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KMID : 0377619870520030168
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Korean Jungang Medical Journal
1987 Volume.52 No. 3 p.168 ~ p.171
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Penetrating Injury of the Abdomen during Pregnancy
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Abstract
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Korean Police Surgeon Association
Penetrating injuries to the abdomen, particularly gravid uterus has resulted from a variety of instruments and missile, and fallen physicians to face two patients simultaneously whose sensitivities to trauma have been different and both of whose management might be separate.
In late pregnancy, the gravid uterus is the largest viscus, occupying a considerable portion of the abdomen. So the uterus acts as a shield for the mother and modifies the type of injury because it displaces the small intestine into narrow space of the upper abdomen and is not a vital organ and has the relatively dense uterine musculature.
The management of stab wounds of the abdomen has changed to the selective conser-vative observation in last 20 years since there were no penetration of the peritoneum in more than 30 percent of cases and in additional 15 to 20 percent there was no injury to require repair in the era of all exploration to injuries, and available adjunctive technique like fistu-logram to identify the peritoneal penetration.
In case of lower abdominal stab wounds, the severity of the injury in fetal wounds can vary from superficial soft tissue wounds to severe, life-threatening ones. Physicians need to perform the peritoneal lavage and amniocentesis to make sure large hemorrhage followed by careful observation, If exploration is undertaken, the physician must decide whether to perform a cesarean section or leave the pregnancy and weigh the potential benefits of cor-rective surgery against the risks of premature delivery. If the uterus limits the repair of maternal injuries, the uterus should be emptied.
In wounds of upper abdomen, constituting over two third of non pregnant stab wounds, the difficulty in assessing the abdominal wall response to peritoneal irritation, the less satisfactory results with peritoneal lavage, and increased viscus injury suggest that pregnant patients should be explored. Often post-injured diaphragmatic hernia lead the mortality of about 20 percent and the importance of early diagnosis because it may remain a symptomatic for a long period and strangulate the visceral organs due to increase the intraperitoneal pressure in any causes.
Gunshot wounds, occurred not a frequently, caused fetal injury and fetal death resulted from the injury directly of cord or placenta in about 59 percent Physician must check fetal heart tone and perform early exploration.
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