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Vol. 29. Núm. 1.
Páginas 13-30 (Enero 2002)
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Vol. 29. Núm. 1.
Páginas 13-30 (Enero 2002)
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Traumatismo no penetrante en la gestante. Un caso de encefalopatía hipoxicoisquémica fetal después de accidente automovilístico materno
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A. Tejerizo-García1, A.I. Teijelo1, E. Nava*, M.M. Sánchez-Sánchez1, R.M. García-Robles1, A. Leiva1, E. Morán1, F. Corredera1, L.C. Tejerizo-López1
1 Servicios de Obstetricia y Ginecología
* Pediatría. Hospital Virgen de la Vega. Salamanca. España
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Summary

We present the case of a patient who had a car accident in the 32nd week of pregnancy. Maternal injuries were minimal. Foetal heart rate patterns showed tachycardia and decreased modulation. Ultrasound scan was normal, with no sign of placental abruption. Twelve days after the accident a caesarean section was performed because of cardiotocograph alterations. A live infant was born. The baby died 12 days later from an ischaemic multicystic encephalopathy

Using a bibliographical review, we try to explain the mechanism of the foetal lesions, despite the apparently minimal maternal injury. Hypovolaemic shock, cava syndrome and maternal stress could be the cause of placental hypoperfusion. Placental abruption or fetoplacen-tary haemorrhage could be other possible causes

With these physiopathological data we review first aid treatment, which is quite often not used in pregnant women, and management in the specialist unit

Resumen

Presentamos el caso de una paciente que sufrióun accidente de automóvil en la vía pública en lasemana 32 de amenorrea, con lesiones maternasmínimas. El registro del ritmo cardíaco fetal erataquicárdico y poco oscilante. La ecografía eranormal, sin hematoma retroplacentario. Se realizóuna cesárea 12 días después del accidente por alteración del trazado cardiotocográfico, naciendo unniño vivo. El niño falleció a los 12 días de vidapor una encefalopatía multiquística de origen isquémico.

Ala vista de los datos de la bibliografía, se intentaexplicar el mecanismo de las lesiones fetales, a pesardel traumatismo aparentemente no grave de la madre. El shock hipovolémico, el síndrome cava y el estrés materno pueden ser el origen de una hipoperfusión placentaria. Un hematoma retroplacentario ouna hemorragia fetoplacentaria pueden ser otras causas posibles.

Apoyándonos en estos datos fisiopatológicos, recordamos la conducta para los primeros auxilios que,a menudo, no es habitual poner en práctica en mujeres embarazadas, y las medidas a tomar en un centroespecializado.

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