Management of Pelvic Fractures and Hip Dislocation in Pregnancy: A Case Report and Review of Literature.

Abstract

Trauma is the leading non-obstetric cause of maternal mortality during pregnancy and pelvic fractures are challenging to manage in such cases due to the effect of trauma on the gravid uterus and altered maternal physiology. About 8-16% of pregnant females can have fatal outcome after trauma, with pelvic fractures contributing majorly to the same, and also can have severe fetomaternal complications. There are only two cases reported till date of hip dislocation in pregnancy, with very little literature available on its outcome. We, hereby, present a case of a 40-year-old pregnant female hit by a moving car with the right superior and inferior pubic rami fracture and left anterior hip dislocation. Closed reduction of the left hip was done under anesthesia and pubic rami fractures were managed conservatively. On follow-up after 3 months, the fracture was completely healed and the patient had a normal vaginal delivery. We have also reviewed management protocols for such cases. Aggressive maternal resuscitation is important for both maternal and fetal survival. Pelvic fractures should not be left unreduced in such cases to prevent mechanical dystocia and can have a good outcome with both closed and open reduction and fixation techniques. Pelvic fractures in pregnancy should be treated by careful maternal resuscitation and timely intervention. The majority of such patients can deliver vaginally if the fracture heals before delivery.