Orthopedic trauma injuries take higher toll on pregnant women and their infants

Researchers calculated 30% rates of perinatal death and placental abruption with pelvic fractures.

LAS VEGAS — Infants born to women who sustained trauma-based orthopedic injuries when they were pregnant were about five times more likely to be admitted to the neonatal intensive care unit and be on a ventilator than those born to pregnant trauma patients without such injuries.

Pregnant trauma patients with orthopedic injuries required nearly a week-long hospital stay and more surgical procedures than those who did not sustain those injuries, according to a retrospective study that Lisa K. Cannada, MD, and colleagues conducted looking at this rarely studied area.

Investigators linked together and reviewed the obstetric and trauma databases at Parkland Hospital in Dallas for their research.

Lower extremity

The investigators studied two groups of pregnant women consisting of 990 trauma patients without and 65 trauma patients with orthopedic injuries who were treated at the hospital between 1995 and 2007.

Investigators found surgery for orthopedic trauma did not put pregnant women at greater risk of early delivery. This woman needed multiple surgeries for one injury because she had her left hand out the window during a car accident, Cannada said. Image: Cannada LK

Both groups’ average age was 24 years. More than 80% of injuries were from motor vehicle accidents or falls. A single orthopedic injury, usually a lower extremity fracture, constituted the reason most patients needed emergency care.

“Twenty-five percent of women with orthopedic injuries presented at less than 23 weeks gestational age,” Cannada, who is a member of the Orthopedics Today Editorial Board, said. The difference between the 28-week gestational age for the orthopedic injury group and the 31-week gestational age for the pregnant trauma patients without orthopedic injuries was significant, she noted.

Multiple orthopedic injuries

Of 14 women who had multiple orthopedic injuries, thirteen delivered while in the hospital. Two had placental abruptions.

“More important: [of] those with orthopedic injuries, more than one-third delivered during their trauma admission,” Cannada said.

Average injury severity scores (ISS) were 7 (range, 1-33) and 1 in the orthopedic trauma and other group, respectively.

Pelvic fractures related to poor outcomes, she said. The 10 women with pelvic fractures had a 30% abruption rate and 30% fetal death rate.

This analysis showed the incidence of pregnant women who experience orthopedic trauma is rare, occurring 3.5 times per 10,000 deliveries at Parkland Hospital. Compared to other groups of pregnant women, these rates of adverse outcomes were high, Cannada said. “Trauma significant enough to fracture bones distinguishes a subgroup of patients at high risk for a poor pregnancy outcome.”

Researchers theorized the increased stress that trauma puts on the mother’s system may account for most pre-term deliveries, as well as the placental abruptions leading to them.

Cannada recommended referring these patients so they receive the coordinated care they need.

For more information:

• Lisa K. Cannada, MD, can be reached at St. Louis University School of Medicine, Department of Orthopedics, Desloge Towers, 3635 Vista Ave., 7th Floor, St. Louis, MO 63110; 314-577-8850; e-mail: lcannada@slu.edu. She has no direct financial interest in any products or companies mentioned in this article.

Reference:

• Cannada LK, Pan P, Hawkins JS, et al. Outcomes in pregnant trauma patients with orthopedic injuries. #170. Presented at the American Academy of Orthopaedic Surgeons 76th Annual Meeting. Feb. 25-28, 2009. Las Vegas.