Panamerican Journal of Trauma, Critical Care & Emergency Surgery

Register      Login

VOLUME 6 , ISSUE 1 ( January-April, 2017 ) > List of Articles


Unstable Chest Surgical Management in Pregnancy: Case Report and Literature Review

Mauricio Velásquez, María F Escobar, Javier A Carvajal, Albaro J Nieto

Citation Information : Velásquez M, Escobar MF, Carvajal JA, Nieto AJ. Unstable Chest Surgical Management in Pregnancy: Case Report and Literature Review. Panam J Trauma Crit Care Emerg Surg 2017; 6 (1):52-57.

DOI: 10.5005/jp-journals-10030-1173

License: NA

Published Online: 14-04-2016

Copyright Statement:  NA



We present a review of the case, management, and progress of an obstetric patient, who suffered a car accident with subsequent severe blunt thoracic trauma (BTT) resulting in flail chest (FC).

Case report

This is a Hispanic female of 44 years involved in a car accident at 14 weeks of gestation, who presented with FC, sternal fracture, and severe respiratory compromise. This woman received surgical management and care in an intensive obstetric care management unit, presenting with osteomyelitis as a complication, along with physical deconditioning and prolonged hospital stay, finally with an obstetric and functional favorable outcome.


Although severe BTT in pregnant patients is uncommon, it is important to highlight the appropriate medical management required for these patients to achieve a successful outcome, as was in this case. This is the only case report of a FC surgical management in pregnancy that we have had in our institution so far.

How to cite this article

Nieto AJ, Velásquez M, Escobar MF, Carvajal JA, Granados M. Unstable Chest Surgical Management in Pregnancy: Case Report and Literature Review. Panam J Trauma Crit Care Emerg Surg 2017;6(1):52-57.


Presentar una revisión de caso, manejo y progreso de una paciente obstétrica que sufrió un accidente automovilístico con posterior trauma torácico severo (TTS) resultando en tórax inestable (TI).

Caso clínico

Este es un caso de mujer hispana de 44 años involucrada en accidente automovilístico a las 14 semanas de gestación que presento TI, fractura esternal y compromiso respiratorio severo.

 Esta mujer recibió tratamiento quirúrgico y atención en unidad de cuidado obstétrico intensivo, presentando osteomielitis como complicación, junto con desacondicionamiento físico y hospitalización prolongada. Finalmente con resultado obstétrico y funcional favorable.


Aunque el TTS en pacientes embarazadas es poco frecuente, es importante destacar el adecuado manejo médico requerido en estos pacientes, con el fin de lograr resultados satisfactorios como sucedió en este caso. Este es el único reporte de caso de manejo quirúrgico de tórax inestable durante el embarazo presentado en nuestra institución hasta ahora.

PDF Share
  1. Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population. Am J Obstet Gynecol 2004 Jun;190(6):1661-1668.
  2. Health situation in Colombia. Basic indicators of 2011 [Internet]. Ministry of Health and Social Protection Republic of Colombia; 2011 [cited 2015 Jun 29]. Available from: y Publicaciones/Indicadores Básicos
  3. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg 2003 Jul;24(1):133-138.
  4. Flail chest: are common definition and management protocols still useful? Eur J Cardiothorac Surg 2012 Jul;42(1):192.
  5. Associated injuries in traumatic sternal fractures: a review of the national trauma data bank. Am Surg 2013 Jul;79(7):702-705.
  6. Epidemiology of sternal fractures. Am Surg 2009 May;75(5):401-404.
  7. A multi-institutional study of factors associated with fetal death in injured pregnant patients. Arch Surg 1999 Nov;134(11):1274-1277.
  8. Chest injury due to blunt trauma. Eur J Cardiothorac Surg 2003 Mar;23(3):374-378.
  9. Utility of three-dimensional computed tomography for the surgical management of rib fractures. J Trauma Acute Care Surg 2015 Mar;78(3):530-534.
  10. Surgical fixation vs nonoperative management of flail chest: a meta-analysis. J Am Coll Surg 2013 Feb;216(2):302-311.
  11. Surveyed opinion of American trauma, orthopedic, and thoracic surgeons on rib and sternal fracture repair. J Trauma 2009 Mar;66(3):875-879.
  12. Blunt thoracic trauma. Analysis of 515 patients. Ann Surg 1987 Aug;206(2):200-205.
  13. Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma 1988 Mar;28(3):298-304.
  14. Chest wall stabilization by soft tissue traction: a new method. J Am Med Assoc 1954 Oct;156(8):768-769.
  15. Prospective, randomized comparison of epidural versus parenteral opioid analgesia in thoracic trauma. Ann Surg 1999 May;229(5):684-691.
  16. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma 2002 Apr;52(4):727-732.
  17. Contemporary management of flail chest. Am Surg 2014 Jun;80(6):527-535.
  18. Management of pulmonary contusion and flail chest: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012 Nov;73(5 Suppl 4):S351-S361.
  19. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg 2013 May;216(5):924-932.
  20. Rib fracture repair: indications, technical issues, and future directions. World J Surg 2009 Jan;33(1):14-22.
  21. Evaluation of blunt abdominal trauma in the third trimester of pregnancy: maternal and fetal considerations. Obstet Gynecol 1990 Jan;75(1):33-37.
  22. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974 Mar;14(3):187-196.
  23. The injury severity score in pregnant trauma patients: predicting placental abruption and fetal death. J Trauma 2002 Nov;53(5):946-949.
  24. Predictors of fetal outcome in pregnant trauma patients: a five-year institutional review. Am Surg 2007 Aug;73(8):824-827.
  25. Fetal death after trauma in pregnancy. Am Surg 2000 Sep;66(9):809-812.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.