Can SVD Occur After Pelvic Fracture?

Summary

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Podcast Summary: Can SVD Occur After Pelvic Fracture?

Dr. Chapa’s Clinical Pearls | September 3, 2025

Main Theme / Purpose

This episode tackles a common but nuanced clinical question:
Can a woman with a prior pelvic fracture — particularly with fixation hardware — safely attempt a spontaneous vaginal delivery (SVD), or is cesarean section (C-section) required?
Dr. Chapa uses a recent real-world case as the springboard for a lively, heavily evidence-based exploration, blending recent literature, orthopedics perspectives, and practical counseling pearls for clinicians.

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Key Discussion Points and Insights

1. The Real-World Clinical Scenario ([00:36])

• Patient Background: Dr. Chapa recounts a case in clinic—a late-teen pregnancy intake. The patient had a "U fracture" of the sacrum (from an MVA a year prior), treated surgically with pinning, now ambulatory with no residual issues.
• Central Concern: The patient, misinformed by a non-medical friend, fears she must have a C-section due to her prior pelvic fracture.
• Framing the Core Question:
  “If you have a patient who has a pelvic fracture... and she has some fixation points... Would you allow that patient to have a vaginal delivery?” ([04:16])

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2. Incidence and Relevance: Why This Matters ([06:30])

• Pelvic Fractures in Reproductive-Age Women:
  • Incidence: 34.3 per 100,000 (AJAAOS, 2024)
  • “Women account for about 69% of these injuries, 23% of which occur in women of childbearing age.” ([07:13])
• Takeaway: Clinicians likely to encounter these scenarios; the question is practical, not rare.

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3. Essentials of Pelvic Mobility in Childbirth ([09:29])

• Bony Pelvis in Labor:
  Movements of the pelvis (sacroiliac joints, pubic symphysis, sacrum) are crucial for fetal descent—so "intuitively," restricting these could threaten vaginal delivery.
• Data from Czech Gynecology (2024):
  Dr. Chapa reviews a study on pelvic bone movement during delivery, emphasizing that fixation can raise concerns—especially for patients and clinicians new to post-fracture deliveries.

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4. What the Evidence Says: Attempting Vaginal Birth Post-Fracture ([12:00], [13:45])

• Orthopedic Literature Review:
  “Orthopods... actually are very pro vaginal delivery... with one big caveat.” ([12:23])
• Observational Data: Cesarean rates in this group are increased (up to 47%), but:
  • It is unclear if this is due to anatomical issues or rather "patient fear, physician fear—that's called physician bias.” ([12:59])
• Key Point: For remote, healed fractures (not acute, no hematoma, hardware not crossing pubic symphysis), SVD can generally be attempted.
• Two Essential Caveats:
  1. Increased C-section rate (need to set patient expectations)—but causation is unclear.
  2. Absolute contraindication is likely when hardware bridges the pubic symphysis.
     “If there is a fixation point... that spans the pubic symphysis... those may not labor well, okay? There has to be a normal movement of the pubic symphysis...” ([14:35])

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5. Mechanisms & Intuition vs. Evidence ([15:27])

• Pelvic Mobility Recap:
  • Sacroiliac movement, pubic symphysis widening, and "nutation" (forward tilt of sacrum) all matter.
  • Complete immobilization is rare—most fixations still permit some movement, unless the pubic symphysis is fixed.
• European Journal of Obstetrics & Gynecology (2022):
  “Vaginal delivery has been found to be the primary mode of delivery even in women with a pelvic fracture, with or without fixation.” ([16:53])
  • Yet, defining the "true" rate of successful SVD is difficult due to bias and preference leading to earlier C-sections.

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6. Review of Seminal Literature and Key Quotes

a) Orthopedic Surgery Perspective ([20:29]):

• 2024, AJAAOS Global Research Review:
  • “At this time, there is no clear evidence to support an elective cesarean section as the sole indication after a prior pelvic fracture.” ([20:29])
  • “Until the increased cesarean section rate has been explained as truly coming from an obstetrical complication, counseling the patient to avoid vaginal delivery is problematic.” ([21:08])
  • Dr. Chapa’s reaction: “Man, is that—I mean, I got orthopods fighting for vaginal delivery. What? I mean, insane.” ([21:22])

b) International Orthopedics, 2023 ([22:00])

• “Reported cesarean section rates after pelvic fracture are higher... The reason... is unknown. It can be assumed that the lack of literature regarding the safety of vaginal delivery... may influence patients and obstetricians to prefer an elective C section.” ([22:32])
• Takeaway: Uncertainty—not evidence—may be driving higher C-section rates.

c) Orthopedic Trauma Association Conference, 2009 ([23:45])

• “A common thought process in the lay population and even in the obstetric community is that women who have had pelvic fractures cannot deliver vaginally. However, there is no large scale study to corroborate this.” ([24:00])
• 42% rate of NSVD after pelvic fracture (excluding those with symphysis fixation).
• “There was no patient with successful normal spontaneous vaginal delivery with transymphyseal fixation, and the women were not given a trial of labor.” ([25:11])
• Implication: Zero successful SVD with symphysis fixation—though this may reflect lack of trial more than absolute anatomical impossibility.

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7. Practical Counseling for Patients ([26:27])

• Summary Counseling Points:
  • “Having a history of pelvic fracture and pelvic bone hardware is not by itself an absolute contraindication for vaginal delivery—unless there’s pubic symphysis fixation...” ([17:58])
  • “Barring some other issue that comes up... this by itself should not be an indication [for C-section].” ([26:27])
• Patient Reassurance: Dr. Chapa’s patient reassured she can attempt vaginal delivery, with the usual caveats about trial of labor.

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Notable Quotes & Moments (with Timestamps)

• Framing the clinical dilemma:

  • "One of my friends told me I needed a C section because of my pelvic fracture. Now, mind you, her friend who's another teenager, is not medical at all." — Dr. Chapa ([03:40])

• Orthopedic-OB rivalry humor:

  • "Bbmf. Bbmf. That is a typical orthopedic progress note... Bone broke me fix." — Dr. Chapa ([11:59])
  • “Orthopods... are very pro vaginal delivery... My ortho bros. Gotta love my ortho bros.” — Dr. Chapa ([12:23])

• Meta-analysis on why C-sections are higher:

  • "It's difficult to figure out if those patients had a section because of patient fear. Physician fear. That's called physician bias." — Dr. Chapa ([13:01])

• Crux of clinical evidence:

  • “At this time, there is no clear evidence to support an elective cesarean section as the sole indication after a prior pelvic fracture.” — Dr. Chapa quoting 2024 AJAAOS ([20:29])
  • “...counseling the patient to avoid vaginal delivery is problematic.” — Same source ([21:08])
  • "The symphysis has to have a little bit of movement to allow for that shoulder to come through. It just has to. And fetal head delivery." — Dr. Chapa ([25:13])

• Key Counseling Takeaway:

  • "She was very reassured that her history of pelvic fracture did not mandate a cesarean section. So, yes, vaginal delivery is possible." — Dr. Chapa ([26:27])

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Important Segment Timestamps

• [00:36] Case introduction and clinical question
• [06:30] Pelvic fracture incidence, epidemiological relevance
• [09:29] Pelvic movement in labor (Czech Gynecology review)
• [12:00] Ortho-OB perspectives, higher C-section rates—why?
• [13:45] Criteria for SVD attempt; absolute contraindications
• [15:27] Intuition vs. evidence: biomechanics vs. outcomes
• [16:53] European literature: SVD typically possible after fracture
• [20:29] 2024 key orthopedic journal quote
• [22:00] 2023 and 2009 supporting studies; focus on symphysis fixation
• [26:27] Final counseling and reassurances for patients

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Conclusion: Clinical Pearls Recap

• Remote, well-healed pelvic fracture (even with hardware, unless at the pubic symphysis) does NOT mandate elective C-section.
• Inform patients:
  • C-section rate may be higher in this cohort but is not clearly due to biomechanical obstruction.
  • Success of SVD hinges on site of fixation (pubic symphysis being the main anatomical 'dealbreaker').
• Key Literature: Multiple recent (2024, 2023) and older sources agree — elective C-section as mainstay is unsupported by data.
• Shared Decision-Making is vital, with accurate, evidence-based counseling to counteract patient/physician bias.

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Dr. Chapa’s Signature Tone:

• Evidence-based, practical, and approachable—with humor, “ortho bro” banter, and frequent direct quotes from current literature.
• Above all, a focus on clear patient communication and individualized, myth-busting counseling.

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Transcript

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[Dr. Chapa]

Well, podcast family, as we've said many times before, sometimes we get ideas for the show from things that are hot in press or things that will soon be out in print or from questions that come in from our podcast family. And sometimes we get ideas for the show from real patient encounters. Like what happened just today. So today I was in our high risk OB clinic and we had a new patient encounter who came in for her intake take. That's our first enrollment into our prenatal care. So this is a late teenager who is in the first trimester pregnancy who has a history of a rollover mva. Now, don't worry, this was not while she was pregnant. This actually happened a year ago when obviously she was not pregnant. And with that rollover mva, she actually sustained a sacrum fracture. It's called a U fracture. Okay, so she had a U fracture of the sacrum, which required. Required pinning. So she went to orthopedics. You know, they saw her in the er. Thankfully, there was no spinal cord involvement, there was no head trauma, otherwise she was fine. No liver lacks. Everything was good. Except she did have this sacral fracture that required pinning. Okay, I've got the op report. I know exactly what they did. And she's got full ambulation, she has no residual issues. And now she was newly pregnant. So here's the question, okay? And it's good as we get ready to enter into coming into the fall for ABOG's oral board sessions for the candidates that are coming in for board certification. Here's a really good clinical question because it's. It's exactly what the patient asked me. Okay, Y' all go where this is going. Right? Right. So here's a question. Hey, Dr. Chapa, you know, I'm. I'm a little concerned about how I'm going to deliver this child because, you know, I had this orthopedic issue. I had this sacrum fracture, had P put in, and nobody really told me what to expect for delivery. So one of my friends. This is what the patient told me. One of my friends told me I needed a C section because of my pelvic fracture. Now, mind you, her friend who's another teenager, is not medical at all. Okay, so that's the question that I received today. And of course, in the back of my mind, I'm like, oh, that's a great question. That's a good podcast topic. So we're gonna bring this up. And actually, we've got recent data as of last year that sheds light on this, because it's one of these issues, guys, where if you understand the normal mechanics of labor, intuitively you would think. Intuitively you would think, wait a minute, there has to be some mobility here of the bony pelvis. There has to be some laxity and some movement to allow for the cardinal phases of labor. And so if there's anything that would disturb that, like a pelvic fracture callus or a fixation, obviously that. That would prevent normal descent. So that would be a contraindication of vaginal birth. That's intuitively what you think. The bony pelvis can't migrate and move as it's required to. And we're going to talk about some of those. Some of those movements that happen intrapartum. If that's not allowed, then why would you let a patient go through labor, just schedule her for a C section? And this was the patient's concern, because she didn't want a C section just for that. Now, she understood that she could get a section for intrapartum reasons or something else happening, but she really wanted to try vaginal. So here's the question, guys, here's the question. As we do this in an oral board style. So, doctor, you have a patient who has a pelvic fracture or a history of that, and she has some fixation points. She's got screws in her pelvic brim. Would you allow that patient to have a vaginal delivery? Well, Doctor, would you. Oh, as you sit in that oral board chair, this song starts going off in your head. Oh, my God, what do I do? Do I letter labor? Do I go straight for section? What's the right answer here? Oh, my God, what do I do? Wait for it. Wait for it. All right, that's my favorite part. That little bling bling part. All right, so anyway, that's the topic. That's the question. That's a good question, isn't it? If you have a patient who has a pelvic fracture, would you allow her to have a vaginal delivery? What would you do? Now, all of this is with the assumption, of course, that she wants to try for a vaginal delivery and doesn't want A primary section for whatever other reason. Okay, now the data is pretty clear here up to a point, because we do have some information to guide us here, although it's not a lot. Now, if you're thinking, wait, why am I even listening to this episode? Pelvic fracture, vaginal delivery, Am I really worried about this? Well, let me give you some little points here to consider. I'm glad you asked. So according to the American Journal of the Academy of Orthopedic Surgeons, their global research review. Yes, that's the journal that was published in 2024, quote, the incidence of pelvic ring injury or pelvic brim fracture is 34.3 per 100,000. So that's higher than I thought it would be, I guess. But. So that's the number that they give. 34 point per 100,000, with trauma, of course, being the most obvious causation. Now, here's what they say. Remember, this is the journal of the American Academy of Orthopedic Surgeons. Quote, women account for about 69% of these injuries. 69% guys over the majority. All right, so 69.7% of these injuries, 23% of which occur in women of childbearing age, end quote. That's not my numbers. I'm reading you from 2024, the Journal of the American Academy of Orthopedic Surgeons Global research review. So we're going to see this. I just saw this today in a patient. So because of this patient population, because of this possibility for pelvic fracture that's going to happen in a reproductive age woman, and because of the natural necessity of pelvic bone movement intrapartum to allow for the cardinal phases of labor to occur, it's a very good and natural question to ask, and it's reasonable to ask, does this require a cesarean section? Again, intuitively you would think, yes, it would require a C section. But this is one of these times, guys, where intuition may lead you down the wrong path. So that's where we're going. We're going to talk about, can SVD occur after pelvic fracture? That's what we're talking about. In honor of our patient, our little 19 year old who came in with a history of a motor vehicle accident and thank God the worst of her injuries was a pelvic fracture which required just some pinning and otherwise she's fine and obviously now is happy with her first trimester pregnancy. So let's get into this issue about pelvic fracture and mode of delivery coming up next. Tired of all the spin in women's health education. Yeah, so are we. This is Dr. Chapa's OBGYN no Spin podcast.

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[Dr. Chapa]

All right, so there actually is a nice summary of the bony pelvis movements during labor. And it comes from kind of an obscure, well, unknown journal. Well, at least it's unknown to us because we don't live in the Czech Republic. It's actually Czech Gynecology. Now, this is what's weird. Why the journal called Czech Gynecology would have a review called, quote, movements of the pelvic bones of expectant mothers during vaginal delivery, when obviously that's clearly obstetrics is beyond me. But whatever. There is this article titled movements of the bony pelvis of expectant mothers during vaginal delivery that was in the Czech Gynecology journal published in 2024. 4. All right, so this is just a year ago, so very timely. And this is the stuff that I actually reviewed with our patient setting the stage here. Hey, first of all, you know, we don't force any kind of mode of delivery on anyone, vaginal or C section. So if you really want to try vaginal delivery, I'm good as long as there's, you know, no real contraindication, like it's an arm presentation. You've got active herpes virus infection. It's not evasive previous. So I covered all these bases, Right? Meanwhile, she's kind of blinking her eyes like what? The short answer was, hey, if there's no other reason that that would say a C section would be safer because of X, Y or Z condition, which we may not know of until later on in Pregnancy. Remember, she's in the first trimester. If this is your only concern, this bony pelvis fracture history that has some fixation points into it. Not an issue. If you want to try vaginal. Absolutely. With a caveat. And I'm gonna give you that caveat in just a minute. It's gonna be relatively short episode, I think, because I'm gonna give you a couple of real nice data points here. One from 2024, one from 2023, and then jump back to 2009, all saying the same thing. And I love some of these perspectives. Some of these are coming from orthopedic journals because they kind of throw OB under the bus a little bit. My ortho bros. Gotta love my ortho bros. I got great friends in our department, in our hospitals, and I always, you know, give them a little jab. I'm like, hey, your progress note, you know, is. Is very easy because it's just four letters. Y' all ever heard this before? Bbmf. Bbmf. That is a typical orthopedic progress note. Anybody know what that is? Bbmf.

[Podcast Co-host or Assistant]

No. Come on.

[Dr. Chapa]

Bone broke me fix. Bone broke me fix. I know it's a little childish and very stereotypical, but, well, who cares? It's funny. And that's how we take jabs at each other. Trust me, I get a lot of jabs at my ortho bros table when I come in and have lunch. So the point is, thank goodness for our orthopedic surgeons. And some of these perspectives I'm gonna give you come from the ortho house. And they're like, man, OB just wants to cut everybody. I mean, let these women try. Can you believe it? From my ortho bros. They actually are very pro vaginal delivery in terms of these articles published, with one big caveat, which is a caveat that I'm talking about here, which is. I'm just gonna say it here, and then we'll walk our way into it and explain. There does tend to be a higher C section rate in these patients when looked at in observational studies. Now, it's not 80%. That'd be weird. But it's like, you know, anywhere from 40%. One report had as high as 47%, but so you're like, wait a minute. It's almost half. I mean, if half end up with a section, that doesn't sound very good. But hold on. Hold on a minute. Because it's very clear here that it's difficult to figure out if those patients had a section because of patient fear. Physician fear. That's called physician bias. Or if a true bony pelvis issue got in the way because it was a direct result of the fracture. In other words, I've looked at about 10 different articles, guys, here, spanning about 15 years to prepare for this episode. You're welcome, by the way. And so our list of references here is about 12. What is it? Let me take a Look here. It's 13. 13 references that I've got on here.

[Podcast Co-host or Assistant]

Okay?

[Dr. Chapa]

And they all say the same thing. In general, I'll give you some caveats here. But in general, unless there's. It's an acute fracture with a big hematoma that is obviously unstable, like she just had a car wreck, and now she's going into labor, that. That may be a separate issue. However, outside of that, in a patient with a past history, even with fixation, vaginal delivery can be attempted. That is not a contraindication to vaginal delivery. With two caveats. I said one caveat. But it's one and a half, really. The one first caveat is patients need to know that there is a higher rate of section in this cohort, although we don't know why. Those may not be direct obstetrical reasons. Some of those are based on patient fear and. Or physician bias. I'm gonna read you those excerpts exactly from the. From the. These articles.

[Podcast Co-host or Assistant]

Okay?

[Dr. Chapa]

And then the second issue is that the one caveat where fixation may absolutely affect delivery is if there is a fixation of the pubic symphysis.

[Podcast Co-host or Assistant]

Okay?

[Dr. Chapa]

So in most points, even if there's a sacral fracture or iliac fixation, those should be okay. The one where maybe you would like to give the patient informed consent that this is probably not going to work is that if there is a fixation point, a bridge that spans the pubic symphysis, based on the data, which is weak data, those may not labor. Well, okay? There has to be a normal movement of the pubic symphysis to allow for passage of the child. So if there is a pubic symphysis fixation, that's the issue that you want to know. All right? So as long as it's not an acute fracture, as long as it's not a big hematoma that's going with it, a remote history of fracture, even with fixation, as long as it does not involve the pubic symphysis, can allow for vaginal delivery. But as I mentioned during the intro, guys, it's kind of counterintuitive because Intuitively, you would think, look, there's so many movements that have to happen, and it's true. So many movements of the pelvis to allow for the baby to descend. That's why there's like the squatting position, you know, the flexible sacrum movements. That is big in midwifery that we now recognize in mainstream medicine, you know, whatever that means, that there are these things that have to occur for the baby to fall down the birth canal correctly. There's small movements of the sacroiliac joint. There is a pubic symphysis that does absolutely have to widen. There's some movement and little tilting of the sacrum itself. That's called mutation. Not mutation, but with an N N where the pelvic symphysis has to do a little tilt so that the baby can kind of drop into the pelvis. All of these things. There's a variety of bony pelvis movements that have to occur for the cardinal phases to happen successfully. So again, intuitive, you would think if the bony pelvis is frozen solid, it's going to get in the way. And while that is true, very few fixation surgeries would fix the pelvis completely. I mean, that would prevent mobility, right? Think about it. I mean, nothing's gonna. It's not a frozen bony pelvis that even if there's some fixation points, the rest of the pelvis should be able to give with the one possible catch that if it is a trans pubic arch, a symphysis pubis fixation, that that may be problematic. However, as this 2022 review in the European Journal of Obstetrics and Gyne stated, quote, vaginal delivery has been found to be the primary mode of delivery even in women with a pelvic fracture, with or without fixation. So, yes, vaginal delivery is possible, but the success rate is very, very hard to figure out to give a number because the data is very biased and conflicted because of surgeons calling in the flag quicker. Does that make sense? So rather than waiting, say six hours of no cervical change or descent in a patient with a pelvic fracture, the more likely to give maybe three or four hours. So it's very hard to tease this out.

[Podcast Co-host or Assistant]

Okay.

[Dr. Chapa]

However, as stated in that 2022 review from the European Journal of Obstetrician Gynecology, quote, the literature consistently demonstrate that while the rate of cesarean section is increased in this population, this is often due to patient or physician preference rather than absolute anatomical contraindications. End quote. Guys, this is not my statement. I'm Telling you exactly what I told the patient is that you can absolutely try as long as you have good mobility. There's no other issue. This has been already taken care of. It was over a year ago. And you want to try? If she doesn't want to try, that's a whole separate issue. Okay, but having a history of pelvic fracture and pelvic bone hardware is not by itself an absolute contraindication for vaginal delivery. Unless there's pubic symphysis fixation, which does seem to raise the risk of failure. All right, so there's a lot to go in here. But in general, short answer is, again, if we're practicing for the oral boards, absolutely. Assuming the patient wants to try, it's not a contraindication, although we don't. We think the C section rate's a little higher, but we're not sure why. Unless the pubic symphysis is gotten, you know, a pin in it, that's going to prevent mobility. That's going to be a flag. Okay, so this is the issue here. Now let me read you an excerpt that I found super, super interesting from 2024. It's the same journal that we gave in the intro. The Journal of the American Academy of Orthopedic Surgery, Global Research Review. This was just 2024, and it's a great reference. And of course, I'll put this on our reference list. The title is actually Pelvic Ring Fracture Management and Subsequent Pregnancy. A Summary of Current Literature.

[Podcast Co-host or Assistant]

Okay.

[Dr. Chapa]

And they have a statement here that is perfect. Perfect. Now, I'm going to give that to you when we come back.

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[Dr. Chapa]

You'Re listening to the OB GYN no Spin podcast. Back to the 2024 Journal of the American Academy of Orthopedic Surgery Global Research Review. Quote at this time. Now remember, this is Orthopods. Orthopods, for heaven's sakes. Quote at this time. There is no clear evidence to support an elective cesarean section as the sole indication after a prior pelvic fracture. End quote. Wow. I mean, we should. We can kind of end there. No, no, no. I got some better quotes coming up, but that's coming from the orthopods. Okay, so, quote, at this time, there is no clear evidence to support an elective cesarean section as the sole indication after a prior pelvic fracture, end quote. Now they go. Go on. They go on to say in this 2024 report, quote, until the increased cesarean section rate has been explained as truly coming from an obstetrical complication, counseling the patient to avoid vaginal delivery is problematic. End quote. Man, is that. I mean, I got orthopods fighting for vaginal delivery. What? I mean, insane. This was just last year, guys. Because, point of reference, we're taping this in the start of September 2025. So this was just one year ago from when we're taping this. Remarkable. There you go, Ortho bros. Good for you. Now, let's go back two years to 2023. This publication had similar conclusions. And this is from the Journal International Orthopedics. Quote, reported cesarean section rates after pelvic fracture are higher than the general population norm. This includes a large registry from Scandinavia which was recently published. Now, listen to this quote. The reason for the high rate of C section in this population is unknown. It can be assumed that the lack of literature regarding the safety of vaginal delivery after pelvic injury may influence patients. Patients and obstetricians to prefer an elective C section. End quote. Wow. All right, so we've got two different journals, 2024, 2023, going, I don't see it in the data. And I'm the bone dude.

[Podcast Co-host or Assistant]

Okay?

[Dr. Chapa]

So I want to protect the bones, but don't blame it on me. That's you guys. Remarkable. Now, let's jump from there back to 2020, 2020, 2009, and give you this statement. This was an abstract published out of the Orthopedic Trauma association, ota, a group of this review, on this very same topic. Listen to this. This is kind of harsh, but I'd expect nothing less from our ortho bros. Quote, a common thought process in the lay population and even in the obstetric community. So let's stop there for a minute. Anytime they grouped obs with the lay population, I'm like, thanks, dude. Come on now. Really? But I'm reading directly from this from the orthopedic trauma association 2009. An abstract presented at that conference. Quote, a common thought process in the lay population and even in the obstetric community is that women who have had pelvic fractures cannot deliver vaginally. However. Oh. However, there is no large scale studies to corroborate this. We had. Now they're talking about their review. A 42% rate of normal spontaneous vaginal delivery after pelvic fracture, including those. This is remarkable. Listen to this. With unstable fractures and. Or those with surgical stabilization that did not cross the symphysis. So here it is, guys. We're going to end it here very, very, very quickly. Quote, there was no patient with successful normal spontaneous vaginal delivery with transymphyseal fixation, and the women were not given a trial of labor, end quote. So did it. Did they. Was it 0% successful vaginal delivery in those with pubic symphysis? Fix it was an obstetrical issue or because they weren't allowed. The answer is because they weren't allowed to. Okay, so we don't have any data, but if those. That if it's. If there's an area that's going to fail, it most likely will be the most important part. And there's every part of pelvic mobility. Bony pelvic mobility is important intrapartum, but the symphysis has to have a little bit of movement to allow for that shoulder to come through. It just has to. And fetal head delivery.

[Podcast Co-host or Assistant]

Okay.

[Dr. Chapa]

Probably next most important is flattening of the sacrum. Third is that mutation of the spine of the sacral promontory as it tilts forward. All of those things matter, but the biggest issue seems to be that transymphyseal fixation. If there's a bridge, a metal plate in the symphysis, it's possibly the highest chance that it's not going to work, even though that is the most limited data because people haven't seemed to allow that in clinical practice. All right, so the short answer is what I told our patient is based on the kind of injury that you had. First of all, thank the Lord that you're fine. I mean, it was a rollover accident and it was terrible. And so, you know, God's hand was on that. I mean, she had a pelvic fracture. I don't mean that like that's all she had. But, you know, she could have had a lot worse. And she had what's called a ring fracture, a u ring fracture of the sacrum that was fixated. I looked at the images. I Looked at the op report, I'm like, there's no reason here why you should not have a trial of vaginal delivery. Now, you may get stuck in labor, and that's a section. Baby may have a D cell, that's a section. But those are things that just are. Are not unique to you. That's just part of labor and delivery.

[Podcast Co-host or Assistant]

Okay.

[Dr. Chapa]

And then as I told her before, barring some other issue that comes up, like active genital herpes, alpacenta, previa, vasoprevia, you start bleeding, baby's got an arm hanging out of the vagina, whatever. If there's some other issue that now that we get out, this by itself should not be an indication. And so, and we talked about this. Now she's in the first trimester. She's got a lot of time to decide. But she was very reassured that her history of pelvic fracture did not mandate. Did not mandate a cesarean section. So, yes, vaginal delivery is possible. And as stated by our ortho bros, until the increased cesarean section rate has been explained as truly coming from an obstetrical issue, and counseling the patient to avoid vaginal delivery is problematic. So there you go, Podcast family. I thought it was interesting that we did have data from 2024, 2023. We jumped back to 2009. I have got 13 references here that are pretty nice to review should you feel inclined to. Of course. We'll put this on our show notes after our little intro narrative. And again, this podcast idea came from a real world condition that just encounter that we just had earlier today in our high risk community OB clinic. All right, Podcast family. I think I've done what I'm supposed to do. Michael. Michael. There you go. Thank you. Let's take it home. Podcast family. We're thankful for all of the support that you've given us throughout the years. This has been the Ob GYN no Spin podcast. We'll see you on the next episode.