Pelvic fractures in pregnant multiple trauma patients

Objective: To study the outcome of pelvic fractures and fetuses in pregnant patients involved in blunt multiple trauma. Design: Retrospective follow-up study. Setting: Level I trauma center. Patients: Pregnant multiple trauma patients with pelvic fractures between 1 974 and 1998. Interventions: Conservative and operative treatment of pelvic fractures ada pted to the clinical status of the mother. Main Outcome Measures: Clinical, functional, and social outcomes were evalu ated. Results: Out of 4,196 patients with blunt multiple trauma treated between 1 974 and June 1998, seven demonstrated the combination of blunt multiple tra uma, pregnancy, and pelvic fractures. These patients had a mean Injury Seve rity Score of 29.9 points. Five mothers and three fetuses survived their in juries. All dead fetuses died on the scene. One surviving fetus was found t o have hydrocephalus unrelated to the injury; the remaining fetuses had an uneventful delivery and were healthy. In two of the three patients whose fe tuses survived, the treatment of the pelvic fracture was modified for the s ake of fetal well-being. In all of these patients, acceptable outcome was a chieved. Conclusion: Modification of the treatment of the pelvic fracture in pregnan t women with multiple trauma may be necessary to minimize the risk of fetal injury. In our experience with these rare cases, this modified treatment d id not severely alter the clinical outcome of the mother's pelvic fracture.