologist for 3 hours in order to perform Tracheostomy and jaw surgery and orthopedic surgery, and eventually the mother was recovered successfully. In the next day, because fetus condition was instable, emergency cesarean section was performed and finally the mother and neonate were discharged with good condition.
Conclusion: In many cases, the death caused by trauma in pregnancy is preventable. When trauma happens, at first, the mother should be stabilized, then the monitoring of the fetus and uterine contractions are important part of dealing with trauma and the increased chance of mother and fetus health after the second trimester of pregnancy.

Keywords


  1. Nankali A, Hemati M. Study of the factors associated with stillbirth in pregnant women admitted in Imam Reza Teaching Hospital in Kermanshah (2011-2014). Iran J Obstet Gynecol Infertil 2017; 20(1):1-9. (Persian).
  2. Patterson RM. Trauma in pregnancy. Clin Obestet Gynecol 2005; 2(1)7:32-8.
  3. Ali J, Yeo A, Gana TJ, Mclellan BA. Predictors of fetal mortality in pregnant trauma patients. J Trauma 2007; 42(5):782-5.
  4. Kissinger DP, Rozycki GS, Morris JA, Knudson MM, Copes WS, Bass SM, et al. Trauma in pregnancy. Predicting pregnancy outcome. Arch Surg 1991; 126(9):1079-86.
  5. Adedinsewo DA, Thurman DJ, Luo YH, Williamson RS, Odewole OA, Oakley GP, Jr. Valproate prescriptions for nonepilepsy disorders in reproductive-age women. Birth Defects Res A Clin Mol Teratol 2013; 97(6):403-8.
  6. Knudson MM, Rozycki GS, Paquin MM. Reproductive system trauma. In: Moore E, Feliciano D, Mattox K, editors. Trauma. 5th ed. New York: McGraw Hill; 2004. P. 851-68.
  7. ACOG educational bulletin. Obstetric aspects of trauma management. Number 251, September 1998 (replaces Number 151, January 1991, and Number 161, November 1991). American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 1999; 64(1):87-94.
  8. de l'Isère C, Meigs CD. Diseases and special hygiene of females. Philadelphia: Lea and Blanchard; 1845.
  9. Staples F. Foetus shot in utero; normal delivery and recovery of the mother. Med Rec 1876; 11:595.
  10. Applewhite JM, Pernot HS. A unique case: bullet wound through the uterus of a pregnant woman; recovery of mother; death of child. Med World 1892; 10:388.
  11. Corbett TH, Canell RG, Enders JL, Lieding K. Birth defects among children of nurse anesthetists. Anesthesiology 1974, 41(4):341-4.
  12. Occupational disease among operating room personnel: a national study. Report of an Ad Hoc Committee on the Effect of Trace Anesthetics on the Health of Operating Room Personnel, American Society of Anesthesiologists. Anesthesiology 1974; 41(4):321-40.
  13. Amini A, Bahrami N. Trauma during pregnancy. Sci J Forensic Med 2006; 12(3):164-70. (Persian).
  14. Newton ER. Trauma and pregnancy. Medicine 2003; 21:2-10.
  15. Grossman NB. Blunt trauma in pregnancy. Am Fam Phys 2004; 70(7):1303-10.
  16. Queenan I, Spong CY, Lockwood CJ. Management of high risk pregnancy. 4th ed. Malden: Blackwell; 1999. P. 385-7.
  17. Sure M. Trauma during pregnancy. Obstet Gynecol 2004; 14:24-8.
  18. Berkowitz GS, Papiernik E. Epidemiology of preterm birth. Epidemiol Rev 1993; 15(2):414-43
  19. Dole N, Savitz DA, Hertz-Picciotto I, Siega-Riz AM, Mcmahon MJ, Buekens P. Maternal stress and preterm birth, Am J Epidemiol 2003; 157(1):14-24.
  20. Steer P, Flint C. ABC of labour care: preterm labor and premature rupture of membranes. BMJ 1999; 318(7190):1059-62.
  21. Aboutanos MB, Aboutanos SZ, Dompkowski D, Dutane TM, Malhorta AK, Ivatury RR. Significance of motor vehicle crashes and pelvic injury on fetal mortality: a five-year institutional review. J Trauma 2008; 65(3):616-20.