The study considered four cases of pregnant women with unstable pelvic fractures. Cases were retrospectively analyzed from two University Hospital records. Foetal and mothers conditions at the time of admittance, description of lesions of acetabular/pelvis fractures, type of fractures, performed surgery, pre, intra and post-operatively care, and mother and foetus outcomes were analyzed. The inclusion criteria were pregnant women with unstable pelvic fractures. A literature review considering the subject was performed.
Table 1 and Fig. 1, Fig. 2, Fig. 3, Fig. 4 present demographic findings on the four patients and their foetus, including foetal and mothers conditions at the time of admittance, description of lesions of acetabular/pelvis fractures/type of fractures, performed surgery, and mother and foetus outcomes were analyzed. The mean age of the women was 23 years; most of them (3/4) were primiparous with a mean pregnancy age of 23 weeks. Two (2/2) women had Malgaigne-type fractures and the other two (2/2) had symphyseal disjunction associated with acetabular fractures.
Considering the first case, the woman was 17 years old. Patient was run over and joined the emergence of hospital with back pain, pelvis pain and the inability to walk. She referred she was pregnant with +-25 weeks, first baby. The radiological evaluation showed fracture with small wedging L4 and disjunction with pelvic right side ascension. Foetal ultrasound evaluation proven foetal viability with normal heartbeats. After two days, under general anaesthesia, she was operated with reduction of the disjunction and fixing it with two perpendicular plates. After surgery, she was monitored in orthopaedics and obstetrics clinic. At 37 weeks it was performed a caesarean, and a girl was born with 3140 g and Apgar 10. After follow-up of 15 years, mother and daughter are completely healthy (Harris Hip Score = 100).
In case 2, the woman was 25 years old. After a motorcycle fall, patient arrived unconscious in the hospital. Her family reports pregnancy status. Radiological examination showed disjunction with pelvic symphysis ascension. Obstetric ultrasound diagnosed foetal death with +-16 weeks of gestation. After a week, with clinical and neurological release, surgery was performed with osteosynthesis with two perpendicular plates to fix the symphysis, and the sacral-iliac fixation was done with a plate and two screws. After two days, the patient was transferred to obstetrics, to voluntarily wait for the elimination of the foetus. The deliberate elimination did not occur, and then it was induced with oxytocin. Five days after curettage was performed. After 15 years of follow up, the patient presents Harris Hip Score of 100.
In case 3, patient was 16 years old, committed by run over accident. Victim was admitted to the Emergency Room conscious and hemodynamically stable. Patient had pain in the pelvic girdle and hip mobilization of the left leg. Radiological examination showed pelvic disjunction with fracture of the left acetabulum. Uterine ultrasound showed the foetus with gestational age +-21 weeks and normal heartbeat. After clinical compensation, patient was operated on the third day after the accident, with epidural block and ilium inguinal approach. The reduction and fixation of acetabular fracture was performed. The disjunction of the symphysis was performed with two orthogonal plates. Foetal monitoring was conducted throughout surgery. With 35 weeks of pregnancy, caesarean was performed, and a girl with 2160 g was born. After nine years of evolution Mother had HARRIS Hip Score of 98, and the child had normal development.
In case IV, the patient was 35 years old. The run over victim was admitted to the hospital unconscious. After radiological examination, it was found the presence of intrapelvic foetus with disjunction of the symphysis, and left the acetabular fracture. Uterine ultrasound diagnosed a viable foetus with 35 or 36 weeks of pregnancy. Two days later, in the same surgery, a caesarean was performed and the baby was born. The fixation of the symphysis fracture and disjunction were fixed with long shaped plate. The foetus was male and weighed 3090 g and received Apgar 9. After follow up of four years, the child was normal and the mother had HARRIS Hip Score 98.