Case Report Decompressive craniectomy in term pregnancy with combined caesarean section for traumatic brain injury Pankaj Dawar a , M.S. Aradhana Kalra b , Deepak Agrawal c, *, Bhawani S. Sharma d a Senior Resident, Department of Neurosurgery, All India Institute of Medical Sciences and Associated Jai Prakash Narayan Apex Trauma Centre, New Delhi, India b Senior Resident, Department of Obstetrics and Gynecology, Deen Dayal Upadhyay Hospital, New Delhi, India c Associate Professor, Department of Neurosurgery, All India Institute of Medical Sciences and Associated Jai Prakash Narayan Apex Trauma Centre, New Delhi, India d Professor and Head of Department, Department of Neurosurgery, All India Institute of Medical Sciences and Associated Jai Prakash Narayan Apex Trauma Centre, New Delhi, India article info Article history: Received 17 February 2013 Accepted 23 October 2013 Available online 9 July 2014 Keywords: Caesarean section Pregnancy Head injury Decompressive craniectomy Maternal death abstract Over the years the maternal mortality depending on the obstetric causes has reduced whereas there is a relative increase in maternal mortality and morbidity due to non- obstetric causes. Trauma during pregnancy, including head injury, is one of the leading causes of incidental maternal death and morbidity, and complicates 6%e7% of all preg- nancies. Furthermore it predisposes two lives at risk and creates unique diagnostic and therapeutic challenges. Because of the physiological hormonal, hemodynamic and anatomical changes associated with pregnancy, certain standard neurosurgical practices may be challenged. We present a case of woman with term pregnancy who sustained moderate head injury requiring urgent caesarean section for pregnancy and decom- pressive craniectomy in the same sitting in Operation Theater. Issues like screening of mother and feto-maternal monitoring; physiological changes during pregnancy, choice of anaesthesia, intraoperative concerns and fetal monitoring, timing of delivery are discussed with review of pertinent literature. Copyright ª 2014, Neurotrauma Society of India. All rights reserved. 1. Introduction Trauma during pregnancy is currently a leading cause of non- pregnancy related maternal death which itself is the most common cause of fetal demise. 1 The most common causes of trauma in pregnancy include road-traffic-accidents (RTA), fall from height, physical assaults, and burns. 2 Women in their reproductive age are among the population at greatest risk for trauma. Over the years the maternal mortality depending on the obstetric causes has declined whereas there is a relative increase in maternal mortality and morbidity due to non- obstetric causes. Trauma during pregnancy, including head * Corresponding author. E-mail addresses: ved@vsnl.com, drdeepak@gmail.com (D. Agrawal). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/ijnt the indian journal of neurotrauma 11 (2014) 162 e165 0973-0508/$ e see front matter Copyright ª 2014, Neurotrauma Society of India. All rights reserved. http://dx.doi.org/10.1016/j.ijnt.2013.10.004