Maternal pelvic injury resulting from road traffic accidents may cause fetal intracranial haemorrhage. A case is described. Caesarean section should be considered in acute trauma.(7Accid Emerg Med 1997;14:1 15-117) Keywords: road traffic accident; pregnancy; fetal intracranial haemorrhage.Road traffic accidents are major causes of trauma in pregnancy.' Maternal injuries include pelvic fractures, which are associated with fetal intracranial trauma.Review of published reports over the past 30 years suggests a high fetal death rate in association with fetal intracranial trauma in such circumstances.'-3 A case is presented of pelvic acetabular fracture in late pregnancy with associated fetal intracranial injury, following a road traffic accident. In the case presented, the fetus was delivered by caesarean section soon after arrival in the accident and emergency (A&E) department.This type of pelvic fracture is an uncommon injury in pregnancy, having been reported on only two previous occasions.2" The mechanism of fetal and maternal injury is discussed. On arrival the she was immediately transferred to the resuscitation area and managed according to the advanced trauma life support procedure of the American College of Surgeons. Her airway was intact, and she was able to speak (complaining of severe pain in her right hip). Her blood pressure was 150/90 and she had a pulse of 1 10 beats/min. There was no clinical evidence of abdominal, chest, or head injury, and there was no history of head injury or loss of consciousness. Cervical spine, chest x ray, and x ray of the right femur were all normal. The patient had noticed fluid draining vaginally since the accident and was now contracting 1 in 4. There was pain on any attempt at moving the right leg, particularly in the region of the right hip; the other limbs were normal. The uterine fundus was soft (between contractions), with a symphysial-fundal height consistent with 39 weeks. The fetal heart was present at a rate of 160.Radiological examination of the pelvis showed a comminuted right acetabular fracture. The fetal skull was engaged in the pelvis, with possible fractures evident over the parietal and occipital areas (fig 1).Vaginal examination revealed the cervix to be 4 cm dilated, almost fully effaced and the vertex 1 cm above the level of the ischial spines. Faintly blood stained liquor was draining. Pethidine 100 mg was given intramuscularly for analgesia (in retrospect the intravenous route may have been more appropriate). Six units of blood were cross matched; the haemoglobin on admission was 12.9 g/dl.In view of the possible fetal skull fracture it was decided to deliver the baby by emergency caesarean section. This was done under spinal anaesthesia. No uterine or other intraabdominal trauma was noted at the time of operation.A pale floppy female infant was delivered with an Apgar score of one. Initial resuscitation with oxygen by bag and mask and intramuscular naloxone produced a rapid improvement with the Apgar score of 8 at eight minutes. A large ...

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