175.
A Review of Pregnant Trauma Patients received at Rigshospitalets
TraumeCenter from January 2000 - May 2012
Peter Horstmann, Henrik Grønborg
Department of Orthopaedic Surgery & Rigshospitalets TraumeCenter
Rigshospitalet, Copenhagen; Department of Orthopaedic Surgery &
Rigshospitalets TraumeCenter, Rigshospitalet, Copenhagen
Background:
Pregnancy can lead to deviation from ATLS guidelines, most
likely in attempt to reduce the fetal exposure to ionization radiation.
Abstaining from a trauma CT (T-CT) can result in missed diagnoses and
complications.
Purpose / Aim of Study:
We aimed to investigate type of injuries and
treatment routines in cases with pregnant trauma patients.
Materials and Methods:
Using a local database of trauma cases received at
Rigshospitalets TraumeCenter 1.1.00–1.5.12, all pregnant patients were
identified (n=48). Each case was reviewed with focus on injury and type of
radiographic study.
Findings / Results:
Age and stage of pregnancy was 30 years [16-40] and 22
weeks [4-40] respectively. ISS was 2 [0-27] with ”Extremities including
pelvis” being the most frequently damaged region (n=10). A rise in ISS was
noticed from 1.1.08. FAST was performed in 39 patients and 37 pt’s had X-ray
studies, incl. 23 cervical spine, 24 chest and 11 pelvis. Eleven pt’s had a T-CT,
9
a regional CT only and 28 had no CT at all. More T-CT’s were performed
after 1.1.08 (8/15) than 1.1.00-31.12.07 (3/33). Ten pt’s underwent acute
surgery with fracture fixation the most frequent. Amongst the 7 secondary
referred pt’s T-CT had been performed in 1/7 and a regional CT in 5/7. Six
pt’s had pelvic fractures (PF), 2/6 had later caesarean section (CS) w. living
foetus (1 acute, 1 elective), 2/6 had abortion (1 spontaneous, 1 assisted), 2/6
had CS within days of admission due to intrauterine death (ID) and 3/6
required ORIF. Two pt’s w/o PF (1 with blunt injuries, 1 with splenic lesion)
had acute CS. No initially missed injuries were later identified.
Conclusions:
Adherence to protocol standards was low. The increased use of
T-CT’s corresponds to a simultaneous rise in ISS. The presence of pelvic
fracture seems to be predictive of a high risk of obstetric complications such as
ID or need for CS.
