The rate of elective cesarean section after pelvic or hip fracture remains high even after the long-term follow-up : A nationwide register-based study in Finland

Abstract

Introduction: There are only few studies on the effects of pelvic or hip fractures on subsequent delivery outcomes. The aim for this study is to evaluate in a nationwide sample whether the rate of elective CS and emergency CS would decrease during the time after maternal hip and pelvic fracture. Material and Methods: In this nationwide registry-based study, data on all women aged 15–49 years with pelvic or hip fractures leading to hospitalization were retrieved from the Care Register for Health Care for the years 1998–2018. Wrist fractures were used as a control group. The data were linked with data from the National Birth Register, where each first pregnancy during the 14-year follow-up is collected. The delivery outcomes of these pregnancies were analyzed. The results were interpreted with odds ratios (OR), adjusted odds ratios (aOR), and 95 % confidence intervals (CI). Results: A total of 2878 women with pelvic fracture, 1330 women with hip fracture, and 29 580 with wrist fracture found in the Care Register for Health Care. Of these, a total of 586 (20.4 %) women gave birth during the following 14 years after pelvic fracture, 147 (11.0 %) women after hip fracture, and 5255 (17.7 %) women after wrist fracture. Women with pelvic fracture had higher odds for CS during each time period. The aOR for CS was 1.62 (CI 1.22–2.12) during first 5 years, 1.87 (CI 1.33–2.62) during years 5–10, and 1.97 (CI 1.11–3.41) during years 10–14. Women with hip fractures had notably higher odds for CS during first 5 years after fracture (aOR 1.64, CI 1.40–2.67). Conclusions: The results of this study advocate that vaginal delivery is generally possible rather quickly after hip or pelvic fracture. Unplanned CS after hip fractures was more common at the beginning, but the exact reason for this remains unknown and further research should be made on this topic.