Orthopaedic conditions with an impact on the delivery method – review

Abstract: Almost in every country, the Caesarean section (CS) delivery ratio has been gradually increasing. Among the orthopaedic conditions, only a few are absolute indications for CS, such as pelvic deformations, which is mechanical obstacle in delivery. In addition, we can also name conditions such as pelvic injury or history of pelvic treatments (e.g. acetabular osteotomy) which may affect the way of childbirth. A full-text scientific publication search in PubMed and review of the latest guidelines was conducted. Following phrases were applied in the search strategy: ‘Caesarean section’, ‘complications’, ‘labour’, ‘orthopaedic indications’, and ‘pregnancy’. Orthopaedic indications are usually elective, so every case should be thoroughly considered before the time of delivery. Analysis of women who had undergone an acetabular osteotomy revealed that there are no significant changes in diameters before and after unilateral procedures. However, after bilateral acetabular osteotomy, Caesarean section is rather advisable. Pregnant women with a history of pelvic fracture, have a Caesarean section more than twice as much as the general population. After surgical treatment, the vaginal delivery is still highly probable. Due to the multiplicity of factors determining the qualification criteria for orthopaedic indications, each case should be considered individually. Vaginal delivery is possible after many orthopaedic operations, including post-traumatic pelvic surgery. However, few studies have been carried out to precisely identify indications for CS due to orthopaedic conditions.

Authors:
Piotr Rekawek, Magdalena Kulak, Joanna Kacperczyk-Bartnik, Pawel Bartnik, Agnieszka Dobrowolska-Redo, Ewa Romejko-Wolniewicz

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