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She was living a peaceful life with her husband and their two toddlers, until the 23 years old lady, found out about her pregnancy , she followed up her third pregnancy at ALMOOSA specialist hospital, in the 37th week of her pregnancy on her way back to home after one of her follow-ups, where the doctor assured her that the fetus was doing well and everything is okay thanks to ALLAH, in her way back home she had a horrible accident and she was seriously injured so she returned to Almoosa Hospital, but this time she returned with a dead fetus, that was alive two hours ago.

Dr. Maher Al Abbady – consultant and the head of OB\GYN department– said that at first caesarean section was considered to deliver the dead fetus but C- section would have put the mother’s life at risk because of (compound femur fractures – pubic fractures – blood transfusion – fetal death).

Consequently, the medical team decided to deliver the baby vaginally through labor induction and artificial rupture of membrane, the baby was delivered with a weight of 2.700 g.

Dr. Safwat Ali –pulmonary and allergy consultant and a member of the medical team – added that although the patient was given anticoagulants, in addition to avoid performing caesarean section and postponed orthopedic operation until stability of the condition, the patient developed pulmonary embolism any way so we have taken the necessary measures to dissolve the PE .

About that Dr. Samir AbouZeid – consultant and head of the department of Vascular Surgery- added that the patient suffered from pelvic vein thrombosis. Leading to a pulmonary embolism, so she was given anticoagulants, as the patient needed emergency operation to fix the fractures and this operation carries a very high risk in terms of the possibility recurrence of another deadly pulmonary embolism. Therefore, we placed a removable filter in the inferior vena cava (IVC) to protect against this problem and enable the orthopedic team to operate safely. This filter was removed within weeks after the patient’s condition is stabilized using an interventional catheter and under local anesthesia.

Dr. Wahid Mahdi –consultant intensive care and pulmonogist – stated that the patient was admitted in the intensive care DEP to be monitored carefully as pulmonary embolism in some cases may lead to respiratory failure and ventilator may be needed , the great challenge was the surgical intervention to fix the fracture right femur shaft while the patient is under blood thinners and anticoagulants ,as these drugs may lead to severe bleeding, this challenge was accepted and the drugs were briefly stopped for a carefully calculated period to avoid any bleeding or recurrence of clotting.

Dr. Teresa Freitas – consultant Orthopedic Surgeon- declared that this fracture is one of the most difficult fractures .the surgical procedure was postponed, due to the increased, life threatening, thromboembolic risk. Then we performed ORIF of right femur shaft fracture by interlocking nail under full anesthesia, assisted by the department of anesthesiology in the hospital.

At the end the patient’s family thanked Almoosa Specialist Hospital for all the efforts made by the medical team in the treatment, which gives a great example of the medical expertise and skills of the integrated medical team in treating such cases