Question: A 37 year old Primigravida, at 22 weeks presented with history of having had a left superior pubic rami fracture 18 years before by traffic accident, concerned about her mode of delivery. She is asymptomatic, but no records are available of the type of the fracture and its management. What would be the ideal investigations to assess the pelvis and when should it be offered?
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Answer: No information was identified on when or how to assess the pelvis in a pregnant woman with a history of fracture.
With regard to delivery, the NICE guideline on intrapartum care (1) recommends that individual assessment is required when planning place of birth in women with a previous fractured pelvis.
(Evidence level IV)
Two case series of pregnancies in women following pelvic fracture were identified (2-3) and report high rates of caesarean section.
(Evidence level III)
References:
- National Institute for Health and Clinical Excellence. Intrapartum care: care of healthy women and their babies during childbirth. London: RCOG Press, 2007.
- Cannada LK. Barr J. Pelvic fractures in women of childbearing age. Clinical Orthopaedics & Related Research. 468(7):1781-9, 2010 Jul. Comment in Vallier HA. Letter to the editor: pelvic fractures in women of childbearing age. Clinical Orthopaedics & Related Research. 468(10):2819 ; author reply 2820-1, 2010 Oct.
- Zhou SR. [Fracture-dislocation of pelvis in the adult female: clinical analysis of 105 cases]. [Chinese] Chung-Hua Wai Ko Tsa Chih [Chinese Journal of Surgery]. 27(8):479-81, 509-10, 1989 Aug. Abstract
Search date: July 2011
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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