Current Trauma Reports

, Volume 4, Issue 3, pp 225–232 | Cite as

Pelvic Trauma and the Pregnant Patient: a Review of Physiology, Treatment Risks, and Options

  • Brad J. YooEmail author
Trauma in Pregnancy (K Davis, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Trauma in Pregnancy


Purpose of Review

Pelvic trauma during pregnancy is an infrequent, but complex clinical scenario requiring immediate multidisciplinary care. This manuscript details epidemiology and pathophysiology, evaluation and treatment, as well as unique elements to the clinical scenario like radiation and anesthesia risks to the pregnant mother and fetus.

Recent Findings

The priority of a multidisciplinary treatment team should be directed toward the mother, as prompt treatment gives both the fetus and mother the best possibility for a good outcome. Radiation risks during diagnostic and therapeutic treatments can be minimized with the appropriate measures. Most anesthesia agents are considered safe in clinical practice.


Orthopedic procedures must consider the morbidity of observation versus the risks of surgical intervention. Coordinated appropriate care will maximize the possibility of both the mother and fetus experiencing favorable results.


Pelvis fracture Fetal trauma Pregnancy Maternal pelvic trauma 


Compliance with Ethical Standards

Conflict of Interest

The author declares no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Peckham CH, King RW. A study of intercurrent conditions observed during pregnancy. Am J Obstet Gynecol. 1963;87:609–24.CrossRefPubMedGoogle Scholar
  2. 2.
    El-Kady D, Gilbert WM, Anderson J, Danielsen B, Towner D, Smith LH. Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population. Am J Obstet Gynecol. 2004;190(6):1661–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Cheng HT, Wang YC, Lo HC, Su LT, Lin CH, Sung FC, et al. Trauma during pregnancy: a population-based analysis of materal outcome. World J Surg. 2012;36(12):2767–75.CrossRefPubMedGoogle Scholar
  4. 4.
    Fildes J, Reed L, Jones N, Martin M, Barrett J. Trauma: the leading cause of maternal death. J Trauma. 1992;32(5):643–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Mendez-Figueroa H, Dahlke JD, Vrees RA, Rouse DJ. Trauma in pregnancy: an updated systematic review. Am J Obstet Gynecol. 2013;209(1):1–10.CrossRefPubMedGoogle Scholar
  6. 6.
    Leggon RE, Wood GC, Indeck MC. Pelvic fractures in pregnancy: factors influencing maternal and fetal outcomes. J Trauma. 2002;53(4):796–804.CrossRefPubMedGoogle Scholar
  7. 7.
    Timberlake GA, McSwain NE Jr. Trauma in pregnancy. A 10-year perspective. Am Surg. 1989;55(3):151–3.PubMedGoogle Scholar
  8. 8.
    Esposito TJ, Gens DR, Smith LG, Scorpio R, Buchman T. Trauma during pregnancy. A review of 79 cases. Arch surg. 1991;126(9):1073–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Chames MC, Pearlman MD. Trauma during pregnancy: outcomes and clinical management. Clin Obstet Gynecol. 2008;51(2):398–408.CrossRefPubMedGoogle Scholar
  10. 10.
    Pape HC, Pohlemann T, Gansslen A, Simon R, Koch C, Tscherne H. Pelvic fractures in pregnant multiple trauma patients. J Orthop Trauma. 2000;14(4):238–44.CrossRefPubMedGoogle Scholar
  11. 11.
    Almog G, Liebergall MN, Tsafrir A, Barzilay Y, Mosheiff R. Management of pelvic fractures during pregnancy. Am J Orthop. 2007;36(11):E153–9.PubMedGoogle Scholar
  12. 12.
    Flik K, Kloen P, Toro JB, Urmey W, Nijhuis JG, Helfet DL. Orthopaedic trauma in the pregnant patient. J Am Acad Orthop Surg. 2006;14(3):175–82.CrossRefPubMedGoogle Scholar
  13. 13.
    Ali J, Yeo A, Gana TJ, McLellan BA. Predictors of fetal mortality in pregnant trauma patients. J Trauma. 1997;42(5):782–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Mattox KL, Goetzl L. Trauma in pregnancy. Crit Care Med. 2005;33(10 Suppl):S385–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Kissinger DP, Rozycki GS, Morris JAJR, Knudson MM, Copes WS, Bass SM, et al. Trauma in pregnancy. Predicting pregnancy outcome. Arch Surg. 1991;126(9):1079–86.CrossRefPubMedGoogle Scholar
  16. 16.
    Pearlman MD, Tintinalli JE, Lorenz RP. A prospective controlled study of outcome after trauma during pregnancy. Am J Obstet Gynecol. 1990;162:1502–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Prokop A, Swol-Ben J, Helling HJ, Neugaus W, Rehm KE. Trauma in the last trimester of pregnancy. Unfallchirurg. 1996;99:450–3.PubMedGoogle Scholar
  18. 18.
    • Jain V, Chari R, Maslovitz S, Farine D. Guidelines for the management of a pregnant trauma patient. J Obstet Gynaecol Can. 2015;37(6):553–74. Discusses physiology and guidelines for the pregnant patient. CrossRefPubMedGoogle Scholar
  19. 19.
    El- Kady D, Gilbert WM, Xing G, Smith LH. Association of maternal fractures with adverse perinatal outcomes. Am J Obstet Gynecol. 2006;195(3):711–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Crosby WM, Snyder RG, Snow CC, Hanson PG. Impact injuries in pregnancy. Am J Obstet Gynecol. 1968;101(1):100–10.CrossRefPubMedGoogle Scholar
  21. 21.
    Pearlman MD, Tintinalli JE, Lorenz RP. Blunt trauma during pregnancy. N Engl J Med. 1990;323(23):1609–13.CrossRefPubMedGoogle Scholar
  22. 22.
    Baethmann M, Kahn T, Lenard HG, Voit T. Fetal CNS damage after exposure to maternal trauma during pregnancy. Acta Paediatr. 1996 Nov;85(11):1331–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Hayes B, Ryan S, Stephenson JB, King MD. Cerebral palsy after maternal trauma in pregnancy. Dev Med Child Neurol. 2007;49(9):700–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Gilles MT, Blair E, Watson L. Trauma in pregnancy and cerebral palsy: is there a link? Mefd J Aust. 1996;164(8):500–1.Google Scholar
  25. 25.
    • Pettrone P, Marini CP. Trauma in pregnant patients. Curr Probl Surg. 2015;52(8):330–51. Details physiologic changes occurring in pregnant patients and how resuscitation is influenced by these maternal physiologic changes. Discusses how gestational age influences treatment decisions related to both maternal and fetal care. CrossRefGoogle Scholar
  26. 26.
    Lucia A, Dantoni SE. Trauma management of the pregnant patient. Crit Care Clin. 2016;32(1):109–17.CrossRefPubMedGoogle Scholar
  27. 27.
    Porter SE, Russell GV, Qin Z, Graves ML. Operative fixation of acetabular fractures in the pregnant patient. J Orthop Trauma. 2008 Sep;22(8):508–16.CrossRefPubMedGoogle Scholar
  28. 28.
    • Matthews LJ, McConda DB, Lalli TA, Daffner SD. Orthostetrics: management of orthopaedic conditions in the pregnant patient. Orthopaedics. 2015;38(10):e874–80. Discusses appropriate antibiotic treatment in the pregnant patient with orthopedic trauma. CrossRefGoogle Scholar
  29. 29.
    Kovacs CS, Ralston SH. Presentation and management of osteoporosis presenting in association with pregnancy or lactation. Orthoporos Int. 2015;26(9):2223–41.Google Scholar
  30. 30.
    Radvinsky DS, Yoon RS, Schmitt PJ, Prestigiacomo CJ, Swan KG, Liporace FA. Evolution and development of the Advanced Trauma Life Support (ATLS) protocol: a historical perspective. Orthopedics. 2012;35(4):305–11.CrossRefPubMedGoogle Scholar
  31. 31.
    Shah AJ, Kilcline BA. Trauma in pregnancy. Emerg Med Clin North Am. 2003;21:615–29.CrossRefPubMedGoogle Scholar
  32. 32.
    Muench MV. Kleihauer-Betke testing is important in all cases of maternal trauma. J Trauma. 2004;57:1094–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Osborn PM, Smith WR, Moore EE, Cothren CC, Morgan SJ, Williams AR, et al. Direct retroperitoneal pelvic packing versus pelvic angiography.: a comparison of two management protocols for haemodynamically unstable pelvic fractures. Injury. 2009;40(1):54–60.CrossRefPubMedGoogle Scholar
  34. 34.
    Katz V. Perimortem cesarean delivery: its role in maternal mortality. Semin Perinatol. 2012;36:68–72.CrossRefPubMedGoogle Scholar
  35. 35.
    Katz VL, Dotters DJ, Droegemjeller W. Perimortem cesarian delivery. Obstet Gynecol. 1986;68:571–6.PubMedGoogle Scholar
  36. 36.
    Oxford CM, Ludmir J. Trauma in pregnanacy. Clin Obstet Gynecol. 2009;52(4):611–29.CrossRefPubMedGoogle Scholar
  37. 37.
    Matzon JL, Lutsky KF, Ricci EK, Beredjiklian PK. Considerations in the radiologic evaluation of the pregnant orthopaedic patient. J Am Acad Orthop Surg. 2015;23(8):485–91.CrossRefPubMedGoogle Scholar
  38. 38.
    Trichopolous D, Zavitsanos X, Koutis C. The victims of Chenobyl in Greece: induced abortions after the accident. Br Med J. 1987;295:1100.CrossRefGoogle Scholar
  39. 39.
    Cohen-Kerem R, Nulman I, Abramow-Newerly M, Medina D, Maze R, Brent RL, et al. Diagnostic radiation in pregnancy: perception versus true risks. J Obstet Gynaecol Can. 2006;28(1):43–8.CrossRefPubMedGoogle Scholar
  40. 40.
    Bentur Y, Horlatsch N, Koren G. Exposure to ionizing radiation during pregnancy: perception of teratogenic risk and outcome. Teratology. 1991;42:109–12.CrossRefGoogle Scholar
  41. 41.
    Toppenberg KS, Hill SA, Miller DP. Safety of radiographic imaging during pregnancy. Am Fam Physician. 1999;59:1813–8.PubMedGoogle Scholar
  42. 42.
    Timins JK. Radiation during pregnancy. N J Med. 2001;98(6):29–33.PubMedGoogle Scholar
  43. 43.
    Otake M and Schull WJ. Br J Radiol 1984 57:677, 409–414.Google Scholar
  44. 44.
    ACOG Committee on Obstetric Practice. ACOG Committee Opinion Number 299, Sept 2004 Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 2004;104–647-51.Google Scholar
  45. 45.
    Yamazaki JN, Schull WJ. Perinatal loss and neurological abnormalities among children of the atomic bomb. JAMA. 1990;264:605–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Brateman L. Radiation safety considerations for diagnostic radiology personnel. Radiographics. 1999;19(4):1037–55.CrossRefPubMedGoogle Scholar
  47. 47.
    Steinberg ES, Santos AC. Surgical anesthesia during pregnancy. Int Anesthesiol Clin. 2009;28:58–66.CrossRefGoogle Scholar
  48. 48.
    Van De Velde M, BuckF D. Anesthesia for non-obstetric surgery in the pregnant patient. Minerva Anestesiol. 2007;73:235–70.Google Scholar
  49. 49.
    Goldenberg RL, Nelson KG, Davis RO, Koski J. Delay in delivery: influence of gestational age and the duration of delay pn perinatal outcome. Obstet Gynecol. 1984;64(4):480–4.PubMedGoogle Scholar
  50. 50.
    Bhandari M, Matta JM, Ferguson T, Matthys G. Predictors of clinical and radiological outcome in patients with fractures of the acetabulum and concomitant posterior dislocation of the hip. J Bone Joint Sug Br. 2006;88(12):1618–24.CrossRefGoogle Scholar
  51. 51.
    Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively with three weeks after the injury. J Bone Joint Surg Am. 1996;78(11):1632–45.CrossRefPubMedGoogle Scholar
  52. 52.
    • Bates SM, Greet IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO. Antithrombotic therapy and prevention of thrombosis. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e691S–736S. Presents risks of thromboembolic disease in the pregnant female. Details evidence-based clinical guidelines for thromboembolic disease prophylaxis in the pregnant female. CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Greer IA. Thrombosis in pregnancy: updates in diagnosis and management. Hematology Am Soc Hematol Educ Program. 2012;2012:203–7.PubMedGoogle Scholar
  54. 54.
    • Bapat P, Pinto LS, Lubetsky A, Aleksa K, Berge H, Koren G, et al. Examining the transplacental passage of apixaban using the dually perfused human placenta. J Thromb Haemost. 2016;14(7):1436–41. Apixaban has been demonstrated in human placental models travel across the blood brain barrier. CrossRefPubMedGoogle Scholar
  55. 55.
    Walfisch A, Koren G. The “warfarin window” in pregnancy: the importance of half-life. J Obstet Gynaecol Can. 2010 Oct;32(10):988–9.CrossRefPubMedGoogle Scholar
  56. 56.
    • Amorosa LF, Amorosa JH, Wellman DS, Lorich DG, Helfet DL. Management of pelvic injuries in pregnancy. Orthop Clin North Am. 2013;44(3):301–15. Comprehensive review of pelvic fracture management in the pregnant patient. Discusses treatment algorithms and epidemiology. CrossRefPubMedGoogle Scholar
  57. 57.
    Copeland CE, Bosse MJ, McCarthy ML, MacKenzie EJ, Guzinski GM, Hash CS, et al. Effect of trauma and pelvic fracture on female genitourinary, sexual, and reproductive function. J Orthop Trauma. 1997;11(2):73–81.CrossRefPubMedGoogle Scholar
  58. 58.
    Busam ML, Esther RJ, Obremsky WT. Hardware removal: indications and expecations. J Am Acad Orthop Surg. 2006;14:113–20.CrossRefPubMedGoogle Scholar
  59. 59.
    • Vallier HA, Cureton BA, Schubeck D. Pregnancy outcomes after pelvic ring injury. J Orthop Trauma. 2012;26(5):302–7. Discusses delivery outcomes following pelvic fracture. States there are no obstetric management parameters available following pelvic fracture. CrossRefPubMedGoogle Scholar
  60. 60.
    Cannada LK, Barr J. Pelvic fractures in women of childbearing age. Clin Orthop Rel Res. 2010;468:1781–9.CrossRefGoogle Scholar
  61. 61.
    McCarthy ML, MacKenzie EJ, Bosse MJ, Copeland CE, Hash CS, Burgess AR. Functional status following orthopedic trauma in young women. J Trauma. 1995;39(3):828–36.CrossRefPubMedGoogle Scholar
  62. 62.
    McLaren AC, Rorabeck CH, Halpenny J. Long-term pain and disability in relation to residual deformity after displaced pelvic ring fractures. Can J Surg. 1990;33:492–4.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Trauma & Fracture CareYale School of MedicineNew HavenUSA

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