Influence of maternal fractures in the last trimester of pregnancy

O. Alexa, V. Gheorghiţă

Abstract: The management of the pregnant woman is difficult because the risk of complications is increased. Trauma is considered to be the main cause for non-pregnancy related maternal death. Fractures are one of the most common injuries that result after most forms of trauma. Our study analyses the relationship between the most common types of trauma and their outcome, the possible complications and the incidence of premature delivery. We studied 23 pregnant women with an average age of 24.3 years admitted to our department between 2003-2007 with one or more fractures caused by different types of trauma. Surgery was performed on 21 of the patients (91.30%); pre-operatory radiographies were necessary in order to ensure a good preoperative planning. We performed the follow-up for all our patients in order to monitor the possible complications of our treatment and the short-term side effect on the fetus. After surgery, the patients were transported to the Obstetrics department, where several tests were performed (local examination, cardiotocography, cardiac frequency of the fetus, ecography). Two of our patients presented a pathological echographical modification; one of them required emergency C-section (woman pregnant in 33 weeks). Medical treatment consisted in antispastic medication and betamethasone/dexamethasone. When comparing the occurrence of complications with the week of pregnancy, we noticed a higher rate of complications in the last 8 weeks before term. We noted that 13 of our patients (17.4%) had a premature delivery, a higher rate than in healthy pregnant women (12%). In our group, a high rate of complications and premature delivery occurred, with a possible connection with the existence of fractures and surgery stress. We found no relationship between the type of trauma and the occurrence of complications. Studying the effects of trauma and fractures on pregnancy and delivery is poorly represented in literature. Further studies are necessary in order to establish a definite relationship between fractures and premature delivery.
Keywords: maternal fractures, premature labor