ABSTRACT
Trauma is the leading cause of nonobstetrical maternal death in pregnancy and is associated with significantly increased risk of morbidity and mortality of the fetus. Initial management of the pregnant trauma patient should follow standardized Advanced Trauma Life Support (ATLS) guidelines, including early assessment of fetal well-being. In the setting of maternal head trauma, the goals of initial management should include preventing secondary brain injury. Although the incidence of emergency neurosurgical intervention in this population is rare, an understanding of the normal anatomic and physiologic changes of pregnancy as well as the potential conflicts between ideal maternal and fetal care is necessary to optimize anesthetic management to both patients. This chapter reviews neuroanesthetic management of the head-injured parturient with discussion of the timing of maternal neurosurgery vs possible fetal delivery, the consequences of maternal elevated intracranial pressure (ICP) management on the fetus, and the potential teratogenicity of maternally administered medications. It includes an up-to-date literature review of maternal and fetal outcomes following maternal neurosurgical intervention in the setting of head trauma as well as a brief discussion of the anesthetic considerations for traumatic spinal cord injury (SCI) in pregnancy.
