Maternal and Fetal Perioperative Outcomes After Pelvic Ring or Acetabulum Fracture in Gravid Patients.

OBJECTIVES

To describe the injury characteristics, treatment methods, and maternal and fetal perioperative outcomes among pregnant patients with pelvic ring and acetabular fractures.

DESIGN

Multisite retrospective cohort study.

SETTING

Nine Level I trauma centers.

PATIENT SELECTION CRITERIA: Adult pregnant patients who presented with pelvic ring or acetabular fractures (AO/OTA 61A-C and/or 62A-C) were included. Patients with trace amounts of human chorionic gonadotropin due to recent miscarriages or deliveries were excluded.

OUTCOME MEASURES AND COMPARISONS: Demographics, concomitant injuries, treatment methods, and perioperative clinical outcomes for both mother and fetus were abstracted and described. Comparisons were made between patients who presented with intrauterine fetal demise (IUFD) and those who did not, as well as between patients treated operatively and nonoperatively.

RESULTS

Seventy-eight female patients were identified, with 68% having pelvic ring fractures, 22% acetabular fractures, and 10% combined fractures. Median age was 25.4 years (range 18-40 years). The median Injury Severity Score (ISS) was 22. Patients' gravid status was evenly distributed by viability (51.3% viable). One-third of the patients arrived with IUFD (n = 25/78), and those with IUFD had higher ISS (median ISS 30.5 in IUFD group, 16.9 in non-IUFD group). Of the remaining 53 patients, 64% were indicated for surgery, and 36% were treated nonoperatively. Maternal complications occurred in 8% of patients (n = 1/19, 5.3% nonoperative; n = 2/19, 10.5% operative). Among patients who did not arrive with IUFD or deliver their baby before orthopaedic management, fetal complications (premature delivery, miscarriage, and neonatal death) occurred in 28.9% (n = 11/38). Fetal complications were lower in the group treated operatively (n = 4/19, 21.1%) as compared with the nonoperative group (n = 7/19, 36.8%). Miscarriages specifically were similar between these groups (n = 3, 15.8% nonoperative; n = 2, 10.5% operative).

CONCLUSIONS

Fractures of the pelvic ring/acetabulum in pregnant patients frequently result in IUFD at presentation or during the hospital stay. Surgical management added minimal additional risk to the fetus. Miscarriage rates were similar among patients treated surgically and those managed nonoperatively.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.