Multi-disciplinary management of pelvic injury in pregnancy

Introduction: Polytrauma occurring during pregnancy presents unique challenges for clinicians, as it requires simultaneous care for two patients (mother and fetus). In addition to the physiological changes in the maternal condition, it is essential to meet the specific needs of the fetus and continuously assess its condition, necessitating a multidisciplinary approach. Case presentation: In this case, a young, 28-week pregnant woman with no known underlying diseases was severely injured (ISS 16) in a high-energy collision. Primary imaging studies confirmed a comminuted fracture with significant displacement of the right hip, avulsion fractures noted on the sacrum, and the sacroiliac joint was opened on the right side, with considerable hematoma visible in the pelvis, pre-sacrally. Abdominal ultrasound flowmetry confirmed the presence of a live fetus not in distress, and no retroplacental hematoma was observed. Before complex trauma care, the patient was admitted to the intensive care unit for perioperative management. The patient’s oxygen-carrying capacity was optimized through fluid resuscitation and transfusion. An epidural catheter was placed for opioid-sparing analgesia. Continuous extended maternal observation was conducted alongside daily fetal diagnostics. Following a cost-benefit assessment by obstetricians, neonatologists, trauma surgeons, and intensive care specialists, a temporary right lower limb extension was applied due to the pelvic ring injury. After a brief preparation, closed reduction and screw osteosynthesis were performed on the iliac bone and sacrum. The procedure was carried out in the presence of a perinatal care team prepared for immediate cesarean delivery. No signs of fetal distress were observed during the intervention. Postoperative observation happened without any complications. The patient was transferred to the local facility for complex rehabilitation. Subsequently, the woman gave birth to a healthy boy at term. Conclusion Our case described above is the first published report of the successful use of internal fixation of the pelvis with fetus in utero. Knowledge of the pillars of multidisciplinary care, establishing a unified approach, and protocolizing the care pathway are essential for better outcomes.