Simultaneous Cesarean Delivery and Pelvic Stabilization for Open-Book Pelvic Injury in Late Pregnancy: A Case Report

Trauma during pregnancy poses a dual threat to the mother and fetus, and disruption of the pelvic ring is among the most challenging injuries a trauma team can encounter in this population. Altered maternal physiology, the presence of a gravid uterus, and concerns regarding fetal radiation exposure all complicate assessment and surgical planning. Evidence to guide management is limited, leaving the sequencing of delivery and skeletal stabilization largely dependent on case-by-case clinical judgment. A 26-year-old woman (gravida 3, para 2) at 35 weeks and 5 days of gestation sustained these injuries after being struck by a car while riding a motorcycle. She presented alert, with stable vital signs and no tachycardia (blood pressure, 127/77 mmHg; heart rate, 72 bpm; SpO₂, 98%). Focused assessment with sonography for trauma (FAST) was negative on two occasions, and cardiotocography was reassuring, with only mild uterine activity. Following multidisciplinary discussion, an emergency lower-segment cesarean section was performed with the pelvic binder in situ, followed by pelvic external fixation using two 5-mm supra-acetabular Schanz pins and retrograde nailing of the right femur during a single three-hour operative session. A 1.9-kg girl was delivered, with Apgar scores of 4, 7, and 10 at 1, 5, and 10 minutes, respectively. Estimated blood loss was 800 mL, and two units of packed red blood cells were transfused. Pelvic reduction was maintained at two weeks, and both the mother and neonate were discharged well on day 8. In near-term pregnancy complicated by combined pelvic and orthopedic trauma, single-session delivery and skeletal stabilization is feasible. An external fixator can provide definitive fixation for an open-book pelvic injury.