The Impact of Pelvic Osteotomies on Birth Canal Anatomy and Cesarean Section Rates: A Systematic Review

Abstract

Background: Various pelvic osteotomies can be performed to improve femoral head coverage for patients with hip dysplasia and other childhood hip disorders with the goal of delaying or preventing osteoarthritis. During preoperative discussions, female patients and their parents often ask about the influence of these osteotomies on future pregnancy. The literature on this topic is varied with no consensus on the appropriateness of elective cesarean section (C-section) for such patients. Therefore, this study sought to review and summarize the literature regarding the impact of different pelvic osteotomies on birth canal anatomy and C-section rates.Methods: All studies assessing the impact of pelvic osteotomies on birth canal anatomy or pregnancy outcomes for patients were identified through a systematic search of four online databases (PubMed, Embase, CINAHL, and Cochrane Library). PRISMA guidelines were then used to evaluate all identified studies for appropriateness, leading to the final inclusion of 17 articles evaluating five general types of pelvic osteotomies.Results: The Salter, double, and triple osteotomies were found to decrease the size of the pelvic outlet in modelbased and radiographic studies. The Chiari osteotomy decreased the dimensions of the pelvic inlet/mid-pelvis and was associated with higher reported C-section rates. The Bernese periacetabular osteotomy was not associated with any changes in pelvic diameters, with reported increased rates of C-section noted to result from obstetrician preference. For osteotomies performed prior to skeletal maturity, resulting pelvic deformities largely remodeled with growth.Discussion: Pelvic osteotomies can alter normal pelvic parameters and may influence the ability for vaginal delivery. Obstetricians may recommend C-section for patients undergoing non-PAO osteotomies depending on skeletal maturity status at the time of their osteotomy and other obstetric-related factors such as fetal size and natural pelvic relaxation. The literature on this subject, however, remains limited.Levels of Evidence: Level IVKey Concepts•Pelvic osteotomies for residual hip dysplasia or other childhood hip disorders alter normal pelvic parameters that may preclude the possibility of vaginal birth, particularly when performed after skeletal maturity.•The Chiari osteotomy primarily alters the dimensions of the pelvic inlet and mid-pelvis, while the Salter, double, and triple osteotomies decrease the size of the pelvic outlet.•The Bernese periacetabular osteotomy does not influence bony birth canal anatomy.•Pelvic deformities resulting from pelvic osteotomies performed before skeletal maturity often remodel with growth.•Obstetricians may recommend cesarean section after pelvic osteotomy, particularly when performed bilaterally, dependent on obstetric-specific factors.