Case 1: Neonatal Trauma Following Motor Vehicle Collision in Pregnancy.

A gravida 2, para 0-0-1-0 woman with an uneventful antenatal course is a restrained driver in a head-on, high-speed motor vehicle accident at a reported gestational age of 27 weeks and 4 days. Her airbag did not deploy because it was not operational. Her presentation is significant for tachycardia, normal blood pressure, and abdominal and hip pain. Bedside ultrasonography confirms fetal heart tones, breech position, and normal amniotic fluid index. Maternal physical examination demonstrates nasal trauma, bruising in the distribution of a seatbelt, and vaginal bleeding. Trauma computed tomography (CT) of the chest, abdomen, and pelvis shows no maternal injuries. Electronic fetal monitoring is significant for a category III tracing: baseline fetal heart rate (FHR) in the 180s, with minimal variability and recurrent late decelerations and contractions every 3 minutes. The decision for emergent cesarean delivery is made in the setting of nonreassuring fetal status with concern for placental abruption. The boy is limp, cyanotic, and apneic with no spontaneous movement. Apgar scores are 1, 1, and 4 at 1, 5, and 10 minutes after birth, respectively. He undergoes intubation and receives chest compressions, emergency umbilical vein catheter placement, and intravenous epinephrine in delivery room resuscitation. Umbilical arterial and venous cord gases at delivery were 7.14 and 7.13, respectively. On admission, the infant has …