Fracture of the pelvic bones in pregnant women. Fall during pregnancy Is it possible to get pregnant with a broken leg

Falling during pregnancy is one of the main fears of pregnant women, not in vain, but, unfortunately, it is impossible to completely insure yourself against this. It is especially likely to fall during pregnancy in winter period the time when ice is underfoot, and heavy winter clothes are on the pregnant woman.

Injuries during pregnancy are especially common for lovers of high heels who have not found the strength to part with them, and it's good if it's just a damaged ankle. A blow to the stomach during pregnancy is very dangerous, no matter how the nature of the baby protects. Danger is also a fall on early dates pregnancy, despite the fact that the baby is protected and located deep in the pelvic cavity.

What is the danger of falling during pregnancy?

Nature has foreseen the possibility of injury during pregnancy.

A fall in the early stages does not directly harm the child, because the uterus is reliably protected by the bones of the woman's pelvis, and even a contusion of the abdomen during pregnancy up to 10-12 weeks often does not affect the baby in any way.

Falling on the stomach during late pregnancy also usually does not lead to injury to the baby himself, he is surrounded by an amniotic bladder and water softens even a direct blow.

But do not forget about the following factors:

A fall is always a sharp shaking of the body, and it is not necessary to fall exactly on the stomach. The body gets a shake in any case, even if mom slipped and fell in the safest way.

Falling even on the "ass" during pregnancy is dangerous at any time, since a sharp shaking of the house where the baby lives can lead to placental abruption and bleeding, and at a later stage, damage to the amniotic fluid.

Placental abruption often leads to the death of the child; in the long term, it endangers the life of the mother.

A fall is fear, stress, the release of a large amount of hormones into the bloodstream, which can in themselves cause a miscarriage. Pregnant women should not be scared and worried, any person knows this.

A direct belly blow during late pregnancy is only partially extinguished by the amniotic fluid and membranes of the fetus. If the injury is serious, the child can suffer directly, that is, get bruises and even fractures.

Strikes during pregnancy deliberately inflicted on a pregnant woman, for example, as a result of beatings, quite often end in sad, miscarriage and death of the child.

Serious injuries during pregnancy, for example, spinal injuries, fractures, traumatic brain injury, can raise the question that now it is not the child that is the main thing, but his mother ...

The consequences of falling during pregnancy can be very serious, even if you just fell on your back. Of course, it is better to try to avoid injury, especially since in most cases this is possible by showing only prudence and caution.

The main rules if you are pregnant:

And the last thing learn to fall properly... Do not smile, falling during pregnancy is also possible correctly, if you attended any section of martial arts, you would be taught to fall correctly in the first place. To minimize the risk of injury when falling to a minimum, even falling on your back or stomach, at the very moment of falling you have the necessary fractions of a second to twist and fall on your side. It's safer. If you fall on your side, you will definitely not break anything or hit your head. Never stretch your arms forward when falling, falling on your arm, you risk getting a fracture. Falling, say, on your left side, the movement of your left hand should be directed, it should not be under you and take the blow. Correctly and safely, if it turns out to be stretched to the side and will take a blow when falling flat, you should, as it were, slap your whole hand on the ground, the load will be distributed not along the axis of the limb, but along it, and you will avoid a fracture.

What if the woman still fell during pregnancy?

Simple bruises during pregnancy are no more dangerous than at any other time, you should not be afraid of ordinary bruises, it is important that your child has not suffered.

If you manage to fall on your stomach, just in case, consult a gynecologist, even if nothing bothers you.

Is a fall during pregnancy dangerous for a child in every specific case can be recognized by a number of symptoms:

Bruises during early pregnancy:

Long-term strokes during pregnancy:

Women can also be injured during pregnancy. If almost everyone falls during pregnancy, but complications are extremely rare, some especially unhappy pregnant women find themselves in more unpleasant situations. Burns during pregnancy, electric shock, serious injuries in road accidents and much more lie in wait for anyone, you just have to relax and stop being careful.

Take care of yourself and your baby, life is full of dangers, and you are responsible for two ...

During pregnancy, many women are haunted by the fear of falling. And it has good reason. Awkward gait associated with a shift in the center of gravity, obstructed vision due to a large abdomen may well lead to a fall. This is especially likely in late pregnancy. However, nature has taken care to protect the baby as much as possible.

Child protection

The child is most protected in the early stages of pregnancy. During this period, the uterus and embryo hide in the pelvic cavity and are reliably hidden behind its bones.

As the term increases, the uterus begins to protrude beyond the pelvic ring and becomes more vulnerable. But in parallel, the volume of amniotic fluid surrounding the embryo also increases. They act as a shock absorber, softening cushion. It is the waters that take the brunt of the blow and dampen its force due to vibrations.

But it would be wrong to say that a fall during pregnancy is absolutely harmless to a child or a mother-to-be. On the contrary, it can lead to very serious consequences.

The result of the injury depends on which area the woman fell on - the stomach, back or side.

Fall on belly

When falling on the stomach, the entire force of the blow is directed precisely at the uterus, especially after 12-16 weeks of pregnancy. For the most part, it is extinguished by amniotic fluid. But the vibrations that arise in this case, in themselves, can harm the baby. Their principle of action is similar to the impact of waves in a stormy sea.

If the fall during pregnancy was severe and the injury was severe enough, it can result in the following:

• Miscarriage or premature birth.
• Premature detachment of a normally located placenta.
• Bleeding.
• In the later stages, there may be direct damage to the child - bruises and even fractures.

The expectant mother with such a fall not only experiences severe stress. When instinctively stretching her arms forward, she has every chance of getting fractures of the bones of the forearm, wrist and hand.

Fall on your back

Falling on your back seems safer at first glance. Indeed, the blow falls on the spine or pelvis. The bones reliably protect the uterus from bruises.

However, there is less shock-absorbing fluid from the back. This means that if a woman falls backward, the entire force of the blow will spread not only to the spine, but also deeper into the body, without encountering any special obstacles in its path.

For the expectant mother, falling on her back is a serious threat. Often such injuries occur in winter, during the icy period. Their result can be:

• Severe contusion of the back and lower back, bruises in this area.
• Kidney contusion.
• Bruise or even subcapsular rupture of the spleen (with a very strong blow).
• Fracture of the spine. This is possible with severe calcium deficiency and osteoporosis and is typical for late pregnancy.

Falling on the back has always been considered a serious injury; it requires a mandatory examination by a doctor to rule out unpleasant complications.

Fall on the side

Although a fall during pregnancy is not a safe occurrence, when a woman lands on her side, the chances of harm to the baby are minimal.

Of course, he will get injured, but it will be softened by the amniotic fluid. In this position, the embryo is most protected by the surrounding membranes and internal organs.

However, the mother may be seriously injured in this case:

• With involuntary extension of the elbow, there is a high risk of arm fracture.
• Falling onto your side can fracture your ribs and damage your lungs, causing pneumothorax. This becomes especially relevant in late pregnancy, when they are compressed by the uterus.
• If future mom falls on the right side and on an uneven surface, there is a possibility of liver damage. It is a life-threatening injury due to developing bleeding.
• Falling to the left side injures the spleen.

Of course, all these serious injuries are possible if the woman was hit sideways with great force or if she fell, for example, on stones.

Under normal circumstances, falling onto flat asphalt, especially when wearing heavy winter clothing, is likely to be minimally injured.

However, no one canceled the fear in such a situation. The stress can be so intense for a woman that it can trigger a miscarriage, placental abruption, or the onset of premature labor. Therefore, you must definitely keep yourself in hand and try not to get nervous.

Action tactics

The first thing that the expectant mother should do when falling is to rise gently, preferably with someone's help, and calm down.

Anxiety and worries about the life and health of the baby will not help him in any way, but they can do harm very seriously - both in the early and late stages of pregnancy.

If a woman feels severe pain in the abdomen, back or side, weakness, dizziness, tremors in the arms and legs, she should immediately call the ambulance. These symptoms may indicate serious damage. internal organs or bleeding.

You also need to do if the expectant mother noticed that:

• The child began to move too actively, or, conversely, suddenly calmed down.
• Painful, growing contractions appeared.
• The amniotic fluid is gone.
• He started bleeding from the genital tract. Even a little bleeding is a dangerous symptom.

The sooner a woman is hospitalized, the sooner she will be provided with the necessary assistance, up to an emergency delivery if necessary.

If the fall was not strong, and the woman does not notice any unpleasant sensations, it is better for her to go home and rest. However, during this or at least the next day, you must see your doctor.

Since any injury is easier to prevent than to treat, certain precautions must be taken to avoid falling and risk factors must be considered.

Risk factors

In some situations, the likelihood of falling increases significantly. Lead to increased risk the following factors:

• Wearing shoes with high heels, especially stiletto heels, as well as sliding flat soles.
• Late pregnancy, when the center of gravity is shifted and gait is disturbed.
• Inability to see an obstacle in the path or a pothole due to an enlarged abdomen.
• Sprains of the ligaments of the pubic articulation, which leads to instability of this joint and a pronounced change in gait.
• Walking in icy conditions and during snowfall or rain.

Prophylaxis

Falls during pregnancy should be avoided at all costs. Indeed, even the seemingly insignificant injury during the period of bearing a child can result in serious complications.

First of all, you need to take care of comfortable shoes. During pregnancy, you should forget about high thin heels or platform. Shoes should be comfortable and stable, but not flat. A low wide heel is highly desirable.

Traumatologists and gynecologists do not recommend expectant mothers to go outside in bad weather. Snow, rain, ice leads to increased trauma, which is especially dangerous in late pregnancy. If you can't do without walking, you need to attach special anti-slip pads to the sole.

In the last weeks, expectant mothers need to move very carefully and, if possible, slowly. Do not run after vehicles or rush without looking at your feet. The smoother your gait, the less likely you are to fall and injure your abdomen or back.

In case of joint instability due to increased elasticity of the ligaments, it is better to follow a home regimen.

If a fall is inevitable, you must try to land on your side, in no case putting your hand forward.

Pregnancy is a special time. At this time, a woman should think not only about herself, but first of all try not to harm the child.

The reasons are divided into: pathological and mechanical.

Pathological reasons include:

• Osteoporosis;
• Osteomalacia;
• Osteomyelitis;
• Malignant neoplasms in the skeletal system (for example, osteosarcoma);
• Benign bone tumors;
• Metastasis of cancerous neoplasms in the bone;
• Bone cysts;
• Lack of vitamin D, calcium and phosphorus;

Mechanical reasons are:

• Falls;
• Strikes and direct strikes to the bone;
• Twisting;
• Bruises;
• Injuries, road accidents.

Symptoms

The clinical picture depends on the site of the fracture, its complexity. The arm is divided into three parts: the shoulder, forearm and hand. Accordingly, the symptoms will be both general and specific.

Hand fracture:

In the presence of a fracture of the wrist bone, the following types are distinguished:

• Disruption of the scaphoid bone is the most common type of wrist fracture. Such a fracture is manifested by swelling, soreness, inability to clench a hand into a fist;
• A lunate fracture is recognized by the appearance of edema, pain that becomes worse with axial loading;
• Pisiform fractures are very rare. The first signs are pain in the little finger, it is difficult to straighten or bend the brush;

A fracture of the wrist reveals pain, swelling, subcutaneous hematoma, deformation of the damaged area, increased pain with axial load, when trying to clench and unclench a fist.

If there is a violation of the integrity of the phalanges of the fingers, then the patient will experience swelling and cyanosis of the injured finger, restriction of movement, deformation of the injured finger, hemarthrosis.

Fractured forearm bones:

• Olecranon process. With its fracture, swelling is observed, a hematoma is formed, the area of ​​the joint is deformed, a sharp pain appears during movement, a straight arm hangs along the body;
• Coronal process. The first signs are edema in the area of ​​the ulnar fossa, hematoma, flexion and extension of the arm is limited, severe pain appears, which intensifies when trying to move the arm;
• Elbow bone. The first signs are manifested in impaired hand function, swelling and cyanosis of the affected area, deformity, crepitus and pathological mobility;
• Radius. Typical for this fracture are: mobility of bone fragments, edema, hematoma, severe and sharp pain.

With a fracture of both bones of the forearm, shortening of the limb appears, crepitus and pathological mobility at the site of injury, deformation of the fracture site occurs, the victim tries to hold on to the injured arm, this fracture is accompanied by severe and sharp pain.

In case of damage to the ulna and radius, an ulnar fracture with dislocation of the radial bone is isolated. In this case, nerve damage occurs, which will affect the loss of sensation below the fracture. The injured arm appears to be shorter than the healthy one. With this type of fracture, an open angle is formed between the radius and ulna. Movement is difficult and very painful.

If we are talking about a fracture of the radius and dislocation of the ulna, the bones of the ray are displaced forward, and the ulnar bones are displaced backward. There is a curvature of the axis of the radius, which will affect the deformation of the hand. In the presence of a hematoma, the formation of hemarthrosis is possible.

A fracture of the radius in a typical location is accompanied by nerve damage. This fracture is characterized by loss of sensation, restriction in movement and common features... Which are typical for all types of fractures.

Fracture of the humerus:

• Violation of the integrity of the shoulder in the upper third is characterized by the preservation of passive mobility of the arm and pain during active movements, swelling, deformity of the arm, shortening of the limb, crepitus, hematoma;
• Violation of the integrity of the humerus in the middle third is recognized by the inability to independently perform flexion and extension movements, the edema is very pronounced, and an extensive hematoma is formed. Pain sensations increase when trying to active movements;
• A fracture of the lower third of the bone is subdivided into condylar and transcondylar fractures. With a supracondylar fracture, pain, edema, hematoma appear, the forearm is visually lengthened (flexion fracture), and with an extension fracture, a shortening of the arm is noted. If the condyles are injured, hemarthrosis, joint deformity, and joint swelling are observed. Flexion and extension movements are not possible.

Diagnosis of a broken arm bone in a pregnant woman

For diagnostics use:

• X-ray examination with measures taken safety to prevent consequences for the fetus;
• Ultrasound diagnostics of joints for the presence of hemarthrosis (pathological accumulation of blood in the joint);
• Using a tuning fork, microcracks in the bones are determined.

Complications

The complications and consequences of such fractures can be varied. For instance:

• No fusion of the fracture;
• Slow healing of the fracture;
• Infectious, purulent-inflammatory process;
• Necrosis;
• Paralysis;
• Disability;
• Improper union of the fracture;
• Osteomyelitis.

Treatment

What can you do

When providing first aid, it is necessary to calm the victim, give pain relievers. Next, the injured limb is immobilized by applying splints or splints to the damaged area of ​​the bone. In this case, the adjacent joints are necessarily firmly fixed. The arm is suspended in a bent state at an angle of 90 degrees on a scarf thrown over the shoulder.

With an open fracture, the blood stops by applying a tourniquet to the place located 5 centimeters above the fracture itself. The wound surface is sanitized.

In no case should you correct fractures on your own, pull the hand.

What the doctor does

Conducts an examination, diagnoses and prescribes treatment. It consists of applying a plaster cast to the broken arm. This method is used for simple fractures. The minimum wearing period for plaster is 1 month. Before the plaster is applied, the doctor performs a closed reduction of the fracture.

If the fracture is comminuted, then osteosynthesis is performed. At the same time, all bone fragments are manually set and fixed with knitting needles, pins, plates. It is possible to use the Elizarov apparatus. In this form, the patient stays for about a month, then a control X-ray is taken and if everything is in order, the fixators are removed and a plaster cast is applied for another 2 months.

After such treatment, a diet, exercise therapy, massages are prescribed.

Prophylaxis

Preventive measures are aimed at preventing possible injury. These include.

The topic of injury during pregnancy is unreasonably ignored by doctors, although in most cases such injuries can be prevented. Indeed, up to 20% of cases of death of pregnant women occur due to injuries and injuries not related to pregnancy.

Most often, women are injured during pregnancy as a result of road traffic accidents (RTA). Fortunately, the frequency of involvement of pregnant women in road traffic accidents, the degree of trauma and the number of deaths do not exceed those of non-pregnant women.

Not inferior to road traffic accidents in frequency and injuries associated with physical violence by a husband or partner and usually received at home. In developed countries, cases of trauma due to physical violence occur in 5-30% of pregnant women, but still the majority of such incidents, especially with minor injuries, remain unreported and not mentioned when visiting a doctor. In 64% of such cases, a woman receives blows to the abdomen. Fetal death occurs in one in 20 pregnant women.

In third place are falls and accidental injuries. With the progress of pregnancy and the growth of the uterus, the woman's center of gravity shifts, which leads to an increase in the loss of balance. From 3 to 30% of falls are accompanied by injury, and the period after 32 weeks of pregnancy is especially dangerous.

Household and other types of injuries are rare in pregnant women, and the degree of damage is determined by the type of injury. The most dangerous are electric shocks, since more than 70% of such accidents end in fetal death.

Despite the increased frequency of injury to pregnant women, the health consequences of injury during pregnancy are less severe than those of non-pregnant women. Doctors attribute this effect to the protective function of increased hormonal levels, as well as more frequent visits by pregnant women to medical institutions. Even with minor bruises and injuries in a pregnant woman more chances undergo a timely examination and receive the necessary assistance in comparison with other groups of people.

The degree of injury caused by injury depends on many factors. However, the gestational age plays a very important role in this. In the first trimester, while the uterus is within the pelvic floor, in case of blows, falls, short-term compression of the abdomen, the danger of harm to pregnancy will be minimal. Up to 3% of women who are injured and are hospitalized as a result are unaware of their pregnancy. The doctor is obliged to check with the woman, if her condition allows it, whether she is protecting herself from pregnancy and when she had her last menstrual period. With a delay in menstruation, the level of hCG is determined to clarify the presence of pregnancy.

In the second trimester, the uterus already extends beyond the pelvic floor, but nevertheless the fetus is surrounded by a sufficient amount of amniotic fluid, which softens the effect of force during falls and blows, so the danger to the fetus in this period of pregnancy is also not too high.

In the third trimester and before childbirth, trauma can lead to premature birth, placental abruption, bleeding, uterine rupture, and intrauterine fetal death.

In the second half of pregnancy, in case of damage, it is important where exactly the placenta is attached. Most often, the child's place is located on the back wall of the uterus - this is one of the protective mechanisms of nature. But in a number of women, the placenta is attached to the anterior wall of the uterus, which significantly increases the risk of placental abruption in case of abdominal trauma. Special attention deserves an abnormal attachment of the placenta - the so-called presentation, which in themselves can be accompanied by a number of complications, but with trauma, these complications appear more often.

What should a pregnant woman do if she is injured from a fall, accident, impact, etc.? To begin with, it is important to correctly assess the degree of harm to your own health and the health of the unborn child. Of course, the reaction of many women, especially in a state of shock, may be inadequate, therefore, in such cases, it is advisable to immediately contact a medical institution.

If the injury is not accompanied by pain, bleeding, increased contractile activity of the uterus, a woman can lie down and monitor her condition and fetal movements, if she felt them before. It is important to remember that from the second half of pregnancy, an enlarged uterus can squeeze the inferior vena cava when a woman lies on her back, and in 30% of cases this is accompanied by unpleasant symptoms and creates a false picture of a worsening condition.

However, if you are injured, it is still undesirable to take any pain relievers. If a blow from a fall or DPT fell directly on the abdomen and the woman experienced severe pain, you need to call an ambulance or immediately go to the hospital on your own.

Up to 40% of pregnant women may experience increased contractions of the uterus after injury, but in 90% of cases, these contractions will stop without negative consequences for pregnancy.

In a medical institution, a doctor is obliged to assess the condition of a woman, if necessary, connect her with oxygen, intravenous droppers. But it is very important to know the condition of the fetus, placenta, amniotic fluid. Ultrasound in this case will be one of best practices diagnostics. If the gestation period is more than 23-25 ​​weeks, the woman can be sent to the maternity ward for observation even with minor injuries.

Ultrasound allows you to determine not only the state of the uterus, placenta, fetus, but also intra-abdominal bleeding. It is important to monitor the fetal heart rate: the stress response of the mother can be reflected in the stress response of the fetus. After 23-34 weeks of pregnancy, the monitoring of the fetus and its activity is carried out for 4 hours, and if necessary, even longer.

After an injury, short-term disturbances in the fetal heart rhythm can be observed, however, such deviations, as a rule, do not have a negative prognostic value. At the same time, a normal heart rate excludes a negative pregnancy outcome due to injury.

Most of the examinations that are used in medicine to assess the patient's condition after injury are safe during pregnancy. Most often, women are worried about the danger of X-ray examination. Clinical studies show that X-rays of the pelvis, spine, and thighs in early pregnancy (5-10 weeks) increase the rate of miscarriages and the occurrence of malformations. After 10 weeks, the effect of radiation is characterized by changes in the central nervous system fetus. The level of negative effects of radiation on the fetus depends on the radiation dose.

Computed tomography is also associated with an increased risk of radiation, although to a lesser extent than x-rays. Nevertheless, any type of examination in which there is fetal irradiation should be prescribed carefully, according to strict indications.

A very important question, which is often overlooked by both doctors and women, is the prevention of Rh sensitization, which is popularly called the Rh-conflict. All pregnant women from 6 weeks of pregnancy with Rh-negative blood group after injury are recommended to administer 300 mg of anti-Rh antibodies (immunoglobulins), since in such cases damage to the placenta is not excluded.

According to indications, tetanus prophylaxis should be carried out in injured pregnant women. This type of vaccine is safe for pregnancy.

In almost 30% of cases with moderate injuries and more than 60% of cases with severe injuries, pregnancy will end in abortion with fetal loss, while minor injuries will not affect the course of pregnancy and its outcome. Up to 20% of pregnant women requiring inpatient treatment lose pregnancy, since hospital treatment is usually required in severe cases. However, even a minor injury doubles the risk of preterm birth. Up to 7% of pregnant women need a caesarean section soon after an injury.

Prevention of all types of injuries and injuries in pregnant women is no different from that in other people. More attention is paid to the prevention of falls, therefore, all women, starting from the second half of pregnancy, are advised to wear low-heeled shoes, increased caution when using stairs, limiting sharp movements, as well as physical activity, accompanied by high risk fall (cycling, skating, skiing, horse riding, jumping, running, etc.). When in public transport, a pregnant woman must wear seat belts. Physical violence and abuse of power must be promptly detected and suppressed by all acceptable measures, including interference law enforcement, social services, family counselors and other professionals.

In general, minor injuries do not have an adverse effect on pregnancy, and the woman safely gives birth to a healthy full-term baby.