Pelvic fractures are commonly sustained in blunt force trauma. The incidence of pelvic ring fractures is between 2 and 8 % of all fractures and can be as high as 25 % in polytrauma patients [1], [2], [3]. Pelvic rings injuries may be managed operatively or nonoperatively. For operative pelvic ring injuries there are many different fixation options for pelvic ring injuries. Broadly, fractures are treated with screw fixation alone or with plate and screw fixation. Pelvic ring injuries can be classified by the Arbeitsgemeinschaft für Osteosynthesefragen (AO) and Orthopedic Trauma Association (OTA) classification system to determine the stability of the pelvic ring: type A stable; type B, partially unstable and type C, completely unstable [4]. This classification helps direct the fixation plan for pelvic ring injuries. For posterior pelvic ring injuries involving the sacroiliac joint these are generally fixed with screw fixation [5]. Anterior fixation can involve transsympheseal fixation with a plate and screw construct [6]. Many of these pelvic ring injuries occur in women of childbearing age who may become pregnant in the future [2,3,7]. These injuries may require surgical fixation or result in pelvic malunion. However, it is unclear how the sequelae of these injuries may affect the normal dynamic movement of the pelvis during childbirth [8], [9], [10], [11], [12].

There is a theoretical concern that the increased constraint of the pelvis due to surgical stabilization or malunion may preclude normal vaginal delivery [[8], [9], [10], [11],13]. Interestingly, no well-developed guidelines currently exist to direct treatment in these patients [8], [9], [10]. The few published articles are limited by low sample size, retrospective designs, and heterogeneity in treatment recommendations and practices. However, what these articles consistently find is that women with prior pelvic fractures deliver via cesarean section at a higher rate than compared to controls. In fact, though sample sizes are small, the what the available literature does show is that these women are able to undergo vaginal delivery successfully without complications even in the presence of retained hardware in the pelvis [[8], [9], [10],14].

The lack of standard treatment recommendations for women who subsequently become pregnant after pelvic ring injury generates confusion during pregnancy in patients with prior pelvic fractures [8], [9], [10]. Obstetricians may consult orthopaedic surgeons for advice on the recommended method of delivery while orthopaedic surgeons may commonly default to recommending cesarean delivery without evidence in spite of the benefits a vaginal delivery may provide [15,16]. The purpose of this study was to assess expert opinion on the recommended treatment of patients with a history of pelvic ring injury who become pregnant.