Some authors have said that CT scan is the best test to assess posttraumatic brain damage to the fetus. In the immediate postnatal period, the transfontanellar ultrasound allowed us to evoke the absence of cerebral contusion and intracranial hemorrhage. An obstetric ultrasound in expert hands may be sufficient to make the antenatal diagnosis of lesions linked to a traumatic brain injury. There is no specificity to suggest a fetal brain injury.
Examination of the amniotic fluid will help to identify abnormalities in favor of fetal distress. Changes in heart rate usually occur before the onset of fetal brain damage. This constitutes an appropriate method for checking his health state. In case of suspected head trauma of the fetus, the gynecological and obstetric evaluation must include monitoring of his heart rate. Therefore, depressed skull fracture could be the consequence of the frontal impact on the maternal spine. The fall of the pregnant with reception on the side should have caused a fracture of the occipital bone by direct impact and not of the left frontal bone. Inside the uterus and in cephalic presentation, the fetus faces the spine so that its back and occipital region are facing forward. The depressed skull fracture of the left frontal bone of our fetus raises questions about its pathophysiology. We have not found a similar case in the literature. The head trauma of the fetus due to the fall of the pregnant woman from her own height reported in our observation seems exceptional. They are often associated with a skull fracture and usually occur in the third trimester of pregnancy. Traumatic brain injuries can have a poor prognosis. They had concerned 2.8% of pregnant women in the United States. Motor vehicle accidents are the most common cause of trauma among pregnant women. Most trauma to the fetus are caused by car accidents, suicide, violence and war. Surgical incision mark, 1.5 centimeters curved line of incision in frontal region + point of drill hole. At 35 months of follow-up, the course was normal, marked by very good healing of the operating area and normal psychomotor development.įigure 2. The baby was discharged from hospital 24 hours later. The operating procedure lasted 17 minutes. A Penfield dissector passing through the drill hole raised the depressed skull fracture by operating the lever. This surgery consisted in making a drill hole one centimeter in diameter through an incision of 1.5 centimeters in the left frontal region at a few millimeters of the fracture ( Figure 2). The newborn was operated on the 2nd day of life. The indication of a lifting of the depressed skull fracture was proposed urgently. The transfontanellar ultrasound (TFU) found no brain contusion or intracranial hematoma. The fontanelles were without particularity.
BABY SKULL FRACTURE SKIN
There was no contusion and no skin bruising next to the depressed skull fracture ( Figure 1). On examination of the newborn, it was found a large depression, roughly circular on the left frontal measuring 4.5 centimeters in diameter and a maximum depth of 3 centimeters. one month later, after an eutocic vaginal delivery, she gave birth to a male newborn weighing 3600 grams with an Apgar of 8 at one and five minutes. The patient returned to her home without any special observation.
The fetus was in cephalic presentation without apparent anomaly. An obstetric ultrasound performed had shown an ongoing pregnancy. The amniotic fluid examination was not performed. The fetal heart sounds were audible at a rate of 96 beats per minute (bpm) and active fetal movements were present. Her medical and surgical history was unremarkable apart from a normal vaginal delivery 2 years earlier. She did not complain of abdominal pain or bleeding. The reception took place on the left flank. Through this case, we will discuss diagnostic and therapeutic modalities.Ī 28-year-old woman, primiparous, second gesture patient consulted her gynecologist as a precaution following a fall from her own height which occurred the same day after tripping over while walking. We report a congenital depressed skull fracture due to maternal-fetal trauma. Depressed skull fractures of the fetus secondary to a fall of a pregnant woman from her own height are exceptional. When they reach the head of the fetus, these traumas can be responsible for complications such as developmental delay or cerebral palsy. Car accidents with pregnant women on board are the main cause of these injuries. Head traumas occurring in the fetus outside obstetrical maneuvers are rare and poorly documented.
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