0071643192.pdf

■ Shield the fetus whenever possible to prevent radiation exposure.
■ Because of concerns about radiation exposure, CT of the abdomen is prob-
ably inappropriate in stable patients who can be admitted for observation.
■ Rh-negative women should receive Rh immunoglobulin.
■ TheKleihauer-Betke testquantifies the volume of fetomaternal hemorrhage
in order to determine the need for larger volumes of Rh immunoglobulin.

TREATMENT

■ Emergent C-section is indicated if the fetus is viable and shows signs of
distress, uterine rupture, or premature labor with fetal malpresentation.
■ Management of an unstable mother with a fetus showing signs of distress
shouldfocus on resuscitating the motherand stabilizing or repairing her
injuries. Emergent C-section should be considered if there is evidence of
fetal distress and the mother can tolerate the procedure.
■ Absence of fetal heart tones indicates fetal death.Emergent C-section is
inappropriate in this setting (spontaneous labor usually occurs within one
week).

PELVIC FRACTURES

Pelvic fractures may be divided into major ring fractures, acetabular fractures,
and avulsion/single bone fractures (see Table 3.9).

Major ring fractures:

Result from the following forces:

■ Lateral compression force →horizontal fractures.
■ Anteroposterior compression force →vertical fractures.
■ Vertical shear force (eg, fall onto feet with weight of upper body transmitted
through spine pushing down between hips) →vertical fractures with ver-
tical displacement.

Acetabular fractures:

Acetabular fractures typically occur via head-on injury with knee hitting dash-
board, causing or lateralcompression. Sciatic injury may occur.

TRAUMA

TABLE 3.9. Classification of Major Pelvic Fractures

TYPE INCIDENCEa MECHANISM RADIOGRAPHICFINDINGS

Lateral compression 45–50% T-bone MVC or pedestrian Transverse pubic ramus fracture

struck on side Sacral compression fracture

Iliac wing fracture

Anteroposterior 25% Head on MVC Pubic symphysis or SI joint disruption

compression (open book)

Vertical shear 5% Fall/jump from height Fracture fragments/symphysis displaced

vertically

aThe remaining 20–25% result in a combination of the above types.