Pregnant Female with EDH

[Ben Reynolds]

This is truly a unique case.  

The question in my mind would be whether the massive
valsalva maneuver during vaginal delivery would worsen
this woman's head injury.  Intuitively I'd say yes,
which if this were me I'd probably push for elective
C-section in the coming weeks since no one (even the
all seeing neurosurgeon) can say with any degree of
certainty that further bleeding wouldn't occur after
the antecedent period leading to a term birth.

As far as the EDH is concerned, I get nervous about
any posterior fossa bleeding, small or not.  The
brainstem and cerebellum don't share their finite real
estate well at all.  And if it remains stable and the
neurosurgeon is set on conservative management it
makes the argument stronger for elective c-section.

Ben Reynolds, PA-C
Pittsburgh, PA
--- navin goyal <drnavingoyal at yahoo.co.in> wrote:

> Dear Mail subscribers,
> 
> A young  and 35  wks preganat female had a fall from
> running train . She attended our trauma centre two
> days after with complains  of vomitting twice on
> that . Patient when attended our trauma centre was
> comfortable except for the complains mentioned . GCS
> 15/15  P-72/min BP-110/70 . No other complains .We
> got her CT Brain done . Which showed small EDH in
> the posterior fossa and SAH in various other part of
> brain . USG showed normal fetal well being with
> reactive  NST( Non stress test).
> I would like to know what should be done ? Whether
> EDH evacuation should be done immediately?EDH
> evacuation should be done only if  the patient has
> labor pain ? Whether Cesarean section should be done
> immediately, alone or along with  EDH evacuation  ?
> Can we go on with the conservative management.
> 
> Navin
> 
> 
> 
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