Unfallbedingte Notfälle bei Schwangerschaft – Fallbeispiel mit Beckenfraktur und Notsectio

Zusammenfassung

Die Versorgung von unfallbedingten Notfällen in der Schwangerschaft gehört selbst in überregionalen Traumazentren nicht zur täglichen Routine. Wir präsentieren den Fall einer 27 Jahre alten, nicht vorerkrankten Polytraumapatientin in der 30. Schwangerschaftswoche. Die führende Verletzung war eine Beckenfraktur mit spinopelviner Dissoziation und kreislaufrelevanter, intrapelviner Blutung. Durch ein konsequentes Polytraumamanagement, notfallmäßige Sectio, Ligatur der Corona mortis, Packing und operative Frakturstabilisierung des Beckens konnte das Leben der Mutter und des Kindes gerettet werden.

Abstract

Emergency trauma management is no daily routine, not even in supraregional trauma centers. We present the case of a 27-year-old, healthy polytrauma patient in the 30th week of pregnancy. The main injury was a pelvic fracture with spinopelvic dissociation and hemodynamically significant intrapelvic bleeding. Due to a consequent polytrauma management, emergency caesarean section, ligation of the corona mortis, packing and surgical fracture fixation the motherʼs and childrenʼs life could be saved.

Schlüsselwörter

Schwangerschaft - Polytrauma - Beckenfraktur - Strahlenschäden - Notsectio

Key words

pregnancy - polytrauma - pelvic fracture - radiation damage - emergency caesarean section

• Literatur

• 1 Muench MV, Canterino JC. Trauma in Pregnancy. Obstet Gynecol Clin North Am 2007; 34: 555-583
• 2 Mendez-Figueroa H, Dahlke JD, Vrees RA. et al. Trauma in pregnancy: an updated systematic review. Am J Obstet Gynecol 2013; 209: 1-10
• 3 Franz M, Kainer F, Husslein P. Die Geburtshilfe. 5. Aufl.. Heidelberg: Springer; 2015
• 4 Jain V, Chari R, Maslovitz S. et al. Guidelines for the Management of a Pregnant Trauma Patient. J Obstet Gynaecol Can 2015; 37: 553-571
• 5 Ninke T, Bayer A. Polytraumatisierte Schwangere im Schockraum: Spezielle (patho-)physiologische und therapeutische Aspekte. Unfallchirurg 2020; 123: 936-943
• 6 Hasbargen U. Schwer verletzte Schwangere aus Sicht der Geburtshilfe. Unfallchirurg 2020; 123: 922-927
• 7 Galvagno SM, Nahmias JT, Young DA. Advanced Trauma Life Support^® Update 2019: Management and Applications for Adults and Special Populations. Anesthesiol Clin 2019; 37: 13-32
• 8 Goodwin H, Holmes JF, Wisner DH. Abdominal ultrasound examination in pregnant blunt trauma patients. J Trauma 2001; 50: 689-693
• 9 Richards JR, McGahan JP. Focused Assessment with Sonography in Trauma (FAST) in 2017: What Radiologists Can Learn. Radiology 2017; 283: 30-48
• 10 Armbruster M, Koliogiannis V. Die (schwer) verletzte schwangere Patientin aus Sicht der Radiologie. Unfallchirurg 2020; 123: 928-935
• 11 Greco PS, Day LJ, Pearlman MD. Guidance for Evaluation and Management of Blunt Abdominal Trauma in Pregnancy. Obstet Gynecol 2019; 134: 1343-1357
• 12 Brown MA, Sirlin CB, Farahmand N. et al. Screening sonography in pregnant patients with blunt abdominal trauma. J Ultrasound Med 2005; 24: 175-181
• 13 Meisinger QC, Brown MA, Dehqanzada ZA. et al. A 10-year restrospective evaluation of ultrasound in pregnant abdominal trauma patients. Emerg Radiol 2016; 23: 105-109
• 14 Goletti O, Ghiselli G, Lippolis PV. et al. The role of ultrasonography in blunt abdominal trauma: results in 250 consecutive cases. J Trauma 1994; 36: 178-181
• 15 Brenchley J, Walker A, Sloan JP. et al. Evaluation of focussed assessment with sonography in trauma (FAST) by UK emergency physicians. Emerg Med J 2006; 23: 446-448
• 16 Jang T, Kryder G, Sineff S. et al. The technical errors of physicians learning to perform focused assessment with sonography in trauma. Acad Emerg Med 2012; 19: 98-101
• 17 Skupski DW, Owen J, Kim S. et al. Estimating Gestational Age From Ultrasound Fetal Biometrics. Obstet Gynecol 2017; 130: 433-441
• 18 Loose R, Wucherer M. Bildgebung in der Schwangerschaft. Radiopraxis 2017; 10: 131-138
• 19 McCollough CH, Primak AN, Braun N. et al. Strategies for Reducing Radiation Dose in CT. Radiol Clin North Am 2009; 47: 27-40
• 20 Murphy NJ, Quinlan JD. Trauma in pregnancy: assessment, management, and prevention. Am Fam Physician 2014; 90: 717-722
• 21 Young MF, Oaks BM, Tandon S. et al. Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta‐analysis. Ann N Y Acad Sci 2019; 1450: 47-68
• 22 Smith W, Williams A, Agudelo J. et al. Early predictors of mortality in hemodynamically unstable pelvis fractures. J Orthop Trauma 2007; 21: 31-37
• 23 Filiberto DM, Fox AD. Preperitoneal pelvic packing: Technique and outcomes. Int J Surg 2016; 33: 222-224
• 24 Kaye ID, Yoon RS, Stickney W. et al. Treatment of Spinopelvic Dissociation: A Critical Analysis Review. JBJS Rev 2018; 6: e7
• 25 Pearson JM, Niemeier TE, McGwin G. et al. Spinopelvic Dissociation: Comparison of Outcomes of Percutaneous versus Open Fixation Strategies. Adv Orthop 2018; 2018: 5023908