Should a history of pelvic fracture fixation be an indication for cesarean section?
Purpose To compare the success rate of a trial of labor (TOL) in a cohort of patients with pelvic fractures, with and without internal fixation, in order to better counsel patients and avoid unnecessary cesarean section (CS). Methods A retrospective review of 35 female patients with 28 pelvic ring,...
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Published in | European journal of orthopaedic surgery & traumatology Vol. 34; no. 7; pp. 3563 - 3569 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Paris
Springer Paris
16.12.2023
Springer Nature B.V |
Subjects | |
Online Access | Get full text |
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Summary: | Purpose
To compare the success rate of a trial of labor (TOL) in a cohort of patients with pelvic fractures, with and without internal fixation, in order to better counsel patients and avoid unnecessary cesarean section (CS).
Methods
A retrospective review of 35 female patients with 28 pelvic ring, five acetabular, and two combined fractures that had subsequent pregnancy; 12 patients had operative fixation and 23 did not. Fracture classification, treatment, type of fixation, mode of deliveries, and reason for CS were documented.
Results
The rate of vaginal delivery, unscheduled CS, and scheduled CS across all patients was 80.0% (
n
= 28), 14.3% (
n
= 5), and 5.7% (
n
= 2), respectively, which was similar to institutional rates of 87.0, 12.0, and 1.0%. A TOL was attempted in 91.4% (32/35) and successful in 87.5% (28/32). Patients who failed a TOL were more likely to have Tile B/C pelvic fractures (100.0 vs. 30.4%, observed difference (OD) 69.6%, 95% confidence interval (CI) 16.4, 86.3%;
p
= 0.01) and more pelvic displacement (6.0 vs. 1.5 mm, OD 4.0, CI 1.0, 18.0;
p
= 0.01). The fixation and control groups had no observed difference in successful TOL (72.7% vs. 95.2%, OD 22.5%, − 49.7%, 5.5%;
p
= 0.10).
Conclusions
A majority of women had successful vaginal deliveries after pelvic fractures, with or without fixation, suggesting that these patients should consider a TOL.
Level of evidence
Diagnostic Level III. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1432-1068 1633-8065 1432-1068 |
DOI: | 10.1007/s00590-023-03804-7 |