Radiologic ABCs of Maternal and Fetal Survival after Trauma: When Minutes May Count1
Stanford M. Goldman, MD and
Louis K. Wagner, PhD
1 From the Department of Radiology, University of Texas Medical School, 6431 Fannin St, MSB 2.132, Houston, TX 77030. From the Plenary Session, Friday Imaging Symposium: Acute Radiology—Where Minutes Count, at the 1998 RSNA scientific assembly. Received February 19, 1999; revision requested April 30 and received May 21; accepted May 21. Address reprint requests to S.M.G.
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Figure 1a. Extensive injuries in a 17-year-old girl after a motor vehicle accident. During the emergency helicopter flight to the hospital, she revealed that she might be pregnant. A pregnancy test was positive, and she was found to have a 12-week-old fetus. An immediate workup in the emergency department was performed. (a) Cystogram shows intraperitoneal bladder rupture and pelvic fractures (arrows). (b) Computed tomographic (CT) scan of the head shows subarachnoid bleeding (arrowheads). (c) Tomogram shows fracture of the pedicle of C2 (arrow). (d) Angiogram shows bleeding from the superior gluteal artery (arrowhead), which required embolization. Immediate surgery included repair of a right hemidiaphragmatic hernia and the bladder laceration. Brain swelling led to brain herniation and maternal death with consequent fetal death 5 days after admission.
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Figure 1b. Extensive injuries in a 17-year-old girl after a motor vehicle accident. During the emergency helicopter flight to the hospital, she revealed that she might be pregnant. A pregnancy test was positive, and she was found to have a 12-week-old fetus. An immediate workup in the emergency department was performed. (a) Cystogram shows intraperitoneal bladder rupture and pelvic fractures (arrows). (b) Computed tomographic (CT) scan of the head shows subarachnoid bleeding (arrowheads). (c) Tomogram shows fracture of the pedicle of C2 (arrow). (d) Angiogram shows bleeding from the superior gluteal artery (arrowhead), which required embolization. Immediate surgery included repair of a right hemidiaphragmatic hernia and the bladder laceration. Brain swelling led to brain herniation and maternal death with consequent fetal death 5 days after admission.
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Figure 1c. Extensive injuries in a 17-year-old girl after a motor vehicle accident. During the emergency helicopter flight to the hospital, she revealed that she might be pregnant. A pregnancy test was positive, and she was found to have a 12-week-old fetus. An immediate workup in the emergency department was performed. (a) Cystogram shows intraperitoneal bladder rupture and pelvic fractures (arrows). (b) Computed tomographic (CT) scan of the head shows subarachnoid bleeding (arrowheads). (c) Tomogram shows fracture of the pedicle of C2 (arrow). (d) Angiogram shows bleeding from the superior gluteal artery (arrowhead), which required embolization. Immediate surgery included repair of a right hemidiaphragmatic hernia and the bladder laceration. Brain swelling led to brain herniation and maternal death with consequent fetal death 5 days after admission.
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Figure 1d. Extensive injuries in a 17-year-old girl after a motor vehicle accident. During the emergency helicopter flight to the hospital, she revealed that she might be pregnant. A pregnancy test was positive, and she was found to have a 12-week-old fetus. An immediate workup in the emergency department was performed. (a) Cystogram shows intraperitoneal bladder rupture and pelvic fractures (arrows). (b) Computed tomographic (CT) scan of the head shows subarachnoid bleeding (arrowheads). (c) Tomogram shows fracture of the pedicle of C2 (arrow). (d) Angiogram shows bleeding from the superior gluteal artery (arrowhead), which required embolization. Immediate surgery included repair of a right hemidiaphragmatic hernia and the bladder laceration. Brain swelling led to brain herniation and maternal death with consequent fetal death 5 days after admission.
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Figure 2. Multiple stab wounds of the left arm, thigh, and back in a 33-year-old gravida 7, para 6 woman who was assaulted with a knife. Admission chest radiograph shows unsuspected collapse of the lower lobe of the left lung (arrowheads), which was probably secondary to aspiration.
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Figures 3, 4. (3) Absence of abruptio placentae in a 34-year-old pregnant woman after a motor vehicle accident. Color Doppler US scan shows a normal, viable 35-week-old fetus with good umbilical cord flow (arrows). (4) Absence of abruptio placentae in a 21-year-old pregnant woman after a motor vehicle accident. Color Doppler US scan shows a 6-week-old viable embryo with flow through the placenta clearly demonstrated (arrow).
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Figures 3, 4. (3) Absence of abruptio placentae in a 34-year-old pregnant woman after a motor vehicle accident. Color Doppler US scan shows a normal, viable 35-week-old fetus with good umbilical cord flow (arrows). (4) Absence of abruptio placentae in a 21-year-old pregnant woman after a motor vehicle accident. Color Doppler US scan shows a 6-week-old viable embryo with flow through the placenta clearly demonstrated (arrow).
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Figure 5. Placental separation in a pregnant patient after trauma. CT scan shows submembranous and subchorionic hemorrhage (arrows). US demonstrated similar findings. (Courtesy of Allen J. Cohen, MD, University of California, Irvine, College of Medicine, Davis).
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Figure 6. Fetal injury in a pregnant patient after trauma. CT scan shows intraventricular hemorrhage within the fetus (arrows). (Courtesy of Allen J. Cohen, MD, University of California, Irvine, College of Medicine, Davis).
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Figure 7a. Placental perfusion defects in a 22-year-old pregnant woman after a motor vehicle accident in which she was restrained. On arrival at the hospital, the patient had abdominal abrasions and abdominal pain. The fetus was viable with a heart rate of 150 beats per minute and remained so for the next 3 hours. (a) Immediate spiral CT scan shows a liver laceration (arrow). Bilateral fractures of the pelvis were also seen. (b) CT scan shows low CT numbers in a significant portion of the lateral aspect of the placenta (arrowhead). Fetal death was noted 2 hours later. Delivery was induced, and a dead fetus was delivered.
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Figure 7b. Placental perfusion defects in a 22-year-old pregnant woman after a motor vehicle accident in which she was restrained. On arrival at the hospital, the patient had abdominal abrasions and abdominal pain. The fetus was viable with a heart rate of 150 beats per minute and remained so for the next 3 hours. (a) Immediate spiral CT scan shows a liver laceration (arrow). Bilateral fractures of the pelvis were also seen. (b) CT scan shows low CT numbers in a significant portion of the lateral aspect of the placenta (arrowhead). Fetal death was noted 2 hours later. Delivery was induced, and a dead fetus was delivered.
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Figure 8. Placental perfusion defects in a 25-year-old pregnant woman after a high-speed motor vehicle accident in which she was restrained and in which there was immediate deployment of an air bag. On arrival at the hospital 45 minutes later, a 25-week-old nonviable fetus was found. Spiral CT scan shows low attenuation of the lateral aspect of the placenta (arrowhead). Other findings included open fractures of the right tibia and fibula, a nondisplaced fracture of the right medial malleolus, and a fracture of the right patella.
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Figure 9. Acute trauma in a 17-year-old pregnant girl after a rollover motor vehicle accident in which she lost consciousness. On arrival at the hospital, a 16-week-old viable fetus was found. CT scan of the head shows multiple sites of intracerebral bleeding in the frontoparietal regions (arrowheads). Other findings were left periorbital edema with a small amount of retrobulbar air, ethmoidal fluid, and facial fractures. The patient underwent multiple surgical and neurosurgical procedures and was discharged to a rehabilitation hospital with a viable fetus.
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Copyright © 1999 by the Radiological Society of North America.
