A case of a gunshot wound to the fetus in utero

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A 23-year-old woman estimated to be 34 weeks pregnant presented to the trauma bay via emergency medical services after sustaining a gunshot to the abdomen with wounds to the anterior abdomen and the left paravertebral musculature. The patient was initially stable and the fetal heart rate was reassuring. Due to concern for intra-abdominal injury, a computed tomography (CT) scan was obtained of the abdomen and pelvis (Fig. 1). The CT scan demonstrated hematometra, hemoperitoneum, and an L5 spine injury. Given these findings, the mother was taken to the operating room accompanied by obstetricians and the neonatal intensive care team. An exploratory laparotomy revealed bleeding from the uterus. Although previously stable, the fetal heart rate worsened and in the setting of a uterine injury, a classic hysterotomy was performed and the fetus delivered to the neonatal intensivists. An exploration of the abdomen was completed which revealed only a serosal tear at the rectosigmoid junction which was over sewn. The uterus and abdomen were then closed.
The neonate was a 2900-g male. He was noted to be limp, apneic, pale, and unresponsive with an undetectable heart rate. Positive pressure ventilation was initiated without response, and he was intubated with an appropriate response in heart rate. He had wounds to the right elbow, midchest, and to the posterior left shoulder with significant bleeding (Fig. 2). Pediatric surgery was then notified. He became bradycardic at 12 minutes of life requiring 3 minutes of CPR, intravenous epinephrine, and a normal saline bolus followed by blood transfusion.
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