Pregnancy outcomes after pelvic ring injury.

OBJECTIVES: Previous studies reported negative effects of pelvic trauma on genitourinary and reproductive function with frequent cesarean delivery. Risk factors for cesarean delivery have not been well defined. The purpose of this project was to evaluate outcomes of pregnancy after pelvic ring injury. We hypothesized that cesarean delivery would be more frequent after pelvic fracture with potential causes including patient and physician preference, malunion, and retained hardware. DESIGN: Retrospective review with prospective collection of obstetric information. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Thirty-one women, 16 to 40 years old, with pregnancy after healed pelvic fracture. INTERVENTION: Orthopaedic Trauma Association (OTA) classification included 10 B-type and 21 C-type fractures, 17 (55%) of which were treated surgically. MAIN OUTCOME MEASUREMENTS: Obstetric questionnaires were obtained for 54 pregnancies after a mean 72 months follow-up. RESULTS: Sixteen women had 25 vaginal deliveries; 28% after surgical treatment for their pelvic fracture with retained anterior (16%) and/or posterior (16%) hardware, including transsymphyseal plating in three patients (12%). Thirteen women had 26 cesarean deliveries, 46% after surgical treatment for their pelvis. The new cesarean delivery rate was 44% versus 17% preinjury (P = 0.02). Two had cesarean deliveries as repeat procedures after preinjury cesarean delivery. Four had cesarean deliveries as a result of medical complications (pre-eclampsia, n = 2; breech, n = 1; labor arrest, n = 2). Seven women (54%) reported 12 cesarean deliveries (46%) resulting from pelvic fracture; three elected cesarean delivery despite their physician offering a trial of labor, whereas four were advised by their obstetrician. Cesarean delivery was not related to age, fracture pattern, treatment type, or residual pelvic displacement. A trend for cesarean delivery related to retained hardware was observed (P = 0.06). CONCLUSIONS: Uncomplicated pregnancies and deliveries are possible after pelvic fracture. The new cesarean delivery rate among these women is significantly increased with over half related to patient and obstetrical preferences. Fracture pattern, minor malalignment, and retained hardware are not absolute indications for cesarean delivery. Neither surgical care of the pelvis or retained fixation precludes successful vaginal delivery. Development of guidelines and objective indications for trial of normal labor after pelvic fracture is needed. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.