The Impact of Pelvic Osteotomies on Birth Canal Anatomy and Cesarean Section Rates: A Systematic Review Original Research

Abstract

Background: Various pelvic osteotomies can be performed to improve femoral head coverage for patients with hip dysplasia and other childhood hip disorders with the goal of delaying or preventing hip osteoarthritis. During preoperative discussions, female patients and their parents often ask about the influence of these osteotomies on future pregnancy and the possibility of vaginal birth. The literature on this topic is varied with limited discussion of potential pregnancy in the original description of these surgeries and no consensus on the appropriateness of elective cesarean section for such patients. Therefore, this study sought to understand the impact of different pelvic osteotomies on birth canal anatomy and cesarean section rates.

Methods: All studies assessing the impact of pelvic osteotomies on birth canal anatomy or pregnancy outcomes for patients were identified through a systematic search of four online databases (PubMed, Embase, CINAHL, and Cochrane Library). PRISMA guidelines were then used to evaluate all identified studies for appropriateness, leading to the final inclusion of 17 articles evaluating 5 general types of pelvic osteotomies (Salter, Double, Triple, Periacetabular, and Chiari).

Results: The Salter, Double (Sutherland), and Triple osteotomies were found to primarily decrease the size of the pelvic outlet in model-based and radiographic studies. Conversely, the Chiari osteotomy largely decreased the dimensions of the pelvic inlet and mid-pelvis and was associated with higher reported cesarean section rates. The Bernese periacetabular osteotomy was not associated with any changes in pelvic diameters, with reported increased rates of cesarean section noted to result from obstetrician preference. For osteotomies performed prior to skeletal maturity, resulting pelvic deformities largely remodeled with growth.

Discussion: Pelvic osteotomies can alter normal pelvic parameters that may influence the ability for vaginal delivery. Obstetricians may recommend cesarean section for patients undergoing Salter, Double, Triple, or Chiari osteotomies depending on skeletal maturity status at the time of surgery and other factors such as fetal size and natural pelvic relaxation at the end of pregnancy.