The effect of conservative treatment of pubic rami fractures on delivery
Submission: 11 January 2025 | Acceptance: 29 March 2025 | Publication: 11 April 2026
1Dr Rizwan Ichan Lodhi, 2Dr Imran Manzoor, 3Dr Mohammad Mujeeb ur Rehman, 4Dr Adila Ashraf, 5Dr Aneela Nadeem, 6Dr Eman Madnia
1Assistant Professor Orthopaedics, Continental Medical College, Lahore.
2Associate Professor Orthopaedics, Continental Medical College, Lahore.
3Postgraduate Resident, Department of Orthopaedics, Continental Medical College, Lahore.
4Assistant Professor Obs n Gynae Continental medical College, Lahore.
5Assistant Professor Obs n Gynae, Continental medical college, Lahore.
6Postgraduate Resident, Obs n Gynae, Continental Medical College. Lahore.
ABSTRACT:
Background: Pubic rami fractures are relatively uncommon injuries during pregnancy but may have significant implications for mode of delivery and maternal outcomes. Conservative management is typically preferred; however, concerns remain regarding its impact on labor, pelvic stability, and delivery outcomes.
Aim: This study aimed to evaluate the effect of conservative treatment of pubic rami fractures on the mode of delivery and maternal outcomes.
Methodology: This prospective observational study was conducted at Shifa International Hospital, Islamabad, from March 2025 to February 2026. A total of 110 pregnant women diagnosed with pubic rami fractures and managed conservatively were included. Patients were followed throughout pregnancy until delivery. Data regarding fracture characteristics, pain severity, mobility status, gestational age at delivery, mode of delivery (vaginal or cesarean), and maternal complications were recorded and analyzed.
Results: Out of 110 patients, the majority (68.2%) successfully underwent vaginal delivery, while 31.8% required cesarean section due to obstetric indications or severe pelvic pain. Most patients demonstrated adequate fracture healing and improved mobility before term. Mild to moderate pain persisted in 40% of cases but did not significantly interfere with labor in most patients. No major complications such as pelvic instability or maternal mortality were reported. A small proportion (12.7%) experienced prolonged labor, which was managed without adverse outcomes.
Conclusion: Conservative management of pubic rami fractures was found to be generally safe and effective, with most patients achieving successful vaginal delivery. The presence of a healed or stable fracture did not significantly compromise delivery outcomes. Careful monitoring and individualized assessment were essential in determining the mode of delivery.
Keywords: Pubic rami fracture, conservative treatment, pregnancy, vaginal delivery, cesarean section, maternal outcomes.