Trauma is one of the main causes of nonpregnancy-related maternal death and it is
related with antagonistic fetal outcomes. About 7 to 8% of all pregnancies are affected
by trauma.[1] A life-saving neurosurgical mediation to treat raised intracranial pressing factor
is decompressive craniectomy. Basic signs are in the administration of severe traumatic
brain injury (TBI).
Recently, a study by Choy and Burns[2] shared their experience to successful simultaneous decompressive craniectomy and
cesarean section. Simultaneous management of concurrent lesions needs a multidisciplinary
approach, optimization of the physiology of the mother and fetus,[4] control of intracranial pressure, and an informed decision whether to deliver the
baby first or perform craniotomy first.[2]
[3]
[4] A study showed a case of TBI happening in a term pregnant lady who went through
concurrent cesarean delivery and neurosurgery under general anesthesia.[3] However, just to emphasize primary goal in the management of trauma during pregnancy
is focused on optimal maternal resuscitation and early fetal assessment.[5] If there is rapid neurological deterioration evacuating the intracranial mass lesion
becomes the priority to safeguard both mother as well as fetus,[2] but if there are signs of fetal distress and the mother is neurologically stable,
caesarean section may be given a priority to deliver the baby.[3] Further, if the fetus is stable performing craniotomy first may give an option of
the vaginal delivery, of course there should not be any signs of fetal distress.[3]
[6]
It is always a challenge to simultaneously manage the intracranial pathology and safe
management of mother and delivery of the baby and require individualized approach
(details regarding type of injury, extent of injury, maternal status, gestational
age, and status of fetal well-being).[3]
[4] A report contributes to decreasing the mortality in women with preeclampsia, given
that neurological complications increase mortality rates,[7] even more before 34 weeks of gestation.[8] It is important to highlight that puerperium is a procoagulant state and should
be carefully surveilled to manage an additional complication in these cases.[9] Despite cesarean section is the standard treatment for preeclampsia, it should be
outlined that it increases the risk of cerebral venous sinus thrombosis (CVST).[9] There are a couple of cases in the advanced literature observing the utilization
of decompressive craniectomy in pregnancy-related CVST; however, in these cases, there
was risk factor.[10]
[11]
