Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland.
Reprod Health. 2022 Mar 24;19(1):73. doi: 10.1186/s12978-022-01387-w.
To date, only a few small studies have assessed the effects of major orthopedic traumas on the subsequent birth rate in fertile-aged woman. We assessed the incidences of traumatic brain injury (TBI) and fractures of the spine, pelvis, and hip or thigh and evaluated their association with the birth rate in fertile-aged woman.
In this retrospective register-based nationwide cohort study, data on all fertile-aged (15-44 years of age) women who sustained a TBI or fracture of the spine, pelvis, hip or thigh between 1998 and 2013 were retrieved from the Care Register for Health Care. A total of 22,780 women were included in TBI group, 3627 in spine fracture group, 1820 in pelvic fracture group, and 1769 in hip or thigh fracture group. The data were subsequently combined with data from the National Medical Birth Register. We used Cox regression model to analyze the hazard for a woman to give birth during 5-year follow-up starting from a major trauma. Women with wrist fractures (4957 women) formed a reference group. Results are reported as hazard ratios (HR) with 95% confidence intervals (CI).
During 5-year follow-up after major trauma, 4324 (19.0%) women in the TBI group, 652 (18.0%) in the spine fracture group, 301 (16.5%) in the pelvic fracture group, 220 (12.4%) in the hip or thigh fracture group, and 925 (18.7%) in the wrist fracture group gave birth. The cumulative birth rate was lower in the hip or thigh fracture group in women aged 15-24 years (HR 0.72, CI 0.58-0.88) and 15-34 years (HR 0.65, CI 0.52-0.82). Women with pelvic fracture aged 25-34 years also had a lower cumulative birth rate (HR 0.79, CI 0.64-0.97). For spine fractures and TBIs, no reduction in cumulative birth rate was observed. Vaginal delivery was the primary mode of delivery in each trauma group. However, women with pelvic fractures had higher rate of cesarean section (23.9%), when compared to other trauma groups.
Our results suggest that women with thigh, hip, or pelvic fractures had a lower birth rate in 5-year follow-up. Information gained from this study will be important in clinical decision making when women with previous major trauma are considering becoming pregnant and giving birth.
迄今为止，仅有少数小型研究评估了重大骨科创伤对育龄妇女随后生育率的影响。我们评估了创伤性脑损伤（TBI）和脊柱、骨盆、髋部或大腿骨折的发生率，并评估了它们与育龄妇女生育率之间的关系。
在这项回顾性基于登记的全国队列研究中，我们从医疗保健登记处检索了 1998 年至 2013 年间发生 TBI 或脊柱、骨盆、髋部或大腿骨折的所有育龄（15-44 岁）妇女的数据。共有 22780 名妇女纳入 TBI 组，3627 名妇女纳入脊柱骨折组，1820 名妇女纳入骨盆骨折组，1769 名妇女纳入髋部或大腿骨折组。随后将这些数据与全国医疗出生登记处的数据相结合。我们使用 Cox 回归模型分析了女性在主要创伤后 5 年随访期间生育的风险。腕部骨折（4957 名妇女）作为参考组。结果以风险比（HR）和 95%置信区间（CI）表示。
在主要创伤后 5 年的随访期间，TBI 组中有 4324 名（19.0%）、脊柱骨折组中有 652 名（18.0%）、骨盆骨折组中有 301 名（16.5%）、髋部或大腿骨折组中有 220 名（12.4%）和腕部骨折组中有 925 名（18.7%）妇女分娩。15-24 岁（HR 0.72，95%CI 0.58-0.88）和 15-34 岁（HR 0.65，95%CI 0.52-0.82）女性中，髋部或大腿骨折组的累积生育率较低。25-34 岁的骨盆骨折女性的累积生育率也较低（HR 0.79，95%CI 0.64-0.97）。对于脊柱骨折和 TBI，未观察到累积生育率降低。阴道分娩是每个创伤组的主要分娩方式。然而，与其他创伤组相比，骨盆骨折的女性剖宫产率更高（23.9%）。
我们的研究结果表明，大腿、髋部或骨盆骨折的女性在 5 年随访期间生育率较低。这项研究的结果对于以前受过重大创伤的女性在考虑怀孕和分娩时的临床决策非常重要。
