Shot in the Womb at 13 Weeks with Good Outcome (390)

Introduction: There are but a few case reports of gunshot injury to the pregnant uterus with outcome of a surviving healthy infant.

Case Report: During a convenience store robbery, a 28-year-old gravida 1 at 14^5/7 weeks gestation sustained 3 gunshot wounds, one of which penetrated her right lower quadrant and uterus, resulting in amniorrhexis and anhydramnios. The initial computerized tomography scan visualized the projectile in the lower uterine segment. Exploratory laparotomy noted absence of obvious intra-abdominal injury. Abdominal and transvaginal ultrasound exam visualized the projectile at the chorio-decidual interface near the fetal feet. Power Doppler noted an adjacent hypervascular region in the myometrium, consistent with uterine injury. Given anhydramnios, amniorrhexis, and the intrauterine projectile, pregnancy termination was considered. However as initial wound care progressed, a small amount of amniotic fluid re-accumulated. Fetal anatomy otherwise appeared normal within the limitations imposed by 13 weeks gestational age. Oligohydramnios, characterized by the deepest vertical amniotic fluid pocket of 2–3 cm, persisted throughout the remainder of the pregnancy. At 28^5/7 weeks (63 days post event) sudden onset of foul bloody vaginal discharge and fever of 103 prompted cesarean delivery. Birth weight was 1350 g and Apgar score was 2/7. Maternal serum lead levels gradually increased from 9 on day 7, to 16 on day 62, to 18 on day 117 post event. During NICU care the neonate's serum lead level was 5, 4, and 2 µg/dL (normal 0–4) on day of life 17, 23 and 29 respectively. On day of life 65 this apparently healthy female infant was discharged from the NICU to her parents care. As of age 2 years, neurodevelopment is normal.

Discussion: This case is significant for the following: Exceptional early onset (13 weeks) and duration (14 weeks) of oligohydramnios after a uterine gunshot wound with outcome of a healthy infant. Documentation of maternal and neonatal serum lead levels.

We speculate that the mechanism of amniorrhexis and oligohydramnios may have been leakage of amniotic fluid into the maternal vasculature via the uterine wound, as there was no vaginal fluid leakage or bleeding until 20 weeks gestation.

Panel A: Admission CT demonstrating a radio-opaque projectile in the uterine cavity.

Panel B: Initial transabdominal ultrasound exam demonstrating anhydramnios and the echogenic projectile in the lower uterine segment.

Panel C: Transvaginal ultrasound demonstrating proximity of the projectile to the fetal feet.

Fig. 1 Admission CT demonstrating a radio-opaque projectile in the uterine cavity.

Fig. 2 Initial transabdominal ultrasound exam demonstrating anhydramnios and the echogenic projectile in the lower uterine segment.

Fig. 3 Transvaginal ultrasound demonstrating proximity of the projectile to the fetal feet.

Publication History

Article published online:
17 September 2021