Department of Orthopaedics and Trauma, Ganga Medical Center & Hospital, Coimbatore, India.
Department of Orthopaedics and Trauma, Ganga Medical Center & Hospital, Coimbatore, India.
Injury. 2024 Nov;55(11):111854. doi: 10.1016/j.injury.2024.111854. Epub 2024 Sep 1.
Pregnancy and trauma are complex situations with significant implications for maternal and fetal health. Physical and psychological trauma during pregnancy can lead to pre-term labor, abruptio-placenta, and fetal injury or death. Management of trauma is challenging due to physiological and anatomical changes, which can affect fracture management and the risk of radiation exposure. A multidisciplinary approach is beneficial for patient care. This study aimed to determine the impact of orthopaedic trauma on pregnancy and its outcome, and influence of pregnancy on fracture management.
A retrospective-study was conducted at a Level-1 trauma-care-center, focusing on 54 pregnant women who sustained trauma between January 2015 and December 2022. The study included patients with closed or open fractures, but excluded those without fractures. Forty-two patients were available with minimum 1 year follow-up. Data was collected from hospital records and PACS, including demographic details, emergency care, and laboratory parameters. Changes made in protocol in fracture management due to pregnancy (primary definitive fixation vs staged management), and impact of trauma on pregnancy outcome; mode-of-delivery, maternal and fetal loss were evaluated.
The mean age was 30-years (range: 21-43years). Road-traffic-collision was most-common mode-of-injury (66.7 %). 38.1 % were in the first-trimester, 35.7 % in second, and 26.2 % in third-trimester. Eight patients had polytrauma, seven had multiple-injuries, and 27 had isolated-injuries. The maternal-mortality-rate was 0.45 %. Three polytraumatized patients ended up with intrauterine death, two polytrauma patients underwent elective abortion, one patient presented with spontaneous-abortion, and fetal loss was 14.3 % (6-of-42). Out of 42 patients, 10 had open-injuries and 32 had closed-injuries. Nine patients underwent LSCS(lower-segment-caesarean-section), six of them were planned for elective-LSCS due to injury and associated fractures (two patients with pelvic injuries, two neck femur fracture patients, one open distal femur fracture, and one ankle fracture dislocation).
Orthopaedic trauma during pregnancy can significantly affect pregnancy outcomes and is associated with a notably higher risk of fetal loss. An elective-caesarean-section is recommended for patients with polytrauma, pelvic-injuries, and those who are immobilized for longer-duration. During the third-trimester and in polytraumatized patients, external-fixator-application for lower-limb-injuries is a safe strategy, and definitive fixation could be performed post-delivery.
妊娠和创伤是复杂的情况，对母婴健康有重大影响。妊娠期间的身体和心理创伤可导致早产、胎盘早剥、胎儿损伤或死亡。由于生理和解剖结构的变化，创伤的管理具有挑战性，这可能会影响骨折的管理和辐射暴露的风险。多学科方法有益于患者的护理。本研究旨在确定骨科创伤对妊娠及其结局的影响，以及妊娠对骨折管理的影响。
在一家 1 级创伤治疗中心进行回顾性研究，重点关注 2015 年 1 月至 2022 年 12 月期间因创伤而就诊的 54 名孕妇。该研究包括闭合性或开放性骨折患者，但不包括无骨折患者。42 名患者具有至少 1 年的随访。从医院记录和 PACS 中收集数据，包括人口统计学细节、急救护理和实验室参数。评估因妊娠而改变的骨折管理方案（主要确定性固定与分期管理），以及创伤对妊娠结局的影响；分娩方式、母婴损失。
平均年龄为 30 岁（范围：21-43 岁）。道路交通碰撞是最常见的损伤模式（66.7%）。38.1%的患者处于妊娠早期，35.7%处于妊娠中期，26.2%处于妊娠晚期。8 名患者为多发伤，7 名患者有多发性损伤，27 名患者为单纯性损伤。孕产妇死亡率为 0.45%。3 名多发伤患者最终宫内死亡，2 名多发伤患者行选择性流产，1 名患者发生自然流产，胎儿丢失率为 14.3%（6/42）。在 42 名患者中，10 名患者为开放性损伤，32 名患者为闭合性损伤。9 名患者接受了 LSCS（下段剖宫产术），其中 6 名患者因损伤和相关骨折而计划行选择性 LSCS（2 名患者为骨盆损伤，2 名颈股骨骨折患者，1 名开放性股骨远端骨折患者，1 名踝关节骨折脱位患者）。
妊娠期间的骨科创伤会显著影响妊娠结局，并与胎儿丢失的风险显著增加相关。对于多发伤、骨盆损伤和需要长时间固定的患者，建议行剖宫产术。在妊娠晚期和多发伤患者中，下肢损伤应用外固定器是一种安全的策略，可在分娩后进行确定性固定。
