17-year experience of fractures in pregnancy at a single centre   — ASN Events
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17-year experience of fractures in pregnancy at a single centre   (#160)

Madhuni Herath 1 2 , Phillip Wong 1 2 3 , Anne Trinh 1 2 3 , Euan Wallace 2 4 , Peter R Ebeling 1 3 , Peter J Fuller 1 2 , Carolyn A Allan 1 2 4 , Frances Milat 1 2 3
  1. Department of Endocrinology, Monash Health, Melbourne, VIC
  2. Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne
  3. Department of Medicine, Monash University, Melbourne, VIC
  4. Department of Obstetrics & Gynaecology, Monash University, Melbourne

Background: There is limited literature examining fracture incidence and management in pregnancy.

Aim: To characterise the demographics and management of fractures over a 17-year period at a tertiary referral centre.

Methods: Building on preliminary data1, we examined medical records at Monash Health from 2000-2016 for fractures in pregnancy using the birthing outcomes system database, with the addition of ICD-10 coding. Site, mechanism, management and outcomes of fractures in pregnancy were documented.

Results: Of the 114,673 live births during this period, 37 women (mean age of 30.7 ± 1.9 years) were identified with fracture in pregnancy (~3.2 maternal fractures/10,000 live births). 32 women sustained minimal trauma fractures (MTF) and 5 had fractures due to motor vehicle accidents (MVA). 16/32 (50%) of MTF occurred in the third trimester and 14/32 (43.8%) occurred during the second trimester. MTF involved the lower limb (57%), upper limb (29%), ribs (9%) and clavicle (3%). Of MTF, 62.5% underwent surgical management: 45% during their second trimester, 20% (3rd trimester), 10% (1st trimester) and 20% had surgery postpartum. Of those with MTF, co-morbidities included asthma (10%), gestational diabetes or insulin dependent diabetes (13%) and thyroid dysfunction (6%). Vitamin D levels were not routinely measured and only 2/32 received medical follow-up postpartum for suspected osteoporosis. One patient received bisphosphonate treatment (zoledronic acid) postpartum. Most women had good post-operative alignment. Heamodynmic instability and bronchospasm complicated surgery during pregnancy in one woman. There were no adverse foetal events documented as a result of surgery. At least 38% of mothers with MTF breastfed.

Conclusion: Fracture in pregnancy is uncommon, but is frequently due to minimal trauma and over half involve the lower limb. Surgical intervention during pregnancy is often necessary. The low rate of medical follow-up in MTF is of concern, and reinforces the need for greater recognition of osteoporosis in this population.

  1. Herath M, Allan CA, Wong P, Wallace EM, Fuller PJ, Ebeling PR, Milat F. Insights into Fracture Occurring in Pregnancy. Poster presented at ANZBMS/MBSANZ/MEPSA Joint Annual Scientific Meeting; 2015 Nov 2-4; Hobart, Tasmania.