Pelvic mortality

Pelvic examinations are effective in detecting obvious tumors with a sensitivity of 67% for detecting all tumors minimal or microscopic disease cannot be detected on physical examination.9 Pelvic examinations are non-invasive and well accepted, but they do not usually detect ovarian cancer until it is in an advanced stage. Therefore, routine pelvic examinations will not improve earlier diagnosis or help to decrease overall mortality.9... 

Any consideration of major issues relating to the balance of benefit and harm, such as cancer or mortality rates, should be supplemented by a consideration of less prominent ones, for example, a reduction in disorders of the menstrual cycle (such as dysmenorrhea, menorrhagia, and the premenstrual syndrome) and the reduced risks of iron deficiency anemia, functional ovarian cysts, uterine fibroids, benign breast disease, pelvic inflammatory disease, and ectopic pregnancy (10,11). 

Pelvic injuries accompanied by haemorrhage are associated with high mortality rates. Unfortunately, surgical exploration is hindered by the often-associated haematoma and the surgical procedure itself can release the tamponade effect of the haematoma leading to a subsequent increase in haemorrhage. TAE results in control in 90% of cases of pelvic haemorrhage in trauma patients. 

Arrest of labor with the necessity of performing secondary cesarean section is a major cause of maternal morbidity and mortality. The fetus is likewise affected hy prolonged labor. Pelvimetry is performed to identify those women in whom an attempt at vaginal delivery is likely to fail due to a narrow pelvis or pelvic anomaly. Hence, the clinical significance of pelvimetry depends on how the following questions are answered ... 

The classification of pelvic fractures has been widely discussed for adult patients. In general, the classification of any paediatric injury follows adult practice, but there is less data available on paediatric injuries. The aim of any classification system is to try and determine the mechanism of injury, assess the degree of instability, aid appropriate management and if possible predict outcome. The multitude of classification systems makes comparison of incidence, mechanism of injury, morbidity and mortality between different studies difficult. 

Pelvic fractures can be associated with significant morbidity and mortality, which reflects the high degree of impact energy associated with these injuries. 

Pelvic fractures account for 3% of all skeletal injuries and are associated with a substantial mortality, with reported figures varying from 5% to 60% [1-21]. Mechanisms for pelvic fractures include motor vehicle accidents (57%), pedestrians hit by motor vehicles (18%), motorcycle accidents (9%), falls (9%), crush injuries (4%), and sports/recreational mechanisms (3%) [22]. Pelvic fractures are grouped based on the direction of the causative force. These forces include lateral compression, anteroposterior compression, vertical shear, and combinations of these three [23]. Most injuries to the infrarenal aorta are caused by seat belts compressing the lower abdomen in the anteroposterior aspect during car accidents. 

A closed stable fracture with stable vital signs offers the best prognosis, while patients with an open fracture and hemodynamic instability have a higher mortality. This latter subgroup only represents l%-2% of all pelvic injuries seen in Level 1 trauma centers [24] but no other skeletal injury carries such a high mortality rate. 

Rothenberger DA, Fischer RP et al. (1978) The mortality associated with pelvic fractures. Surgery 84(3) 356-61... 

Gilliland MD, Ward RE et al. (1982) Factors affecting mortality in pelvic fractures. J Trauma 22(8) 691-3... 

Flint L, Babikian G et al. (1990) Definitive control of mortality from severe pelvic fracture. Ann Surg 211(6) 703-6 discussion 706-7... 

Poole GV and Ward EF (1994) Causes of mortality in patients with pelvic fractures. Orthopedics 17(8) 691-6... 

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