Resuscitative Endovascular Balloon Occlusion of the Aorta in the Management of a Gunshot Wound and Rupture of the Uterus

Trauma is the leading cause of non-obstetrical maternal death. A 19-year-old woman at 20 weeks’ gestation was brought to the emergency room after suffering a gunshot wound to the lower abdomen. Upon arrival, she was hemodynamically stable and imaging was obtained. CT revealed a rupture of the uterus with a partially extrauterine fetus, and the patient was immediately taken for an explorative laparotomy. Prior to the surgical start, the patient’s blood pressure declined and, subsequently, a resuscitative endovascular balloon occlusion of the aorta (REBOA) was placed. The fetus and placenta were delivered and both uterine arteries and the inferior epigastric artery were ligated. Following an unremarkable postoperative course, she was discharged on hospital day 17. The mainstay approach to trauma in pregnancy should be to utilize focused imaging techniques to assess extent of trauma and provide adequate circulation to vital organs. Aortic balloon occlusion may be considered as a viable strategy to enhance resuscitation.

Thoracoabdominal impalement injury during pregnancy

Trauma has emerged as the leading cause of death during pregnancy. Penetrating abdominal trauma in pregnancy requires a rigorous clinical evaluation to establish a complete assessment of obstetric and non-obstetric lesions. In the case of major trauma, treatment is essentially carried out in a trauma centre with a multidisciplinary team to improve maternal and fetal prognosis. This is a case of a 20-year-old primigravid woman, 33 weeks and 4 days age of gestation, who was admitted for impaled foreign body. She was brought to the emergency department for a penetrating wound of the chest and abdomen after being accidentally impaled by a metre-long, inch-thick steel rod. Emergency laparotomy, caesarean section and thoracotomy were performed. The aim of this report is to discuss the assessment, management and role of the multidisciplinary team in the management of a pregnant trauma patient.

Trauma in Pregnancy : Diversifying Obstetric Retrieval Service in Sabah

The Obstetric and Gynaecological Retrieval Service in West Coast Sabah has been well-established since year 2015, parallel to the global advancement of Emergency Retrieval Service. The decision to transfer a patient or to deploy team to the patient lies in the hands of Retrieval Unit. Additionally the mode of transportation, surgeon availability, weather and travel time have to be taken into account. Even though the structure of the program is steadfast in diversifying retrieval services, there are still insufficient studies available to decide its worth. We report a case of a 19-year old primigravida at 27 weeks; involved in a high-impact motor vehicle accident and sustained class 4 hemorrhagic shock. Evaluated in a district hospital, uterine rupture was diagnosed. Hence, the dilemma was either to deploy a team to perform the surgery in district hospital, or to put the patient through a perilous journey back. We would discuss on how we had organised and coordinated a team of obstetrician and anaesthesiologist, along with the Retrieval Team, to perform an Emergency Exploratory Laparotomy in district hospital. Nevertheless, the best method of care is still debatable as astute judgement is crucial and this approach has to be taken on a case to case basis. Ultimately, the patients well-being is the utmost priority.