Ultrasound in firearm injuries in pregnancy

Objective

We aimed to evaluate the subject of using diagnostic ultrasound and other radiological methods for firearm injury in pregnant women
The military conflicts and terrorism is on the rise in our times.
Mass casualty situations are encountered more frequently, nowadays, involving civilians and also pregnant women, therefore injuries with military weapons tend to increase in daily practice, with another increasing contribution being the violence against women using firearms.

Methods

The literature on the subject was searched using Clinical Keys® and PubMed®.
The evaluation of firearm injuries during pregnancy is critical. The extent of the injury and fetal involvement should be well evaluated and documented.
The projectile should be identified,localized and recovered for ballistic investigation.

Results

There are limited literature on the subject. However some guidelines are formed.
In the pregnant trauma patient, ultrasound is often easily accessible in an emergency department and can provide crucial information. (1)

Conclusion

Although ultrasound is the primary tool of diagnosis for obstetricians, additional radiological investigations including computer tomography or plain X rays may aid in diagnosis, and should be ordered without hesitation when necessary, especially in life threathening conditions involving high speed penetrating projectile injuries to the abdomen.
As stated in the guidelines (2):”Concern about possible effects of high-dose ionizing radiation exposure should not prevent medically indicated maternal diagnostic X-ray procedures from being performed. During pregnancy, other imaging procedures not associated with ionizing radiation should be considered instead of X-rays when possible.”
Viability of the fetus can also be assessed and documented using fetal biometry and possible vascular injuries to both fetus and placenta can be assessed by using color doppler.
3D/4D ultrasound may also be utilized to surface scan the fetus for any possible injury when there is suspected uterine penetrating injury, this is of course, when the mother and fetus is stable.
It should be remembered that ultrasound is unreliable for detecting placental abruption but it may be helpful to exclude placenta previa and demonstrate significant hemorrhage.

Keywords

Pregnancy, firearm, injury

1)Osnaya-Moreno H, Zaragoza Salas TA, Escoto Gomez JA, Mondragon Chimal MA, Torres Castaneda Mde L, Jimenez Flores M
Gunshot wound to the pregnant uterus: case report. Rev Bras Ginecol Obstet. 2013 Sep;35(9):427-31.
2) Robert D. Barraco RD, Chiu WC, Clancy TV, et al.
Practice Management Guidelines for the Diagnosis and Management of Injury in the Pregnant Patient: The EAST PracticeManagement Guidelines Work Group J Trauma. 2010;69: 211–214
3) Sela HY, Shveiky D, Laufer N, Hersch M, Eina S
Pregnant Women Injured in Terror-Related Multiple Casualty Incidents: Injuries and Outcomes
J Trauma. 2008;64:727–732.