Pelvic Ring Fixation Metalware Retention and Birth Modality in Women of Childbearing Age: A Systematic Review and Meta‐Analysis

BACKGROUND: The aim of this study was to determine whether the retention of pelvic ring fixation metalware in women of childbearing age following traumatic fractures is associated with increased rates of caesarean section at subsequent childbirth. METHODS: Database searches were conducted across MEDLINE, Embase, CENTRAL and Scopus, spanning 1946-2025. Eligible studies included women of childbearing age with prior traumatic pelvic ring fractures, managed either operatively or non-operatively and compared outcomes between those with and without retained fixation metalware at the time of childbirth. The outcome of interest was the incidence of subsequent caesarean section delivery. Fixed effect meta-analysis using the Mantel-Haenszel method was undertaken, with the resultant pooled odds ratio (OR) presented as a forest plot. RESULTS: Three studies were included for review, a total of 118 births (51 caesarean section and 67 vaginal) eligible for meta-analysis. Retention of pelvic ring metalware at the time of subsequent childbirth was associated with an increased likelihood of caesarean section (OR 2.39, 95% CI 1.03-5.56; p = 0.04) compared to women giving birth without retained metalware. CONCLUSIONS: Retention of pelvic fixation metalware following pelvic ring fracture may be associated with a higher likelihood of caesarean section among women of childbearing age compared with those without metalware in situ at the time of subsequent childbirth. Further research is warranted to inform counselling and shared decision-making regarding removal of pelvic fixation metalware in this population, given the absence of consensus recommendations from any orthopaedic or obstetric advisory bodies.