Navigating Anesthetic Management in the Setting of Uterine Rupture and Spinal Fracture: A Case Report

Intrapartum trauma with spinal instability may require delivery by cesarean section (CS). While regional anesthesia is typically preferred in CS, general anesthesia may be necessary in emergent presentations that require rapid induction of anesthesia. We report a case wherein a patient presented with uterine rupture and spinal instability following a motor vehicle accident and received regional anesthesia prior to CS. A 27-year-old multiparous female at 37 + 6 weeks of gestation presented to the Emergency Department after a high-speed motor vehicle accident with significant abdominal pain and contractions, and a positive seatbelt sign was noted on examination. CT imaging revealed multiple spinal fractures and an apical pneumothorax. A spinal block was placed with the patient in the lateral decubitus position, after which she was logrolled to the dorsal position for surgery. A cesarean section was then performed, resulting in the delivery of a viable female infant. This case emphasizes the need for comprehensive clinical assessment when administering anesthesia in obstetrical trauma with spinal instability. Obstetricians and gynecologists are uniquely positioned within the multidisciplinary team to advocate for optimal maternal and fetal outcomes.