Orthopaedic Injury: High Risk to Pregnant Women

Pregnant women who experience orthopaedic trauma may minimize the risk of preterm birth and other prenatal complications if they receive care at a medical center equipped to treat both high-risk pregnancies and orthopaedic injuries, according to a study presented today at the 2009 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). The study reveals that even seemingly minor orthopaedic trauma can have an adverse affect on pregnancy.

“Our results suggest that pregnant women with orthopaedic injuries, regardless of the severity of the injury, experience a significant increase in adverse pregnancy outcomes,” said Lisa K. Cannada, M.D., lead author of the study and associate professor at the St. Louis University Department of Orthopaedic Surgery.

Although trauma is clearly a complication with major issues for pregnant women and their infants, Dr. Cannada said most orthopaedic studies have focused on the impact of pelvic injuries on pregnancy. This study sought to examine the effects of all orthopaedic traumas on pregnancy outcomes.

“Pelvic injuries, of course, carry the highest risks, because they’re often associated with abdominal injury,” Dr. Cannada noted. “The interesting thing we learned in this study is that all trauma-related orthopaedic injuries pose a risk to pregnancy.”

Dr. Cannada and her team, with Dr. Brian Casey in the Department of Obstetrics and Gynecology, conducted a retrospective study of 1,067 pregnant women who were treated at Parkland Memorial Hospital in Dallas between 1995 and 2007, including 65 women who had experienced trauma-related orthopaedic injuries, such as:
• fractures
• complex hand injuries
• soft tissue injuries extending to the bone

The study showed that, when compared to pregnant women with non-orthopaedic injuries, the pregnant women who experienced orthopaedic trauma were at greater risk for adverse pregnancy outcomes, including:
• preterm birth
• placental abruption
• poor infant condition at birth
• fetal death
• death of the infant soon after birth

Dr. Cannada said one possible explanation for the increase in pregnancy complications may be that orthopaedic trauma often results from high-energy impact, such as car accidents, which may cause underlying damage to the placenta.

“Even an isolated fracture can be the result of a high-energy event, and the impact can have a significant influence over fetal outcome,” she noted.

Dr. Cannada said results of the study clearly indicate that pregnant women who experience orthopaedic trauma benefit from treatment at a medical center equipped to handle high-risk pregnancies.

“If an orthopaedic surgeon is treating a trauma-related broken bone in a woman who is more than 20 weeks pregnant, we recommend the surgeon refer her to a high-risk obstetrician and consider having any surgery performed at the same center where the obstetrician is located,” she said. “That way, both the trauma and any potential complications regarding the pregnancy can be more successfully addressed.”