Intrauterine Arrow Injury.

Injury of a pregnant lady risks both mother and fetus. Various modes of injuries are possible. But arrow injury is not usually heard of in today's world. We have reported a male child delivered with a cut injury on the face. It was caused by a penetrating arrow hitting his mother in her lower abdomen at term. The injury of the baby was repaired successfully.

INTRODUCTION

Maternal-fetal trauma during pregnancy is a known and well-studied entity. Road traffic accidents constitute the most common cause. Among the penetrating injuries, gunshot and stab injury are the main causes in the Western world.[1] In India, proper incidence and causes are not known. Though in Western literature it is unheard of the arrow injury, it is a common finding in India, especially in the tribal areas. Delivery of a baby with wound caused by penetrating injury in mother is not commonly encountered. Here, we are presenting a case of intra uterine injury of a fetus caused by an arrow striking his mother at term.

CASE REPORT

A male baby of 2.7 kg weight was brought to outpatient department with the history of delivery with an injury on the right cheek [Figure 1]. The delivery was performed in another block of the hospital by emergency cesarean section. The cesarean section was done as the mother had a penetrating arrow injury on her lower abdomen due to an assault 9 h before. She came to hospital with the arrow still penetrating in her body [Figure 2].

Figure 1

Baby with the wound on the face

Figure 2

Mother with the arrow

There was a four cornered star shaped injury of 2.5 cm diameter on the right cheek. The edges did not have active bleeding. The cut involved the skin and cheek muscles exposing the buccal pad of fat. Mouth cavity was spared. No other abnormality was detected in the baby.

The wound was cleaned, debrided, and repaired in layers with absorbable suture. As general anesthesia could not be arranged immediately, the procedure was done under local anesthesia. Wound healed well with minimal scar.

DISCUSSION

Trauma during pregnancy is a unique event because two patients, the mother and her fetus, are at risk and need special evaluation and management.[1] Penetrating injury as a cause of maternal-fetal injury during pregnancy is found in one third of such cases. Gunshot, stab wounds, and attempt of illegal abortion are the most common causes of penetrating trauma.[23] In penetrating trauma, probability of maternal organ damage is about 15–40% and fetal injury is about 70%.[3] If compared with blunt trauma fetal injury is more likely in penetrating trauma.[456] Fetal death after gunshot injury is 71% and stabbings 42%.4

Muzumdar and his colleague described a bizarre case from Canada where a baby had head injury when mother herself fired an air gun through her vagina at term. Following a spontaneous precipitous vaginal delivery the baby had convulsion and was found to have intracranial hemorrhage with a metal pellet near the right lateral ventricle. Later on, it formed a brain abscess. Neurosurgical intervention was required in this baby.[7]

In another case, a pregnant woman was stabbed at the lower abdomen at 30th week of gestation. She was managed nonsurgically. Spontaneous vaginal delivery occurred at term. The newborn had a right temporal swelling and it was diagnosed as a subcutaneous hemangioma. But at 2΍ years of life, it was symptomatic and diagnosed as growing skull fracture with dural tear due to the prenatal injury. Patient needed neurosurgical procedure.[8]

Though the injury in the baby and its management was simple in our case, it is presented here because of its fascinating nature and the interesting backdrop.

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FINANCIAL SUPPORT AND SPONSORSHIP

Nil.

CONFLICTS OF INTEREST

There are no conflicts of interest.