Anesthesia Challenges in Pregnant Lady with Traumatic Brain Injury: Report of Two Cases

Keywords

traumatic brain injury - Pregnancy - anesthesia

Introduction: Trauma is the commonest nonobstetrical cause of death in females, complicating approximately 6 to 7% of all pregnancies. The common etiology for trauma in pregnancy is motor vehicle accidents, falls, violent assaults, and burn injuries. Management of these patients poses a lot of challenges to anesthesiologists, neurosurgeons, and obstetricians as two lives are involved.

Methodology/Description: We describe successful anesthesia management and maternal and fetal outcome of two patients admitted with neurotrauma, sustained after fall from Mumbai local train. The first was a 26-year-old lady, 36 weeks pregnant with acute right temporoparietal extradural hematoma diagnosed on computed tomography (CT) scan with Glasgow Coma Scale (GCS) 15/15, operated under general anesthesia. She was extubated postoperatively and discharged after 5 days. After a week of discharge, she delivered a baby boy without any abnormality. Another pregnant female, 29 years old, came with head injury. CT scan showed depressed right parietal skull bone fracture with brain contusion. She was admitted with GCS 12/15 and 18 weeks gestation on USG with viable fetus and underwent decompression craniotomy under general anesthesia. Postoperatively, she required ventilatory support for prolong time and delivered 1.4 kg premature baby at 32 weeks of gestation. She showed no neurological improvement and succumbed to death after 6 months of hospital stay. Our aim to report these cases is to assess, how timely multifaceted intervention in pregnant lady with post-traumatic brain injury can affect the outcome.

Conclusion: The management of trauma in pregnancy requires a multidisciplinary approach so that maternal and fetal condition is optimized timely, managed appropriately and judiciously to achieve best outcome.

• References

• 1 Reddy SV, Shaik NA, Gunakala K. Trauma during pregnancy.. J Obstet Anaesth Crit Care 2012; 1: 3-9
• 2 Satapathy MC, Mishra SS, Das S, Dhir MK. Emergency management strategy for pregnant head trauma victimscase report and review of literature.. Indian J Neurotrauma 2014; 11: 45-48