Pregnancy, delivery and puerperium in a woman after extensive pelvic bone fracture and bilateral high lower limb amputation in childhood – a case report

Abstract

ntroduction: The aim of study was to analyze two pregnancies, deliveries and puerperal periods in a woman who had experienced bilateral lower limb amputation, pelvic bone fracture and severe injury of the urinary tract and reproductive organs.

Case report: At the age of 4 she was the victim of a traffic accident, getting squashed by a trolley car, which caused crush wounds to both lower limbs and extensive perineal injury. Surgical intervention consisted of bilateral lower limb amputation at the level of the coxofemoral joint, and suturing of the torn vagina and rectum, with a temporary artificial anus formed from the sigmoid colon. Subsequent reconstructive surgery made spontaneous and well-controlled urination and defecation possible. The severe bodily injury experienced in the early life of the patient caused irreversible physical disability, accompanied, obviously, by psychological trauma. Despite this, at the age of 42, the patient decided to procreate.

The first pregnancy was complicated by hyperthyroidism. Delivery by caesarean section was performed in the 31st week 

of gestation because of the premature rupture of membranes. Before delivery the patient was given a standard course of corticosteroids to accelerate foetal maturation. The second pregnancy was complicated not only by hyperthyroidism, but also by recurrent tachycardia and gestational diabetes mellitus. The patient received a standard dose of corticosteroids in the 32nd week of gestation. Caesarean section was performed in the 36th week of gestation because of spontaneous labour onset.

During both pregnancies no neurologic abnormalities were found in the patient. She was able to asses foetal movements and uterine activity adequately, which made ambulatory perinatal care possible. The reconstructive surgery of the urinary and digestive tract that the patient underwent in her childhood was not only a strong risk factor for operative delivery complications, but also because changes in anatomy and the potential presence of adhesions could have affected the pregnancy course itself.