Skip to main content
SpringerLink
Log in

Gyn. Injuries/Pregnant Patient in Polytrauma

  • Chapter
  • First Online:
Textbook of Polytrauma Management

  • 1543 Accesses

Abstract

Trauma in pregnancy is an uncommon but challenging problem. There are two patients involved, the mother and the fetus. The best management for the fetus is appropriate management of the mother. The alterations of the maternal anatomy and physiology must be considered. Signs of fetal distress may be the initial indication of maternal blood loss and compromise. Life-saving interventions and investigations should be carried out without compromise but detailed knowledge on radiological background, e.g., the cumulative dose received by the patient, is essential for on-going management decisions. There is little exposure of the fetus in limb radiographs.

Fractures should be treated much in the same way as in the non-pregnant patient. Use of minimally invasive techniques of fracture reduction and fixation or other techniques dependent on intraoperative imaging is not advocated in the pregnant patient. A multidisciplinary management of pregnant trauma patients requires the early involvement of at least the trauma surgeon, obstetrician, and radiologist.

Special knowledge of female organs and their treatment is mandatory.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Fildes J, et al. Trauma: the leading cause of maternal death. J Trauma. 1992;32:643–5.

    Article  CAS  PubMed  Google Scholar 

  2. El-Kady D, et al. Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population. Am J Obst Gynec. 2004;190:1661–8.

    Article  Google Scholar 

  3. Esposito T. Trauma during pregnancy. Emerg Med Clin N Am. 1994;12:167–99.

    Article  CAS  Google Scholar 

  4. Rosenfeld J. Abdominal trauma in pregnancy. When is fetal monitoring necessary? Postgrad Med. 1990;88:89–91.

    Article  CAS  PubMed  Google Scholar 

  5. Vaizey C, Jacobson M, Cross F. Trauma in pregnancy. Br J Surg. 1994;81:1406–15.

    Article  CAS  PubMed  Google Scholar 

  6. Lavin J, Polsky S. Abdominal trauma during pregnancy. Clin Perinatol. 1983;10:423–38.

    Article  PubMed  Google Scholar 

  7. Connolly A, et al. Trauma and pregnancy. Am J Perinatol. 1997;14:331–6.

    Article  CAS  PubMed  Google Scholar 

  8. Shah A, Kilcline B. Trauma in pregnancy. Emerg Med Clin N Am. 2003;21:615–29.

    Article  Google Scholar 

  9. Shah K, et al. Trauma in pregnancy: maternal and fetal outcomes. J Trauma. 1998;45:83–6.

    Article  CAS  PubMed  Google Scholar 

  10. Chang J, et al. Homicide: a leading cause of injury deaths among pregnant and postpartum women in the United States, 1991–1999. Am J Public Health. 2005;95:471–7.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Theodorou D, et al. Fetal death after trauma in pregnancy. Am Surg. 2000;66:809–12.

    CAS  PubMed  Google Scholar 

  12. Hill C. Trauma in the obstetrical patient. Women's Health (Lond Engl). 2009;5:269–83.

    Article  Google Scholar 

  13. Ikossi D, et al. Profile of mothers at risk: an analysis of injury and pregnancy loss in 1,195 trauma patients. J Am Coll Surg. 2005;200:49–56.

    Article  PubMed  Google Scholar 

  14. Aynaci O, et al. Bilateral non-traumatic acetabular and femoral neck fractures due to pregnancy-associated osteoporosis. Arch Orthop Trauma Surg. 2008;128:313–6.

    Article  PubMed  Google Scholar 

  15. Willis-Owen C, et al. Bilateral femoral neck fractures due to transient osteoporosis of pregnancy: a case report. Cases J. 2008;1:120.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ali J, et al. Predictors of fetal mortality in pregnant trauma patients. J Trauma. 1997;42:782–5.

    Article  CAS  PubMed  Google Scholar 

  17. Goodwin T, Breen M. Pregnancy outcome and fetomaternal hemorrhage after noncatastrophic trauma. Am J Obst Gynec. 1998;162:665–71.

    Article  Google Scholar 

  18. Pearlman M, Tintinalli J, Lorenz R. A prospective controlled study of outcome after trauma during pregnancy. Am J Obst Gynec. 1990;162:1502–9.

    Article  CAS  Google Scholar 

  19. ATLS. Advanced trauma life support program for doctors. 10th ed. Chicago: American College of Surgeons; 2018.

    Google Scholar 

  20. Leshikar D, Salcedo E, Cocanour C. Chapter 37: Trauma in pregnancy. In: Moore, et al., editors. Trauma. McGraw Hill Education; 2017.

    Google Scholar 

  21. Greiss FJ. Uterine vascular response to hemorrhage during pregnancy, with observations on therapy. Obstet Gynecol. 1966;27:549–54.

    Article  PubMed  Google Scholar 

  22. Jouppila R, Jouppila P, Hollmen A. Laryngeal oedema as an obstetric anaesthesia complication: case reports. Acta Anaesthesiol Scand. 1980;24:97–8.

    Article  CAS  PubMed  Google Scholar 

  23. Kuczkowski K, Reisner L, Benumof J. Airway problems and new solutions for the obstetric patient. J Clin Anesth. 2003;15:552–63.

    Article  PubMed  Google Scholar 

  24. Muench M, Canterino J. Trauma in pregnancy. Obstet Gynecol Clin N Am. 2007;34:555–83.

    Article  Google Scholar 

  25. Vanner R. Mechanisms of regurgitation and its prevention with cricoid pressure. Int J Obstet Anesth. 1993;2:207–15.

    Article  CAS  PubMed  Google Scholar 

  26. Flik K, et al. Orthopaedic trauma in the pregnant patient. J Am Aad Orthop Surg. 2006;14:175–82.

    Article  Google Scholar 

  27. Tsuei B. Assessment of the pregnant trauma patient. Injury. 2006;37:367–73.

    Article  PubMed  Google Scholar 

  28. Jain V, et al. Guidelines for the management of a pregnant trauma patient. Obstet Gynaecol Can. 2015;37(6):553–74.

    Article  Google Scholar 

  29. Brown H. Traum in pregnancy. Obstet Gynecol. 2009;114:147–60.

    Article  PubMed  Google Scholar 

  30. Pape HC, et al. Pelvic fractures in pregnant multiple trauma patients. J Orthop Trauma. 2000;14(4):238–44.

    Article  CAS  PubMed  Google Scholar 

  31. Petrone P, Asensio J. Trauma in pregnancy: assessment and treatment. Scand J Surg. 2006;95:4–10.

    Article  CAS  PubMed  Google Scholar 

  32. Hirsh H. Routine pregnancy testing: is it a standard of care? South Med J. 1980;73:1365–6.

    Article  CAS  PubMed  Google Scholar 

  33. Sperry J, et al. Long-term fetal outcomes in pregnant trauma patients. Am J Surg. 2006;192:715–21.

    Article  PubMed  Google Scholar 

  34. Chames M, Pearlman M. Trauma during pregnancy: outcomes and clinical management. Clin Obstet Gynecol. 2008;51:398–408.

    Article  PubMed  Google Scholar 

  35. Kissinger D, et al. Trauma in pregnancy. Predicting pregnancy outcome. Arch Surg. 1991;126:1079–86.

    Article  CAS  PubMed  Google Scholar 

  36. Katz V, Dotters D, Droegemueller W. Perimortem cesarean delivery. Obstet Gynecol. 1986;68:571–6.

    CAS  PubMed  Google Scholar 

  37. Suresh M, Latoya Mason C, Munnur U. Cardiopulmonary resuscitation and the parturient. Best Pract Res Clin Obstet Gynaecol. 2010;24:383–400.

    Article  PubMed  Google Scholar 

  38. Lowe S. Diagnostic radiography in pregnancy: risks and reality. Aust N Z J Obstet Gynaecol. 2004;44:191–6.

    Article  PubMed  Google Scholar 

  39. Mattox K, Goetzl L. Trauma in pregnancy. Crit Care Med. 2005;33(Suppl. 10):S385–9.

    Article  PubMed  Google Scholar 

  40. Patel S, et al. Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. Radiographics. 2007;27:1705–22.

    Article  PubMed  Google Scholar 

  41. Michels G, Jaspers N, editors. Notfallsonographie. Berlin, Heidelberg: Springer-Verlag; 2014.

    Google Scholar 

  42. Sardanelli F, et al. Evidence-based radiology: why and how? Eur Radiol. 2010;20:1–15.

    Article  PubMed  Google Scholar 

  43. National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2. 2006.

    Google Scholar 

  44. Shannoun F, et al. Radiation protection in diagnostic radiology. Dtsch Arztebl Int. 2008;105:41–6.

    PubMed  PubMed Central  Google Scholar 

  45. Wikipedia, Strahlungswichtungsfaktor. http://de.wikipedia.org/wiki/Strahlenwichtungsfaktor. 2010.

  46. Wikipedia, Effektive Dosis. http://de.wikipedia.org/wiki/Effektive_Dosis. 2010.

  47. Dierker J, Eschner W, Gosch D. Pränatale Strahlenexposition aus medizinischer Indikation. Deutsche Gesellschaft für Medizinische Physik. 2002;

    Google Scholar 

  48. Wikipedia, Strahlenbelastung. http://de.wikipedia.org/wiki/Strahlenbelastung. 2010.

  49. Raptis C, et al. Imaging of trauma in the pregnant patient. Radiographics. 2014;34:748–63.

    Article  PubMed  Google Scholar 

  50. ACR-SPR, American College of Radiology and the Society for Pediatric Radiology. ACR-SPR practice guideline for imaging pregnant or potentially pregnant adolescents and women with ionizing radiation. http://www.acr.org/~/media/9e2ed55531fc4b4fa53ef3b6d3b25df8.pdf. 2013.

  51. ACOG, American College of Obstetrics and Gynecology Committee on Obstetric Practice. ACOG committee opinion: guidelines for diagnostic imaging during pregnancy. Obstet Gynecol. 2004;104:647–51.

    Article  Google Scholar 

  52. NCRPM, National Council on Radiation Protection and Measurements. Medical radiation exposure of pregnant and potentially pregnant women. Report no. 54. Bethesda, MD; 1977.

    Google Scholar 

  53. Zha N, Patlas M, Katz D. Chapter 01: Emergency imaging of the pregnant patient: general principles. In: Emergency imaging of pregnant patients. Cham: Springer Nature Switzerland AG. p. 1–9.

    Google Scholar 

  54. Ma O, et al. Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma. 1995;38:879–85.

    Article  CAS  PubMed  Google Scholar 

  55. Brenner D, et al. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176:189–96.

    Article  Google Scholar 

  56. Radiology, E.E.S.o.U., Guidelines of the European Society of Urogenital Radiology. 2010.

    Google Scholar 

  57. Brodsky J, et al. Surgery during pregnancy and fetal outcome. Am J Obst Gynec. 1980;138:1165–7.

    Article  CAS  Google Scholar 

  58. Steinberg E, Santos A. Surgical anesthesia during pregnancy. Int Anesthesiol Clin. 1990;28:58–66.

    Article  CAS  PubMed  Google Scholar 

  59. Meroz Y, Elchalal U, Ginosar Y. Initial trauma management in advanced pregnancy. Anesthesiol Clin. 2007;25:117–29.

    Article  PubMed  Google Scholar 

  60. Cook P. The influence on foetal outcome of maternal carbon dioxide tension at caesarean section under general anaesthesia. Anaesth Intensive Care. 1984;12:296–302.

    Article  CAS  PubMed  Google Scholar 

  61. Schueler B, et al. An investigation of operator exposure in interventional radiology. Radiographics. 2006;26:1533–41.

    Article  PubMed  Google Scholar 

  62. Timberlake G, McSwain MN Jr. Trauma in pregnancy. A 10-year perspective. Am Surg. 1989;55:151–3.

    CAS  PubMed  Google Scholar 

  63. James A, Tapson V, Goldhaber S. Thrombosis during pregnancy and the postpartum period. Am J Obst Gynec. 2005;193:216–9.

    Article  Google Scholar 

  64. Jacobsen A, Skjeldestad F, Sandset P. Ante- and postnatal risk factors of venous thrombosis: a hospital-based case-control study. J Thromb Haemost. 2008;6:905–12.

    Article  CAS  PubMed  Google Scholar 

  65. James A, et al. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obst Gynec. 2006;194:1311–5.

    Article  Google Scholar 

  66. Bain E, et al. Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period. Cochrane Database Syst Rev. 2014:CD001689. https://doi.org/10.1002/14651858.CD001689.pub3.

  67. Andersen A, Berthelsen J, Bergholt T. Venous thromboembolism in pregnancy: prophylaxis and treatment with low molecular weight heparin. Acta Obstet Gynecol Scand. 2010;89:15–21.

    Article  CAS  PubMed  Google Scholar 

  68. Weiss H, Songer T, Fabio A. Fetal deaths related to maternal injury. JAMA. 2001;286:1863–8.

    Article  CAS  PubMed  Google Scholar 

  69. Rogers F, et al. A multi-institutional study of factors associated with fetal death in injured pregnant patients. Arch Surg. 1999;134:1274–7.

    Article  CAS  PubMed  Google Scholar 

  70. Scorpio R, et al. Blunt trauma during pregnancy: factors affecting fetal outcome. J Trauma. 1992;32:213–6.

    Article  CAS  PubMed  Google Scholar 

  71. Malgaigne J. Double vertical fractures of the pelvis: the classic. Clin Orthop. 1980;151:8–11.

    Google Scholar 

  72. Mulla N. Fracture of the pelvis in pregnancy. Am J Obst Gynec. 1957;74:68–9.

    Article  Google Scholar 

  73. Schuman W. Fractured pelvis in obstetrics. Am J Obst Gynec. 1932;23:103–7.

    Article  Google Scholar 

  74. Chalks P, For C. Gross traumatic disruption of the pelvic ring in pregnancy. J Obstet Gynaec. 1969;76:77–80.

    Google Scholar 

  75. Pals S, Brown C, Friemood T. Open reduction and internal fixation of an acetabular fracture during pregnancy. J Orthop Trauma. 1992;6:379–81.

    Article  CAS  PubMed  Google Scholar 

  76. Dunlop D, McCahill J, Blakemore M. Internal fixation of an acetabular fracture during pregnancy. Injury. 1997;28:481–2.

    Article  CAS  PubMed  Google Scholar 

  77. Luschka H. Die Kreuzdarmbeinfuge und die Schambeinfuge des Menschen. Arch f Path Anatomie u Physiologie f Klin Medizin. 1854;7:299–316.

    Google Scholar 

  78. Young J. Pelvic Osteo-arthropathy of Pregnancy. Proc R Soc Med. 1939:121–7.

    Google Scholar 

  79. Young J. Relaxation of the Pelvic Joints in Pregnancy: Pelvic Arthropathy of Pregnancy. J Obst Gynec. 1940;47:493–524.

    Google Scholar 

  80. Roberts R. Discussion on the physiology and pathology of the pelvic joints in relation to child-bearing. Proc R Soc Med. 1934;27:1217–25.

    Google Scholar 

  81. Cherni Y, et al. Evaluation of ligament laxity during pregnancy. J Gynecol Obstet Hum Reprod. 2019;48:351–7.

    Article  PubMed  Google Scholar 

  82. Leggon R, Wood G, Indeck M. Pelvic fractures in pregnancy: factors influencing maternal and fetal outcomes. J Trauma. 2002;53:796–804.

    Article  PubMed  Google Scholar 

  83. Loegters T, et al. Treatment of unstable fractures of the pelvic ring in pregnancy. Arch Orthop Trauma Surg. 2005;125:204–8.

    Article  PubMed  Google Scholar 

  84. Almog G, et al. Management of pelvic fractures during pregnancy. Am J Orthop (Belle Mead NJ). 2007;36:E153–9.

    Google Scholar 

  85. Alvi F, Kumar A, Clayson A. Open reduction and internal fixation of an unstable pelvic ring injury during pregnancy. J Orthopaed Traumatol. 2007;8:192–4.

    Article  Google Scholar 

  86. Schwartsmann C, et al. Update on open reduction and internal fixation of unstable pelvic fractures during pregnancy: case reports. Rev Bras Ortop. 2017;53:118–24.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Zhang P, et al. Management of hemodynamically unstable pelvic fracture in pregnancy: a case report and review of literature. Chin J Traumatol. 2012;15:234–7.

    PubMed  Google Scholar 

  88. Stohlner V, et al. Definitive use of external fixation for pelvic ring injuries (open book/APC2) in pregnancy. BMJ Case Rep. 2015; https://doi.org/10.1136/bcr-2015-212690.

  89. Porter S, et al. Operative fixation of acetabular fractures in the pregnant patient. J Orthop Trauma. 2008;22:508–16.

    Article  PubMed  Google Scholar 

  90. Neumann C, et al. Operative Versorgung einer Acetabulumfraktur in der Schwangerschaft. Fallbericht und Literaturübersicht Unfallchirurg. 2003;106:419–23.

    Article  CAS  Google Scholar 

  91. Kloen P, Flik K, Helfet D. Operative treatment of acetabular fracture during pregnancy: a case report. Arch Orthop Trauma Surg. 2005;125:209–12.

    Article  PubMed  Google Scholar 

  92. Charnell A, et al. Combined caesarean section and open reduction internal fixation for the treatment of an acetabular fracture in late pregnancy. JRSM Open. 2018;9(2):2054270417732698. https://doi.org/10.1177/2054270417732698. eCollection 2018 Feb

    Article  PubMed  PubMed Central  Google Scholar 

  93. Speer D, Peltier L. Pelvic fractures and pregnancy. J Taruam. 1972;12:474–80.

    CAS  Google Scholar 

  94. Curet M, et al. Predictors of outcome in trauma during pregnancy: identification of patients who can be monitored for less than 6 hours. J Trauma. 2000;49:18–25.

    Article  CAS  PubMed  Google Scholar 

  95. Madsen L, Jensen J, Christensen S. Parturition and pelvic fracture. Follow-up of 34 obstetric patients with a history of pelvic fracture. Acta Obstet Gynecol Scand. 1983;62:617–20.

    Article  CAS  PubMed  Google Scholar 

  96. Voegelin A, McCall M. Some acquired bony abnormalities influencing the conduct of labor. Am J Obst Gynec. 1944;48:361–70.

    Article  Google Scholar 

  97. Zhou S. Fracture-dislocation of the adult female: clinical analysis of 105 cases. Thonghua Wai Ke Za Zhi. 1989;27:479–81.

    CAS  Google Scholar 

  98. Copeland C, et al. Effect of trauma and pelvic fracture on female genitourinary, sexual and reproductive function. J Orthop Trauma. 1997;11(2):73–81.

    Article  CAS  PubMed  Google Scholar 

  99. Cannada L, Barr J. Pelvic fractures in women of childbearing age. Clin Orthop Rel Res. 2010;468:1781–9.

    Article  Google Scholar 

  100. Vallier H, Cureton B, Schubeck D. Pregnancy outcomes after pelvic ring injury. J Orthop Trauma. 2012;26:302–7.

    Article  PubMed  Google Scholar 

  101. Sachs B, et al. The risks of lowering the cesarean-delivery rate. N Engl J Med. 1999;340:54–7.

    Article  CAS  PubMed  Google Scholar 

  102. Giannoudis P, Chalidis B, Roberts C. Internal Fixation of traumatic diastasis of pubic symphysis: is plate removal essential? Arch Orthop Trauma Surg. 2008;128:325–31.

    Article  PubMed  Google Scholar 

  103. Raman R, et al. Implant retention and removal after internal fixation of the symphysis pubis. Injury. 2005;36:827–31.

    Article  PubMed  Google Scholar 

  104. Riehl J. Caesarean section rates following pelvic fracture: a systematic review. Injury. 2014;45:1516–21.

    Article  PubMed  Google Scholar 

  105. Pohlemann T, Gänsslen A. Die operation der Symphysensprengung. Oper Orthop Traumatol. 1999;11:149–59.

    Article  CAS  PubMed  Google Scholar 

  106. Lybrand K, et al. Does removal of the symphyseal cartilage in symphyseal dislocations have any effect on final alignment and implant failure? J Orthop Trauma. 2015;29:470–4.

    Article  PubMed  Google Scholar 

  107. Pfeifer C, Gänsslen A. Chapter 40: Implant removal. In: Gänsslen A, Lindahl J, St G, Füchtmeier B, editors. Pelvic ring fractures. Heidelberg.; ISBN-13 : 978–3030547295: Springer-Verlag; 2020. https://doi.org/10.1007/978-3-030-54730-1_40.

    Chapter  Google Scholar 

  108. Heinrich SD, et al. Open pelvic fracture with vaginal laceration and diaphragmatic rupture in a child. J Orthop Trauma. 1988;2(3):257–61.

    Article  CAS  PubMed  Google Scholar 

  109. Ikpeme J, Morison C. Vaginal avulsion complicating pelvic fracture. Br J Surg. 1970;57(4):317–8.

    Article  CAS  PubMed  Google Scholar 

  110. Niemi TA, Norton LW. Vaginal injuries in patients with pelvic fractures. J Trauma. 1985;25(6):547–51.

    Article  CAS  PubMed  Google Scholar 

  111. Smith RJ. Avulsion of the nongravid uterus due to pelvic fracture. South Med J. 1989;82(1):70–3.

    Article  CAS  PubMed  Google Scholar 

  112. Pohlemann, T., et al. Chapter: Notfallbehandlung und Komplextrauma. In: Tscherne H, Pohlemann T (Hrsg.), Tscherne Unfallchirurgie: Becken Und Acetabulum; 1998. Berlin and Heidelberg: Springer-Verlag.

    Google Scholar 

  113. Lopez H, Focseneanu M, Merritt D. Genital injuries acute evaluation and management. Best Pract Res Clin Obstet Gynaecol. 2018;48:28–39.

    Article  PubMed  Google Scholar 

  114. DuHabek D, Kulan T. Nonobstetrics vulvovaginal injuries: mechanism and outcome. Arch Gynecol Obstet. 2007;275:93–7.

    Article  Google Scholar 

  115. Faringer P, et al. Selective fecal diversion in complex open pelvic fractures from blunt trauma. Arch Surg. 1994;129:958–64.

    Article  CAS  PubMed  Google Scholar 

  116. Fu G, et al. Modified classification and repair of perineal soft tissue injuries associated with open pelvic fractures. J Reconstr Microsurg. 2015;31:12–9.

    PubMed  Google Scholar 

  117. Bjurlin M, et al. Genitourinary injuries in pelvic fracture morbidity and mortality using the National Trauma Data Bank. J Trauma. 2009;67:1033–9.

    PubMed  Google Scholar 

  118. Fan S, et al. Female pediatric and adolescent genitalia trauma: a retrospective analysis of the National Trauma Data Bank; 2020. https://doi.org/10.1007/s00383-020-04736-7.

    Book  Google Scholar 

  119. Virgili A, et al. Serious hematoma of the vulva from a bicycle accident: a case report. J Reprod Med. 2000;45:662.

    CAS  PubMed  Google Scholar 

  120. Goldman H, Idom CJ, Dmochowski R. Traumatic injuries of the female external genitalia and their association with urological injuries. J Urol. 1988;159:956–9.

    Article  Google Scholar 

  121. Kunishima K, et al. Transarterial embolization of a nonpuerperal traumatic vulvar hematoma. Radiat Med. 2008;26:168.

    Article  PubMed  Google Scholar 

  122. Kanai M, Osada R, Maruyama K. Warning from Nagano: increase of vulvar hematoma and/or lacerated injury caused by snowboarding. J Trauma. 2001;50:328.

    Article  CAS  PubMed  Google Scholar 

  123. Ernest A, Knapp G. Severe traumatic vulva hematoma in teenage girl. In: Clinical case reports. John Wiley & Sons Ltd.; 2015.

    Google Scholar 

  124. Kaminsky A, Sperling H. Notfälle im Bereich des äußeren Genitale. Urologe A. 2016;55:444–53.

    Article  CAS  PubMed  Google Scholar 

  125. Summerton D, et al., European association of urology guidelines on urological trauma. http://uroweb.org/guideline/urological-trauma. assessed: 01.09.2020; 2015.

  126. Moore E, Jurkovich G, et al. Organ injury scaling VI: extrahepatic biliary, esophagus, stomach, vulva, vagina, uterus (nonpregnant), uterus (pregnant), fallopian tube, and ovary. J Trauma. 1995;39(6):1069–70.

    Article  CAS  PubMed  Google Scholar 

  127. Propst A, Thorp J. Traumatic vulvar hematomas: conservative versus surgical management. South Med J. 1998;91:144–6.

    Article  CAS  PubMed  Google Scholar 

  128. Benrubi G, et al. Vulvar and vaginal hematomas: a retrospective study of conservative versus operative management. South Med J. 1987;80:991–4.

    Article  CAS  PubMed  Google Scholar 

  129. Papoutsis D, Haefner H. Large vulvar haematoma of traumatic origin. J Clin Diagn Res. 2017;11:QJ01–2.

    PubMed  PubMed Central  Google Scholar 

  130. Hernández-Tiria M, Navarro-Devia A, Osorio-Ruiz A. Lesión vulvar y perineal secundaria a trauma pelviperineal complejo: presentación de un caso y revisión de la literatura. Rev Colomb Obstet Ginecol. 2015;66:297–305.

    Article  Google Scholar 

  131. Hudock J, Dupayne N, McGeary J. Traumatic vulvar hematomas; report of six cases and review of the literature. Am J Obst Gynec. 1955;70:1064–73.

    Article  CAS  Google Scholar 

  132. Pavelka T, et al. Urogenital trauma associated with pelvic ring fractures. Acta Chir Orthop Traumatol Cechoslov. 2010;77:18–23.

    CAS  Google Scholar 

  133. Vallier H, Cureton B, Schubeck D. Pelvic ring injury is associated with sexual dysfunction in women. J Orthop Trauma. 2012;26:308–13.

    Article  PubMed  Google Scholar 

  134. Delaney K, et al. Risk factors associated with bladder and urethral injuries in female children with pelvic fractures: an analysis of the National Trauma Data Bank. Trauma Data Bank J Trauma Acute Care Surg. 2016;80:472–6.

    Article  PubMed  Google Scholar 

  135. Husmann D. Editorial comment. J Urol. 1998;159:959.

    Article  Google Scholar 

  136. Patel D, et al. Female urethral injuries associated with pelvic fracture: a systematic review of the literature. BJU Int. 2017;120:766–73.

    Article  PubMed  Google Scholar 

  137. Fowler J, et al. Long-term vaginal sequelae secondary to pediatric pelvic fracture. J Pediatr Adolesc Gynecol. 2009;22:e15–9.

    Article  PubMed  Google Scholar 

  138. Li P, et al. Management and outcome of pelvic fracture associated with vaginal injuries: a retrospective study of 25 cases. BMC Musculoskelet Disord. 2019;20:466.

    Article  PubMed  PubMed Central  Google Scholar 

  139. Cannada L, et al. Open pelvic fracture with vaginal laceration and arterial injury in a pediatric patient. Am J Orthop (Belle Mead NJ). 2011;40:415–7.

    Google Scholar 

  140. Dauwe J, Gänsslen A. Chapter 17: Open pelvic fractures. In: Gänsslen A, Lindahl J, Grechenig S, Füchtmeier B, editors. Pelvic ring fractures. Heidelberg.; ISBN-13: 978–3030547295: Springer-Verlag; 2020. https://doi.org/10.1007/978-3-030-54730-1_40.

    Chapter  Google Scholar 

  141. Choi W. Management of colorectal trauma. J Korean Soc Coloproctol. 2011;27:166–73.

    Article  PubMed  PubMed Central  Google Scholar 

  142. Crispen P, et al. Immediate postoperative complications of combined penetrating rectal and bladder injuries. J Trauma. 2007;62:325–9.

    PubMed  Google Scholar 

  143. Herzig D. Care of the patient with anorectal trauma. Clin Colon Rectal Surg. 2012;25:210–3.

    Article  PubMed  PubMed Central  Google Scholar 

  144. Shlamovitz G, et al. Poor test characteristics for the digital rectal examination in trauma patients. Ann Emerg Med. 2007;50:25–33.

    Article  PubMed  Google Scholar 

  145. Ross G, et al. Rectal perforation in unstable pelvic fractures: the use of flexible sigmoidoscopy. Injury. 2001;32:67–8.

    Article  CAS  PubMed  Google Scholar 

  146. Aihara R, et al. Fracture locations influence the likelihood of rectal and lower urinary tract injuries in patients sustaining pelvic fractures. J Trauma. 2002;52:205–8.

    PubMed  Google Scholar 

  147. Moore E, Cogbill T, et al. Organ injury scaling II: pancreas, duodenum, small bowel, colon, and rectum. J Trauma. 1990;30(11):1427–9.

    Article  CAS  PubMed  Google Scholar 

  148. Johnson E, Steele S. Evidence-based management of colorectal trauma. J Gastrointest Surg. 2013;17:12–9.

    Article  Google Scholar 

  149. Wu K, et al. Trauma to the pelvis: injuries to the rectum and genitourinary organs. Curr Trauma Rep. 2015;1:8–15.

    Article  Google Scholar 

  150. Lunsjo K, Abu-Zidan F. Does colostomy prevent infection in open blunt pelvic fractures? A systematic review. J Trauma. 2006;60:1145–8.

    Article  PubMed  Google Scholar 

  151. Berne J, et al. The high morbidity of colostomy closure after trauma: further support for the primary repair of colon injuries. Surgery. 1998;123:157–64.

    Article  CAS  PubMed  Google Scholar 

  152. Petrone P, et al. Treatment of complex perineal trauma. a review of the literature. Cir Esp. 2016;94:313–22.

    Article  PubMed  Google Scholar 

  153. Hashish A. Perineal trauma in children: a standardized management approach. Ann Ped Surg. 2011;7:55–60.

    Article  Google Scholar 

  154. Kudsk K, Hanna M. Management of complex perineal injuries. World J Surg. 2003;27:895–900.

    Article  PubMed  Google Scholar 

  155. Harrison S, Nghiem H, Shy K. Uterine rupture with fetal death following blunt trauma. AJR Am J Roentgenol. 1995;165:1452.

    Article  CAS  PubMed  Google Scholar 

  156. Suchecki G, et al. Management of traumatic uterine rupture in blunt abdominal trauma: a case report and literature review. Cureus. 2020;12(6):e8396. https://doi.org/10.7759/cureus.8396.

    Article  PubMed  PubMed Central  Google Scholar 

  157. Malik H. Frequency, predisposing factors and fetomaternal outcome in uterine rupture. J Coll Phys Surg Pak. 2006;16:472–5.

    Google Scholar 

  158. Zia S, et al. Uterine rupture: changing trend obstetrics and lessons for obstetricians. J South Asian Feder Obstet Gynecol. 2012;4:155–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, Orthopedics and Hand Surgery, Hospital Wolfsburg, Wolfsburg, Germany

    Axel Gänsslen

  2. Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

    Annelie Weinberg

Authors
  1. Axel Gänsslen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annelie Weinberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Trauma Surgery, University Hospital ZĂĽrich, ZĂĽrich, Switzerland

    Hans-Christoph Pape

  2. Department of Orthopaedic Surgery & Sports Medicine, The University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Joseph Borrelli Jr.

  3. Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA

    Ernest E. Moore

  4. Klinik fĂĽr Traumatologie, University Hospital of ZĂĽrich, ZĂĽrich, Switzerland

    Roman Pfeifer

  5. Rocky Vista University, College of Osteopathic Medicine, Parker, CO, USA

    Philip F. Stahel

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gänsslen, A., Weinberg, A. (2022). Gyn. Injuries/Pregnant Patient in Polytrauma. In: Pape, HC., Borrelli Jr., J., Moore, E.E., Pfeifer, R., Stahel, P.F. (eds) Textbook of Polytrauma Management . Springer, Cham. https://doi.org/10.1007/978-3-030-95906-7_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-95906-7_23

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-95905-0

  • Online ISBN: 978-3-030-95906-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation