Occelli B, Depret-Mosser S, Renault B, Therby D, Codaccioni X, Monnier J C
Maternité Jeanne de Flandre, CHRU, Lille.
Contracept Fertil Sex. 1998 Dec;26(12):869-75.
The authors are dealing with a case of a pelvic fracture (right superior pubic ramus) after a road traffic accident to a patient who arise a pregnancy with twins at twenty five weeks pregnant. Seven per cent of a road traffic accident affect pregnancy with a maternal death rate from eight to sixteen per cent and a fetal death rate up to fifty seven per cent. Pelvic trauma are more deleterious during the pregnancy because of the gravide uterus, of the abdominal injuries binding more often, and of pregnancy secondary maternal physiology which lead to delay diagnosis and therapeutics. Blunt fetomaternal consequences are ruled by pelvic haematomas, uterine rupture, prematurity, acute fetal distress, fetal injuries and in utero death. At mid and long range arise the problem of child birth way and the risk of mechanical dystocy. Cesarean is store in case of vesical and urethral injuries, or perineal injury, several pelvic fractures or in case of the pelvic belt fracture moved and not reduced, bringing to a surgical unsymmetrical pelvis. In the other cases, the obstetrical prognoses will be done after a dialogue with all medical staff and a full synthesis of the file based on the fetopelvic comparisons (obstetrics previous, clinic, fetal biometry, pelvimetry X ray).
作者正在处理一名交通事故后骨盆骨折（右侧耻骨上支）的患者，该患者怀孕25周，怀有双胞胎。7%的交通事故会影响妊娠，孕产妇死亡率为8%至16%，胎儿死亡率高达57%。由于妊娠子宫、腹部损伤更常发生以及妊娠导致的母体生理变化会导致诊断和治疗延迟，骨盆创伤在孕期更具危害性。钝性胎儿-母体后果取决于骨盆血肿、子宫破裂、早产、急性胎儿窘迫、胎儿损伤和宫内死亡。中长期会出现分娩方式问题和机械性难产的风险。在膀胱和尿道损伤、会阴损伤、多处骨盆骨折或骨盆带骨折移位且未复位导致手术性不对称骨盆的情况下，应进行剖宫产。在其他情况下，将在与所有医务人员进行讨论并根据胎儿-骨盆比较（既往产科情况、临床情况、胎儿生物测量、X线骨盆测量）对病例进行全面综合分析后做出产科预后判断。
