Abstract
ObjectiveOnly a few small studies have assessed the effects of pelvic fractures on pregnancies, deliveries, and rates of cesarean sections. We aimed to evaluate the effect of pelvic fractures on subsequent pregnancy and delivery in Finland. Study designIn this retrospective register-based nationwide cohort study, data on all fertile-aged (aged 15–49) women with a pelvic fracture during our study period (1998–2018) were retrieved from the Care Register for Health Care. The data were subsequently combined with data from the National Medical Birth Register. Women with pelvic fracture before pregnancy were compared with a no-fracture group consisting of 621 141 women who had had 1 156 723 singleton deliveries without a preceding pelvic fracture. We used logistic regression to analyze preterm deliveries, cesarean sections, and neonatal health. Results are reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI). ResultsA total of 2 878 women with a previous pelvic fracture were identified. Of these, 596 women had 1024 singleton deliveries after pelvic fracture. In the no-fracture group, 621 141 women had 1 156 378 singleton deliveries. Compared to the no-fracture group, women with a previous pelvic fracture had higher rates of cesarean sections (22.6% vs 15.9%) (AOR 1.55 CI 1.32–1.80), higher rate of preterm deliveries (6.2% vs 4.6%) (1.32 CI 1.01–1.69), and a higher rate of neonates requiring intensive care unit treatment (13.5% vs 10.0%) (AOR 1.35 CI 1.13–1.62). ConclusionVaginal delivery was the primary mode of delivery despite the higher rate of cesarean section among women with a previous fracture of the pelvis. The rate for preterm deliveries and need for neonatal intensive care was also higher, but the clinical importance of these findings is unclear. Our results suggest that vaginal delivery after fractures of the pelvic circle is generally safe for both mother and neonate.
Highlights
The incidence of pelvic fractures in the younger population is approximately 20/100 000 personyears. 1 In younger populations, fractures of the pelvic circle are typically the result of high energy collisions, such as falls from height or traffic accidents, whereas falls from standing height are more common in older populations. 1 Among the Finnish adult population during the years 1997-2014, around 8.2% of all pelvic fractures were treated surgically 2
Only a few small studies have assessed the effects of pelvic fractures on pregnancies, deliveries, and rates of cesarean sections
We aimed to evaluate the effect of pelvic fractures on subsequent pregnancy and delivery in Finland
Summary
The incidence of pelvic fractures in the younger population is approximately 20/100 000 personyears. 1 In younger populations, fractures of the pelvic circle are typically the result of high energy collisions, such as falls from height or traffic accidents, whereas falls from standing height are more common in older populations. 1 Among the Finnish adult population during the years 1997-2014, around 8.2% of all pelvic fractures were treated surgically 2. 4. Fractures of the pelvic circle may affect the sexual health of fertile-aged women, causing pain during sexual intercourse and sexual dysfunction.[5] To date, there have only been a few small studies that have assessed deliveries and pregnancies after pelvic fractures. Fractures of the pelvic circle may affect the sexual health of fertile-aged women, causing pain during sexual intercourse and sexual dysfunction.[5] To date, there have only been a few small studies that have assessed deliveries and pregnancies after pelvic fractures It seems that even though pelvic fractures have affected the mode of delivery, vaginal delivery is still possible after pelvic trauma.[6 7 8] even after operatively treated pelvic fractures with associated damaged pubic symphysis, vaginal delivery is still possible.[5]. It is suggested that the reason behind the increased risk for CS is most likely multifactorial and requires further investigation.[10]
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