Delivery outcomes following previous pelvic ring injury: A systematic review, meta-analysis and evidence informed management pathway.
systematic_review · Level I
Where this comes from
- Record sourced from PubMed, PMID 42679428.
- Also identified by DOI 10.1016/j.injury.2026.113642.
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Abstract
Pelvic ring injuries (PRI) are hypothesised to cause mechanical obstruction to the pelvic outlet thus affecting delivery mode in pregnancy. Research has shown a higher caesarean section rate following PRI as a result. Our objective was to synthesise the current evidence for delivery outcomes following PRI and appraise the influence of fracture morphology, operative management and retained implants to derive an evidence informed management pathway. A systematic review with meta-analysis of proportions was conducted in line with PRISMA guidelines. Women of reproductive age with any previous pelvic ring injury were included. Maternal and neonatal outcomes were recorded as secondary outcomes. Ten observational studies (1983-2024) contributed 1253 women and 1719 deliveries. The pooled caesarean section (CS) rate was 40% (95% CI 27-53) with high heterogeneity (I<sup>2</sup>=94%) and a wide prediction interval (8-82%). The pooled vaginal delivery rate was 60%. Trial of labour succeeded in 86% (95% CI 78-91), with intrapartum CS occurring in approximately 13% of attempted labours. Accounting for one delivery per woman and CS-naive cohorts did not change the pooled estimate. Operatively managed fractures (51% CS versus 32% non-operative, OR 2.24, 95% CI 0.92-5.44) and retained implants showed a non-significant trend towards higher CS rate. The data is inconclusive as to whether fracture morphology affects delivery outcomes. Preterm birth (aOR 1.32) and neonatal intensive care unit admission (aOR 1.31) were modestly raised but had confounding contributions. Birthweight and perinatal mortality wasunaffected. Chronic genitourinary symptoms and sexual dysfunction are associated with PRI. To conclude, CS is more common after PRI but widely varies amongst cohorts and should not be read as an individual risk. Much of the excess reflects clinician and patient preference rather than mechanical need. A trial of labour should be considered in all women with PRI unless there is a clear obstetric reason against this as retained implants, operative management and most fracture patterns are not barriers to vaginal delivery. We propose an individualised shared decision-making plan between patient and clinician when considering delivery outcomes.