Stepwise approach and management of traumatic brain injury during pregnancy

Abstract

Introduction. Trauma is the leading cause of non-obstetric maternal mortality and affects up to 8% of all pregnancies. Pregnant patients with traumatic brain injury (TBI) are a vulnerable population and management is complex with multiple special considerations. Recommendations proposed for the management of TBI patients are non applicable to pregnant women as often have been excluded from these major trials. Evidence on TBI management in pregnant women is limited and mostly based on clinical experience. Aim and objective. This study is to share our experiences in the management of TBI during pregnancy at a tertiary trauma centre in north India to formulate a stepwise approach consisting of different tiers of treatment. Methods. Case records of thirty pregnant patients with traumatic brain injury admitted at the tertiary apex trauma centre of northern India during the period of January 2015 to June 2022 were retrospectively analyzed. Results. Road traffic accidents (specifically two-wheelers) were the most common cause of TBI in pregnancy (80%). 60% suffered from moderate to severe TBI. Operative neurosurgical intervention was required in 30% of cases. During hospital stay, 27 patients (90%) had continuation of pregnancy. Nine patients (30%) who expired, belonged to moderate to severe TBI. Conclusion. Moderate or severe TBI in pregnancy is associated with unfavourable maternal and fetal outcomes. The complex physiological modifications occurring in pregnancy have a crucial role in the management and require a stepwise approach. Fetal concerns and the paucity of high-quality evidence further complicate the issue and more studies including this group specifically are required.

Keywords

• pregnancy
• paediatric traumatic brain injury
• Glasgow coma scale