Head injury and pregnancy.

Even mild; head injury during pregnancy can threaten either the maternal or the fetal life. Traffic accidents are the main causes so head injury is of ten associated with other lesions, frequently abdominal trauma. Among all t hese possible lesions head injury and hemorrhagic schock are the main sourc es of fatality in pregnant women. All kinds of trauma and especially head injuries have a potentially deleter ious effect on fetal viability. This risk is associated with systemic and c erebral consequences of post-traumatic arterial hypotension, anoxia or anem ia. Moreover, diagnostic procedures and medications can add their noxious s econdary effects, contributing more or less to poor fetal outcome. Decision making is necessarily dictated by the severity of the consciousness disord ers and/or the encephalic lesions. A convergent discussion between the inte nsive care physician, the neurosurgeon, the obstetrician and the anesthesio logist is needed. Severe or prolonged traumatic coma is highly dramatic sit uation because the maternal outcome remains largely unknown for days or wee ks. Technically, for these severe comas, there are no substantial differenc es with what is usually done in a similar case without pregnancy. Neurosurg ical indications follow the usual rules, except that some non-urgent indica tions should be delayed for a while. Usually, this simple rule of independe ncy in indications also applies to the obstetrician. Special care must be t aken for fetal monitoring required throughout the initial critical phase.