Do all patients with history of pelvic ring injuries need a cesarean section? - A survey of orthopaedic and obstetric providers

Jasmine Scott; Jenna Glavy; Bradley Deafenbaugh; William Kent; Yvette LaCoursiere; Alexandra Schwartz; Monica Lutgendorf; Benjamin Wheatley

doi:10.1016/j.jogoh.2024.102779

Do all patients with history of pelvic ring injuries need a cesarean section? - A survey of orthopaedic and obstetric providers

J Gynecol Obstet Hum Reprod. 2024 Mar 27;53(6):102779. doi: 10.1016/j.jogoh.2024.102779. Online ahead of print.

Authors

Jasmine Scott¹, Jenna Glavy², Bradley Deafenbaugh³, William Kent⁴, Yvette LaCoursiere⁵, Alexandra Schwartz⁴, Monica Lutgendorf⁶, Benjamin Wheatley⁷

Affiliations

¹ Department of Orthopaedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States. Electronic address: jasmine.a.scott8.mil@health.mil.
² Department of Gynecologic Surgery and Obstetrics, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States.
³ Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, 620 John Paul Circle, Portsmouth, VA 23708, United States.
⁴ Department of Orthopaedic Surgery, University of California San Diego, 9500 Gilman Drive, San Diego, CA 92093, United States.
⁵ Department of Gynecologic Surgery and Obstetrics, University of California San Diego, 9500 Gilman Drive, San Diego, CA 92093, United States.
⁶ Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States.
⁷ Department of Orthopaedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States.

PMID: 38552957
DOI: 10.1016/j.jogoh.2024.102779

Abstract

Objective(s): The recommended mode of delivery following pelvic ring fractures with surgical fixation is unclear. The objective of this study was to assess expert opinions from orthopaedic surgeons and obstetrician gynecologists on their recommended delivery recommendations for pregnant individuals with a history of pelvic ring injury, and to see if there was any difference in recommendations between the two specialties, and what factors influenced recommendations.

Study design: An electronic, web-based survey was administered to a convenience sample of orthopaedic surgeons and obstetrician gynecologists, via advertisement to members of the Orthopaedic Trauma Association (OTA), the Society for Maternal Fetal Medicine, and querying obstetrician gynecologists practicing within the Military Health System. The survey was administered from November 2021 to December 2022. A two-proportion z-test, Chi-square or Fisher's Exact Test, and descriptive statistics were used to analyze data.

Results: Survey respondents included 44 orthopaedic surgeons and 37 obstetricians. A total of 74 % obstetricians would recommend a trial of labor with hardware in place, while orthopaedic surgeon's recommendations varied based on the type of fixation. Forty four, 100 % of orthopaedic surgeons, recommended trial of labor if non-operative pelvic injury or unilateral posterior fixation only, 88 % recommended trial of labor if bilateral posterior fixation only, and 47.7 % for anterior trans-symphyseal plating only, 50 % for unilateral posterior and trans-symphyseal plating, and 43.2 % for bilateral posterior fixation with trans-symphyseal plating.

Conclusions: The results of these surveys demonstrate the lack of consensus as to the most appropriate birth plan for patients with a history of pelvic ring injuries. Vaginal delivery following pelvic ring fracture and fixation is possible, yet these patients are significantly more likely to undergo cesarean section than the general population. As such, we recommend that women who become pregnant after operative treatment of a pelvic ring injury develop an in-depth birthing plan with their obstetrician to determine the best course.

Keywords: Cesarean section; Delivery planning; Fracture; Orthopaedic; Pelvic ring injury; Pelvis.