Pregnancy outcomes after pelvic ring injury

Area of Science:

• Orthopaedic Surgery
• Obstetrics & Gynecology
• Trauma Surgery

Background:

• Pelvic trauma can negatively impact genitourinary and reproductive function.
• Previous studies suggest a high rate of cesarean delivery following pelvic ring injuries.
• Risk factors for cesarean delivery in this population are not well-defined.

Purpose of the Study:

• To evaluate pregnancy outcomes in women with a history of pelvic ring injury.
• To identify risk factors associated with cesarean delivery after pelvic fracture.
• To test the hypothesis that cesarean delivery is more frequent due to factors like malunion or retained hardware.

Main Methods:

• Retrospective review combined with prospective obstetric data collection.
• Analysis of 54 pregnancies in 31 women (ages 16-40) with healed pelvic fractures.
• Fracture classification using the Orthopaedic Trauma Association (OTA) system; 55% of fractures were surgically treated.

Main Results:

• The rate of cesarean delivery increased significantly post-injury (44%) compared to pre-injury rates (17%).
• Over half of cesarean deliveries were attributed to patient or physician preference, not solely medical necessity.
• Fracture pattern, surgical treatment, or residual displacement did not significantly correlate with cesarean delivery; retained hardware showed a trend (P=0.06).

Conclusions:

• Successful pregnancy and delivery are achievable following pelvic fracture.
• Increased cesarean delivery rates are largely influenced by patient and physician preferences.
• Fracture characteristics and retained hardware are not absolute contraindications for vaginal birth; guidelines are needed.