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 1974 and 1998.
Interventions: Conservative and operative treatment of pelvic fractures adapted to the clinical status of the mother.
Main outcome measures: Clinical, functional, and social outcomes were evaluated.
Results: Out of 4,196 patients with blunt multiple trauma treated between 1974 and June 1998, seven demonstrated the combination of blunt multiple trauma, pregnancy, and pelvic fractures. These patients had a mean Injury Severity Score of 29.9 points. Five mothers and three fetuses survived their injuries. All dead fetuses died on the scene. One surviving fetus was found to have hydrocephalus unrelated to the injury; the remaining fetuses had an uneventful delivery and were healthy. In two of the three patients whose fetuses survived, the treatment of the pelvic fracture was modified for the sake of fetal well-being. In all of these patients, acceptable outcome was achieved.
Conclusion: Modification of the treatment of the pelvic fracture in pregnant women with multiple trauma may be necessary to minimize the risk of fetal injury. In our experience with these rare cases, this modified treatment did not severely alter the clinical outcome of the mother's pelvic fracture.