The association between developmental handicaps and traumatic brain injury during pregnancy: an issue that deserves more systematic evaluation.
OBJECTIVE
Trauma during pregnancy is commonly viewed as benign for the foetus when the delivery occurs normally. This study revisits that point of view.


METHODS
We included eighteen patients having a neurological handicap with an anamnesis of an accident during pregnancy and a follow-up sufficient to determine a definite outcome.


RESULTS
Pregnancy outcome and observed management. Foetal abnormalities were detected in six cases between the first and the thirteenth day after the trauma. Emergency delivery or rapid birth after signs of foetal distress occurred in five cases. One baby died soon after birth. One-third of cases were not submitted to any investigation. VARIOUS NEUROLOGICAL HANDICAPS WERE RECORDED: Congenital microcephaly (three patients), congenital hydrocephalus (three), Infantile cerebral hemiplegy (six), quadriplegy with severe encephalopathy (four), diplegy (one), clumsiness with cerebellar atrophy (one), Moebius syndrome (one), mental retardation with autistic features (two), learning disability (one) auditory agnosia (one). Cerebral imaging showed macroscopic abnormalities in fourteen patients, evoking various pathogenetic hypotheses.


CONCLUSIONS
The association between maternal trauma and foetal brain lesions lacks sufficient investigation in many cases. Prospective studies are needed to clarify both medical and legal issues. Guidelines are proposed for obstetrical and paediatric management after significant maternal trauma.
Leroy-Malherbe
V
V
Service de Neurologie Pédiatrique, CHU KREMLIN-BICETRE, LE KREMLIN-BICETRE 94275, France.
Bonnier
C
C
Papiernik
E
E
Groos
E
E
Landrieu
P
P
D000059:Accidents; D006259:Craniocerebral Trauma / Q000209:etiology / Q000473:pathology / Q000523:psychology*; D002658:Developmental Disabilities / Q000209:etiology*; D005260:Female; D005316:Fetal Distress / Q000209:etiology; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006429:Hemiplegia / Q000196:embryology; D006801:Humans; D006849:Hydrocephalus / Q000196:embryology; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008831:Microcephaly / Q000196:embryology; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011297:Prenatal Exposure Delayed Effects; D049188:Prenatal Injuries / Q000473:pathology / Q000523:psychology*; D012189:Retrospective Studies