Delivery outcomes following previous pelvic ring injury: A systematic review, meta-analysis and evidence informed management pathway.
Vinay Kumar Gupta, Syau Nian Phua, Saffron Kaur Rai et al.
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In 30 seconds
This systematic review and meta-analysis examined delivery outcomes among women of reproductive age with a previous pelvic ring injury, drawing on 10 observational studies comprising 1253 women and 1719 deliveries. The pooled caesarean section rate was 40% (95% CI 27-53), with substantial between-study heterogeneity (I 2 =94%) and a wide prediction interval (8-82%). Vaginal delivery occurred in 60% of deliveries, and trial of labour succeeded in 86% (95% CI 78-91). The authors conclude that prior injury alone does not establish a need for caesarean delivery.
Key findings
- The pooled caesarean section rate was 40% (95% CI 27-53), with high heterogeneity (I 2 =94%) and a prediction interval of 8-82%.
- Vaginal delivery accounted for 60% of deliveries; trial of labour succeeded in 86% (95% CI 78-91), with intrapartum CS in approximately 13% of attempted labours.
- Caesarean section occurred in 51% after operative management versus 32% after non-operative management (OR 2.24, 95% CI 0.92-5.44); the difference was not statistically conclusive.
- Preterm birth (aOR 1.32) and neonatal intensive care unit admission (aOR 1.31) were modestly raised, with confounding contributions; birthweight and perinatal mortality were unaffected.
Why it matters
The pooled caesarean rate may appear to support routine operative delivery after pelvic ring injury, but its wide variation across cohorts and the high success rate of trial of labour argue against treating the pooled estimate as an individual prediction. The review highlights that delivery decisions may reflect clinician and patient preference as well as mechanical considerations, and that evidence on fracture features and implants remains uncertain.
What to keep in mind
The evidence came from 10 observational studies and showed substantial heterogeneity, limiting certainty about individual risk and the effects of fracture morphology, operative management, or retained implants.