Evaluation and Resuscitation of the Pregnant Orthopaedic Trauma Patient: Considerations for Maternal and Fetal Outcomes.

Abstract

» Orthopaedic injuries warranting trauma activation in pregnant patients are associated with increased risks of preterm birth, placental abruption, and infant and maternal death.» Physiological changes associated with pregnancy can mask the severity of orthopaedic injury sustained during trauma. Providers must perform all appropriate imaging studies associated with the mechanism of injury and perform a careful clinical examination in order to avoid missing injuries.» Pregnancy is a hypercoagulable state, and adequate prophylaxis for blood clots includes low-dose heparin as well as mechanical prophylaxis. Additionally, patients who have sustained orthopaedic trauma must be assessed frequently for thrombophlebitis.» Fetal outcomes are dependent on maternal resuscitation. In addition to the normal steps of trauma resuscitation, additional measures (including Rhesus typing, obtaining a coagulation profile, placing the patient in the left lateral decubitus position, early use of supplemental oxygen to maintain SaO2 [oxygen saturation] at >95%, having a low threshold for intubation, and placing a nasogastric tube to prevent aspiration) should also be performed. Fetal assessment should be completed after appropriate maternal resuscitation.» Factors related to the definitive treatment of orthopaedic injuries, including the type of surgical fixation, use of advanced imaging, and methods of surgical anesthesia, should prioritize maternal outcome. Thorough work-up of maternal injuries and comprehensive maternal resuscitation lead to the greatest benefit in terms of fetal outcomes.