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Morino S, Ishihara M, Umezaki F, Hatanaka H, Yamashita M, Aoyama T. History of pain around the lumbopelvic region during perinatal period: a prospective cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1440-1446. [PMID: 38427055 DOI: 10.1007/s00586-024-08193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Many women experience pain around the low back and pelvic girdle during/after pregnancy. These pains have different risk factors and require independent management strategies. Therefore, an epidemiological database is required to understand when each type of pain occurs, and how serious it could be. Thus, the history of pain in the lumbopelvic region throughout the perinatal period was investigated. METHODS The information of 170 women recruited at the obstetrics and gynecology clinics in Japan was collected at 12, 24, 30, and 36 weeks of pregnancy, in the early days after childbirth, and one month after childbirth. The presence and severity of sacroiliac joint pain, pubic pain, groin pain, and low back pain were assessed using a numerical rating scale. Descriptive statistics were used to determine changes in the prevalence of pain. In addition, the change in the severity of each type of pain was observed through descriptive statistics, by including only those who had pain. RESULTS The sacroiliac joint pain showed a twofold increase from 12 to 24 weeks, while the pubic pain suddenly increased after 24 weeks. The severity of pubic and groin pain increased sharply during pregnancy. Regarding low back pain, the change in the severity was lesser than the other pains. The sacroiliac joint pain was the highest among the four pains during pregnancy. CONCLUSION Each type of pain had a different incidence rate and a different time of onset and aggravation. These results help women and health professionals to manage, and prevent these harmful symptoms.
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Affiliation(s)
- Saori Morino
- Department of Rehabilitation Science, School of Medicine, Osaka Metropolitan University, 3-7-30 Habikino, Habikino-shi, Osaka, 583-8555, Japan.
| | | | | | | | | | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Kubicka AM. Changes in plasticity of the pelvic girdle from infancy to late adulthood in Homo sapiens. Sci Rep 2023; 13:9698. [PMID: 37322042 PMCID: PMC10272276 DOI: 10.1038/s41598-023-36703-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/08/2023] [Indexed: 06/17/2023] Open
Abstract
Previous research on the effects of body mass on the pelvic girdle focused mostly on adult females and males. Because the ontogenetic plasticity level in the pelvis remains largely unknown, this study investigated how the association between body mass index (BMI) and pelvic shape changes during development. It also assessed how the large variation in pelvic shape could be explained by the number of live births in females. Data included CT scans of 308 humans from infancy to late adulthood with known age, sex, body mass, body stature, and the number of live births (for adult females). 3D reconstruction and geometric morphometrics was used to analyze pelvic shape. Multivariate regression showed a significant association between BMI and pelvic shape in young females and old males. The association between the number of live births and pelvic shape in females was not significant. Less plasticity in pelvic shape in adult females than during puberty, perhaps reflects adaptation to support the abdominopelvic organs and the fetus during pregnancy. Non-significant susceptibility to BMI in young males may reflect bone maturation accelerated by excessive body mass. Hormonal secretion and biomechanical loading associated with pregnancy may not have a long-term effect on the pelvic morphology of females.
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Affiliation(s)
- Anna Maria Kubicka
- Department of Zoology, Poznań University of Life Sciences, Wojska Polskiego 71C, 60-625, Poznań, Poland.
- PaleoFED Team, Département Homme et Environnement, Muséum National d'Histoire Naturelle. Musée de l'Homme, UMR 7194, CNRS, Place du Trocadéro 17, 75016, Paris, France.
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Filippini C, Saran S, Chari B. Musculoskeletal steroid injections in pregnancy: a review. Skeletal Radiol 2023:10.1007/s00256-023-04320-9. [PMID: 36917270 DOI: 10.1007/s00256-023-04320-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
Pregnant women experience a wide range of musculoskeletal pain disorders, which include general ailments occurring during pregnancy, exacerbation of pre-existing conditions, or pregnancy-specific pain/inflammatory conditions. There are significant concerns and knowledge gaps surrounding the safety, dosage, and potential long-term effects of several drugs used during pregnancy. Our article reviews the use of focal steroid injections during pregnancy. A mixture of case studies, meta-analyses, and randomised controlled trials have shown at least there is no adverse side effect to the mother or baby from maternal use of non-systemic injection during pregnancy and a significant improvement in symptoms of pain or paraesthesia can be achieved in patients that do not respond to more conservative measures. As with all patients, the use of steroid injection should be judged on a case-by-case basis to ensure that it is the most appropriate treatment choice. However, being pregnant should not be considered a contraindication to a single dose of non-systemic steroid administration, as these women can achieve significant symptomatic relief that reduces reliance on systemic medication and can significantly improve their quality of life.
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Affiliation(s)
- Claire Filippini
- Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK
| | - Sonal Saran
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Basavaraj Chari
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK.
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Nyrhi L, Kuitunen I, Ponkilainen V, Jokihaara J, Huttunen TT, Mattila VM. Incidence of Peripheral Nerve Decompression Surgery During Pregnancy and the First Year After Delivery in Finland From 1999 to 2017: A Retrospective Register-Based Cohort Study. J Hand Surg Am 2023; 48:452-459. [PMID: 36922291 DOI: 10.1016/j.jhsa.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/18/2022] [Accepted: 01/04/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE We aimed to report the incidence of peripheral nerve decompression surgery during pregnancy and 12 months after delivery in Finland from 1999 to 2017. METHODS Using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register, all women of potentially childbearing age (15-49 years) who underwent peripheral nerve decompression surgery or had a pregnancy ending in delivery from January 1, 1999, to December 31, 2017, were included. Incidence rates and incidence rate ratios for operations were calculated for both childbearing women and the age-adjusted general female population. RESULTS In total, 308 women underwent carpal tunnel release (CTR) during pregnancy, and an additional 675 women underwent CTR within 12 months after delivery. The incidence of CTR during pregnancy was 38 per 100,000 person-years, with an incidence rate ratio of 0.5 (95% CI, 0.4-0.6), when compared with that in the general population. Women who were active smokers before becoming pregnant were more likely to undergo CTR during pregnancy (odds ratio, 2.4; 95% CI, 1.8-3.0). The highest rates of CTR were observed during the first trimester. The incidence of CTR in the first postpartum year increased steadily during the first 4 months to 79 per 100,000 person-years. During the latter 8 months, incidences were similar to those in the general population (incidence rate ratio, 1.0; 95% CI, 0.9-1.2). Women who smoked were more likely to undergo CTR during the first postpartum year (odds ratio, 1.6; 95% CI, 1.3-1.9). CONCLUSIONS Carpal tunnel release is performed more rarely during pregnancy than in the age-matched general population. Postpartum incidences increased toward the end of the first year, reaching those observed in the general population after the first 4 months. Smoking before pregnancy is associated with increased incidences of CTR both during pregnancy and the first year after delivery. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Lauri Nyrhi
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Ilari Kuitunen
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland; School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Jarkko Jokihaara
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - Tuomas T Huttunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
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SARIYILDIZ A, COŞKUN BENLİDAYI İ. Gebelik Dönemindeki Potansiyel Kas-İskelet Sistemi Sorunları. ARŞIV KAYNAK TARAMA DERGISI 2022. [DOI: 10.17827/aktd.1178874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Gebelik sırasında kadınlarda çeşitli fizyolojik ve anatomik değişiklikler meydana gelmektedir. Bu biyomekanik, hormonal ve vasküler değişiklikler gebelik ilerledikçe belirginleşmektedir. Kas-iskelet sistemi bu değişimlerden en çok etkilenen sistemlerden biridir. Gebelikle ilişkili kas-iskelet sistemi problemlerinin başında bel ağrısı gelmekte ve bunu sırt ağrısı, el-el bilek ağrısı ve kalça ağrısı takip etmektedir. Gebelikle ilişkili bu problemlerin çoğu gebelikten sonraki aylarda düzelmektedir. Ancak bazı gebelerde ciddi ağrı ve dizabiliteye neden olmaktadır. Bu nedenle, gebelik döneminde görülen kas-iskelet sistemi problemlerinin erken tanınması, koruyucu önlemlerin alınması ve bireysel tedavinin planlanması önemlidir. Bu yazıda, gebelik döneminde görülen kas-iskelet sistemi değişiklikleri, sık görülen patolojiler ve bu problemlerin tedavisi ile ilgili güncel literatürün gözden geçirilmesi amaçlanmaktadır.
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Tanaka MJ, Forman JM, Otwell AG, Frischmann LD, Jones LC, Szymanski LM. Characterization of knee dysfunction and related risk factors during pregnancy. PHYSICIAN SPORTSMED 2022; 50:78-83. [PMID: 33507121 DOI: 10.1080/00913847.2021.1882277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Knee pain can be a common complaint during pregnancy; however, the severity of symptoms and their associated risk factors have not been described. QUESTIONS/PURPOSES The aim of this study was to characterize knee-related dysfunction and describe risk factors in a general obstetric population. PATIENTS AND METHODS Patients in obstetric clinics completed the International Knee Documentation Committee (IKDC) questionnaire to assess their knee function, as well as the Pregnancy Physical Activity Questionnaire (PPAQ), a validated tool to assess physical activity. Age, weeks gestation, height, weight, and history of knee problems prior to pregnancy were analyzed to identify independent associations with IKDC score and determine predictors of knee dysfunction. RESULTS 310 patients were included in this study, of which 68, 111 and 131 were in their first, second and trimesters, respectively. Mean age of the total study group was 30.3 ± 5.5 years. Knee function decreased with each trimester, from a mean IKDC score of 88.9 ± 13.0 in the first trimester, 84.5 ± 16.8 in the second, and 82.0 ± 20.0 in the third, with corresponding decreases in activity levels of 258.5 ± 141.7, 254.0 ± 141.5, and 246.1 ± 156.6 MET-h/wk. Of the total study group, 26.1% had IKDC scores <75, including 13.2%, 25.2%, and 33.6% in the first, second and third trimesters. Risk factors for knee dysfunction included high activity levels of PPAQ ≥ 500 MET-h/wk (OR 2.8), history of knee problems (OR 2.7), age <25 years (OR 2.6), and BMI ≥ 30 kg/m2 (OR 1.9). CONCLUSION In our cohort, 26.1% of pregnant women reported severe knee dysfunction, and this was associated with high levels of activity, younger age, greater BMI, and history of knee problems. These findings may have implications for women who wish to maintain training and fitness during pregnancy. Future studies are recommended to assess the need for intervention, as well as to identify optimal methods to prevent and address symptoms in this population. LEVEL OF EVIDENCE IV, Case Series.
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Affiliation(s)
- Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jared M Forman
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Alexandra G Otwell
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Leah D Frischmann
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Linda M Szymanski
- Division of Maternal-Fetal Medicine, Mayo Clinic, Rochester, MD, USA
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Parker EA, Meyer AM, Goetz JE, Willey MC, Westermann RW. Do Relaxin Levels Impact Hip Injury Incidence in Women? A Scoping Review. Front Endocrinol (Lausanne) 2022; 13:827512. [PMID: 35185802 PMCID: PMC8855110 DOI: 10.3389/fendo.2022.827512] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/05/2022] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The aim of this review is to assess the current evidence regarding the impact of relaxin on incidence of soft tissue hip injuries in women. METHODS A trained research librarian assisted with searches of PubMed, Embase, CINAHL, and SPORTDiscus, with a preset English language filter. The review was completed per the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis methodology. Included studies required assessment of relaxin effects on musculoskeletal health, pelvic girdle stability, or hip joint structures in human subjects. Letters, texts, and opinion papers were excluded. RESULTS Our screen yielded 82 studies. Molecularly, relaxin activates matrix metalloproteinases (MMPs) including collagenases MMP-1/-13 and gelatinases MMP-2/-9 to loosen pelvic ligaments for parturition. However, relaxin receptors have also been detected in female periarticular tissues, such as the anterior cruciate ligament, which tears significantly more often during the menstrual cycle peak of relaxin. Recently, high concentrations of relaxin-activated MMP-9 receptors have been found on the acetabular labrum; their expression upregulated by estrogen. CONCLUSIONS Menstrual cycle peaks of relaxin activate MMPs, which locally degrade collagen and gelatine. Women have relaxin receptors in multiple joints including the hip and knee, and increased relaxin correlates with increased musculoskeletal injuries. Relaxin has paracrine effects in the female pelvis on ligaments adjacent to hip structures, such as acetabular labral cells which express high levels of relaxin-targeted MMPs. Therefore, it is imperative to investigate the effect of relaxin on the hip to determine if increased levels of relaxin are associated with an increased risk of acetabular labral tears.
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Affiliation(s)
- Emily A. Parker
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
- *Correspondence: Emily A. Parker,
| | - Alex M. Meyer
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Jessica E. Goetz
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
- Orthopedic Biomechanics Laboratories, Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Michael C. Willey
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Robert W. Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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Allameh F, Javadi A, Dadkhahfar S, Naeeji Z, Moridi A, Tadayon N, Alahyari S. A Systematic Review of Elective Laser Therapy during Pregnancy. J Lasers Med Sci 2021; 12:e50. [PMID: 34733773 DOI: 10.34172/jlms.2021.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/26/2021] [Indexed: 12/15/2022]
Abstract
Introduction: Currently, lasers are used to treat many diseases and their complications. However, the use of lasers in pregnant patients is still controversial. Methods: In this review, the application of lasers in the fields of urology, surgery, obstetrics, dermatology, and musculoskeletal disorders is evaluated. The following keywords were used to search through PubMed, Google Scholar, and Scopus: pregnancy, laser, urolithiasis, endovenous laser ablation (EVLA) or treatment, leg edema, varicose vein, venous insufficiencies, hair removal, pigmentation, telangiectasia, vascular lesions, Q switch laser, diode laser, holmium, holmium-YAG laser, erbium laser and Pulsed dye laser, low-level laser therapy, high-intensity laser therapy, pain, musculoskeletal disorders, twin to twin transfusion syndrome (TTTS), amnioreduction, and safety. Results: Totally, 147 articles were found, and their abstracts were evaluated; out of 53 articles extracted, 14 articles were about dermatology, 24 articles were about urology, 12 articles were about obstetrics and gynecology, 10 articles were about musculoskeletal disorders and three articles were related to surgery. Conclusion: Laser therapy can be used as a safe treatment for urolithiasis, skin diseases, TTTS and varicose veins of the lower extremities. However, the use of laser therapy for musculoskeletal disorders during pregnancy is not recommended due to lack of evidence, and also we cannot recommend endovenous ablation.
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Affiliation(s)
- Farzad Allameh
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Javadi
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Naeeji
- Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Moridi
- Department of Gynecology and Obstetrics, Mahdiye Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niki Tadayon
- Department of General and Vascular Surgery, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sam Alahyari
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kjeldsen LL, Blankholm AD, Jurik AG, Salvig JD, Maimburg RD. Pelvic capacity in pregnant women, identified using magnetic resonance imaging. Acta Obstet Gynecol Scand 2021; 100:1454-1462. [PMID: 33991336 DOI: 10.1111/aogs.14168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/13/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Maternal pelvic capacity plays a major role during childbirth because the passage of the fetus through the bony birth canal enables vaginal birth. Maternal birthing position may influence pelvic capacity because upright positions optimize capacity, possibly due to free movement of the pelvic joints. Herein, pelvic capacity was assessed by comparing changes in pelvic dimensions across pregnancy and in three birthing positions. MATERIAL AND METHODS This diagnostic imaging study of 50 pregnant women was conducted at Aarhus University Hospital, Denmark. Pelvic measurements were obtained with 1.5 T magnetic resonance pelvimetry during gestational weeks 20 and 32, in three birthing positions: kneeling squat, semi-lithotomy and supine. Pelvic capacity was compared between gestational weeks and positions. RESULTS In all three positions there is an overall increase in pelvic capacity from gestational week 20-32 at both the pelvic inlet and outlet. Comparing pelvic capacity at gestational week 32 between the semi-lithotomy and supine positions revealed that the pelvic inlet was larger in the supine position, whereas the mean pelvic outlet was 0.2 cm (p < 0.001) larger in the semi-lithotomy position. Likewise, the pelvic inlet was larger in the supine than in the kneeling squat position. Shifting from supine to kneeling squat position increased the midplane and pelvic outlet dimensions by up to 1 cm (p < 0.001). CONCLUSIONS The finding herein of an increased pelvic capacity as the pregnancy progresses is novel. Further, the results indicate that the supine position is optimal for increasing pelvic inlet size, whereas the semi-lithotomy and kneeling squat positions are optimal for increasing mid- and outlet-pelvic capacities.
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Affiliation(s)
- Louise L Kjeldsen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Midwifery, University College of Northern Denmark, Aalborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Anne Grethe Jurik
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jannie D Salvig
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke D Maimburg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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Sung JH, Kang M, Lim SJ, Choi SJ, Oh SY, Roh CR. A case-control study of clinical characteristics and risk factors of symptomatic postpartum pubic symphysis diastasis. Sci Rep 2021; 11:3289. [PMID: 33558543 PMCID: PMC7870961 DOI: 10.1038/s41598-021-82835-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/25/2021] [Indexed: 01/27/2023] Open
Abstract
Postpartum pubic symphysis diastasis (PPSD) refers to the separation of pubic symphysis after delivery. It is typically diagnosed based on clinical symptoms and radiologic findings. This study tried to assess clinical characteristics and risk factors of PPSD. This was a nested case-control study matched for year of delivery and gestational age at delivery using a retrospective cohort of women who delivered vaginally at a single institution. The incidence of PPSD was 0.156% (33/21,131). The incidence rate increased from 0.08% (7/9328) in 2000-2004 to 0.13% (9/7138) in 2005-2009 and to 0.36% (17/4665) in 2010-2016, simultaneously with an increase of maternal age (30.7 ± 3.5 years in 2000-2004 to 31.8 ± 3.8 years in 2005-2009 and 32.8 ± 3.8 years in 2010-2016). Nulliparity was associated with a higher incidence of PPSD (81.8% in cases vs. 57.6% in controls, p = 0.01). Other factors including pre-pregnancy body mass index, weight gain during pregnancy, gestational diabetes, induction of labor, duration of labor, epidural anesthesia, vacuum-assisted delivery, episiotomy, neonatal sex and birth weight failed to show difference between the two groups. In short, the incidence of PPSD increased with time along with an increase of maternal age. Nulliparity was the only significant risk factor for PPSD.
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Affiliation(s)
- Ji-Hee Sung
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Mina Kang
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seung-Jae Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Cheong-Rae Roh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
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Iuamoto L, Ferreira V, Hsing W. Multidisciplinary management of musculoskeletal pain during pregnancy: A review of literature. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2021. [DOI: 10.4103/jisprm-000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Swany L, Larson AN, Shah SA, Grabala P, Milbrandt T, Yaszemski MJ. Outcomes of pregnancy in operative vs. nonoperative adolescent idiopathic scoliosis patients at mean 30-year follow-up. Spine Deform 2020; 8:1169-1174. [PMID: 32578160 DOI: 10.1007/s43390-020-00158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine whether patients who underwent surgical treatment of adolescent idiopathic scoliosis (AIS) in childhood would have an increased C-section risk in adulthood. Although the impact of scoliosis on future pregnancy and child delivery is a common question for patients and parents, there is limited data regarding pregnancy outcomes following childhood treatment of AIS. METHODS Between 1975 and 1992, 60 female patients underwent treatment for AIS with bracing, surgery, or observation and had data available regarding obstetrical history in the electronic medical record or in paper charts. In childhood, 28 had nonoperative treatment and 32 had fusion surgery. During the follow-up period, 2 nonoperative patients and 1 operative patient had fusion surgery in adulthood, but after childbearing years. Mean age at latest follow-up was 43 years (CI 38, 48). Meantime to follow-up since childhood treatment was 31 years (CI 26, 35). RESULTS 29% of nonoperative patients had a C-section with at least one live birth compared to 38% of operative patients (p = 0.464). For surgical patients fused to L3 or lower, 46% required at least one C-section, compared to 32% of patients fused to L2 or higher (p = 0.40). Overall, 33% of the cohort of patients-including those with all scoliosis treatment methods-required at least one C-section, compared to the state weighted C-section rate of 20.5% (p = 0.014). The percentage of patients with operative treatment-including all levels of fusion-requiring at least one C-section was statistically different than the weighted state C-section rate (p = 0.020). CONCLUSION In this long-term cohort of 60 US scoliosis patients, childhood operative fusion treatment was associated with a statistically significant increased incidence of C-section compared to the state incidence at both the patient level and the delivery level. LEVEL OF EVIDENCE III, comparative cohort study.
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Affiliation(s)
- Lauren Swany
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 200 1st St SW, USA
| | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 200 1st St SW, USA.
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Pawel Grabala
- Department of Pediatric Orthopaedic Surgery and Traumatology, Medical University of Bialystok, Bialystok, Poland
| | - Todd Milbrandt
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 200 1st St SW, USA
| | - Michael J Yaszemski
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 200 1st St SW, USA
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Austin K, Schoenberger H, Saha S. Special situations: Performance of endoscopy while pregnant. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kesikburun S, Güzelküçük Ü, Fidan U, Demir Y, Ergün A, Tan AK. Musculoskeletal pain and symptoms in pregnancy: a descriptive study. Ther Adv Musculoskelet Dis 2018; 10:229-234. [PMID: 30515249 PMCID: PMC6262502 DOI: 10.1177/1759720x18812449] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 10/04/2018] [Indexed: 11/16/2022] Open
Abstract
Background Pregnancy-induced hormonal and physiologic changes increase the risk of musculoskeletal problems in pregnancy. The purpose of this report is to provide a comprehensive look at the musculoskeletal pain and symptoms experienced during pregnancy. Methods A total of 184 women (mean age 30.9 ± 5.0 years) who gave birth in the obstetrics clinic of a tertiary hospital were included in the study. The participants who had given birth at 37-42 weeks of pregnancy (term pregnancy) and aged over 18 years were selected for participation. Basic demographic and clinical characteristics of the participants including age, body mass index, weight gained during pregnancy, education level, occupation, parity, sex of baby, and exercise habits were collected from the medical chart and face-to-face interviews. Musculoskeletal pain sites were defined as hand-wrist, elbow, shoulder, neck, back, low back, hip, knee, and ankle-foot in a diagram of the human body. The interviews with participants were performed to assess their musculoskeletal pain separately at each trimester follow-up visit. Results The most frequent musculoskeletal complaints during pregnancy were low back pain (n = 130, 70.7%), back pain (n = 80, 43.5%), hand-wrist (n = 61, 33.2%) and hip pain (n = 59, 32.1%). The participants experienced musculoskeletal pain most in the third trimester except for elbow, shoulder and neck pain compared with the first and second trimesters (p < 0.05). Conclusions The results of the study suggest that numerous musculoskeletal problems may complicate pregnancy especially in the third trimester.
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Affiliation(s)
- Serdar Kesikburun
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gülhane School of Medicine, Gaziler Physical Therapy and Rehabilitation Research and Training Hospital, Gaziler Fizik Tedavi ve Rehabilitasyon Eğitim Araştırma Hastanesi 06800 Bilkent-Ankara, Turkey
| | - Ümüt Güzelküçük
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gülhane School of Medicine, Gaziler Physical Therapy and Rehabilitation Research and Training Hospital, Ankara, Turkey
| | - Ulaş Fidan
- Department of Gynecology and Obstetrics, University of Health Sciences, Gulhane School of Medicine, Ankara, Turkey
| | - Yasin Demir
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gülhane School of Medicine, Gaziler Physical Therapy and Rehabilitation Research and Training Hospital, Ankara, Turkey
| | - Ali Ergün
- Department of Gynecology and Obstetrics, University of Health Sciences, Gulhane School of Medicine, Ankara, Turkey
| | - Arif Kenan Tan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gülhane School of Medicine, Gaziler Physical Therapy and Rehabilitation Research and Training Hospital, Ankara, Turkey
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Duarte VM, Meucci RD, Cesar JA. Dor lombar intensa em gestantes do extremo Sul do Brasil. CIENCIA & SAUDE COLETIVA 2018; 23:2487-2494. [DOI: 10.1590/1413-81232018238.22562016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/23/2016] [Indexed: 08/30/2023] Open
Abstract
Resumo O objetivo deste artigo é medir a prevalência e identificar fatores associados à dor lombar intensa (DL intensa) entre parturientes do município de Rio Grande, RS, Brasil, em 2013. Questionário padronizado aplicado por entrevistadoras previamente treinadas em até 48 horas após o parto. Realizou-se análise multivariável utilizando regressão de Poisson tendo a razão de prevalência como medida de efeito. Dentre as 2685 parturientes incluídas no estudo, 51,2% referiram dor lombar gestacional e 27,3% tinham DL intensa, com maior probabilidade de ocorrência entre adolescentes, mulheres com sobrepeso/obesidade, ex-fumantes e naquelas que praticaram atividade física na gestação. Entre as parturientes que tiveram DL intensa, 29,2%, 37,3% e 33,3% tiveram que deixar de fazer as lidas da casa, faltar ao trabalho e procurar um médico devido à DL, respectivamente. É elevada a prevalência de dor lombar intensa no período gestacional e preocupante seu impacto sobre as atividades da vida diária e utilização de serviços de saúde. Recomenda-se investigação clínica e manejo da dor lombar durante a gestação nas consultas de rotina do pré-natal.
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Abstract
Chronic anterior pelvic ring instability can cause pain and disability. Pain typically is localized to the suprapubic area or inner thigh; often is associated with lower back or buttock pain; and may be exacerbated by activity, direct impact, or pelvic ring compression. Known etiologies of chronic anterior pelvic ring instability include pregnancy, parturition, trauma, insufficiency fractures, athletics, prior surgery, and osteitis pubis. Diagnosis often is delayed. Physical examination may reveal an antalgic or waddling gait, tenderness over the pubic bones or symphysis pubis, and pain with provocative maneuvers. AP pelvic radiographs may demonstrate chronic degenerative changes at the pubic symphysis or nonhealing fractures. Standing single leg stance (flamingo view) radiographs can demonstrate pathologic motion at the pubic symphysis. CT may be useful in assessing posterior pelvic ring involvement. The initial management is typically nonsurgical and may include the use of an orthosis, activity modification, medication, and physical therapy. If nonsurgical modalities are unsuccessful, surgery may be warranted, although little evidence exists to guide treatment. Surgical intervention may include internal fixation alone in select patients, the addition of bone graft to fixation, or symphyseal arthrodesis. In some patients, additional stabilization or arthrodesis of the posterior pelvic ring may be indicated.
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Hensel KL, Carnes MS, Stoll ST. Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects: The PROMOTE Study Protocol. J Osteopath Med 2016; 116:716-724. [PMID: 27802557 DOI: 10.7556/jaoa.2016.142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The structural and physiologic changes in a woman's body during pregnancy can predispose pregnant women to low back pain and its associated disability, as well as to complications of pregnancy, labor, and delivery. Anecdotal and empirical evidence has indicated that osteopathic manipulative treatment (OMT) may be efficacious in improving pain and functionality in women who are pregnant. Based on that premise, the Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects (PROMOTE) study was designed as a prospective, randomized, placebo-controlled, and blinded clinical trial to evaluate the efficacy of an OMT protocol for pain during third-trimester pregnancy. The OMT protocol developed for the PROMOTE study was based on physiologic theory and the concept of the interrelationship of structure and function. The 12 well-defined, standardized OMT techniques used in the protocol are commonly taught at osteopathic medical schools in the United States. These techniques can be easily replicated as a 20-minute protocol applied in conjunction with usual prenatal care, thus making it feasible to implement into clinical practice. This article presents an overview of the study design and treatment protocols used in the PROMOTE study.
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Aydın S, Bakar RZ, Aydın ÇA, Özcan P. Assessment of postpartum symphysis pubis distention with 3D ultrasonography: a novel method. Clin Imaging 2016; 40:185-90. [PMID: 26995568 DOI: 10.1016/j.clinimag.2015.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/17/2015] [Accepted: 10/30/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Determining the accuracy of three-dimensional (3D) sonographic measurement of symphysis pubis (SP) distension in comparison to plain X-ray pelvic radiographs and assessing the interperformer reliability of this method. METHODS Pelvic X-ray was performed on 86 women who delivered singleton babies within 36 h of delivery then each woman was examined by 3D transperineal ultrasound imaging by two sonogrographers. RESULTS Measurements of SP with 3D transperineal ultrasonography in comparison to pelvic X-ray showed 95% limits of agreement. Interperformer reproducibility was substantial (interclass correlation coefficient 0.66-0.70) for measures of SP. CONCLUSIONS Pubic symphysis width, superior pubic ligament length, and SP height can be reliably measured with 3D ultrasonography.
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Affiliation(s)
- Serdar Aydın
- Bezmialem University Obstetric and Gynecology Department, İstanbul, Turkey.
| | - Rabia Zehra Bakar
- Bezmialem University Obstetric and Gynecology Department, İstanbul, Turkey
| | | | - Pınar Özcan
- Bezmialem University Obstetric and Gynecology Department, İstanbul, Turkey
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Matthews LJ, McConda DB, Lalli TAJ, Daffner SD. Orthostetrics: Management of Orthopedic Conditions in the Pregnant Patient. Orthopedics 2015; 38:e874-80. [PMID: 26488781 DOI: 10.3928/01477447-20151002-53] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 02/04/2015] [Indexed: 02/03/2023]
Abstract
Managing orthopedic conditions in pregnant patients leads to challenges that must be carefully considered so that the safety of both the mother and the fetus is maintained. Both perioperative and intraoperative considerations must be made based on physiologic changes during pregnancy, risks of radiation, and recommendations for monitoring. Operative timing, imaging, and medication selection are also factors that may vary based on trimester and clinical scenario. Pregnancy introduces unique parameters that can result in undesirable outcomes for both mother and fetus if not handled appropriately. Ultimately, pregnant patients offer a distinct challenge to the orthopedic surgeon in that the well-being of 2 patients must be considered in all aspects of care. In addition, not only does pregnancy affect the management of orthopedic conditions but the pregnant state also causes physiologic changes that may actually induce various pathologies. These pregnancy-related orthopedic conditions can interfere with an otherwise healthy pregnancy and should be recognized as possible complications. Although the management of orthopedic conditions in pregnancy is often conservative, pregnancy does not necessarily preclude safely treating pathologies operatively. When surgery is considered, regional anesthesia provides less overall drug exposure to the fetus and less variability in fetal heart rate. Intraoperative fluoroscopy can be used when appropriate, with 360° fetal shielding if possible. Lateral decubitus positioning is ideal to prevent hypotension associated with compression of the inferior vena cava.
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Postpartum Sacral Stress Fracture: An Atypical Case Report. Case Rep Orthop 2015; 2015:704393. [PMID: 26246926 PMCID: PMC4515257 DOI: 10.1155/2015/704393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/08/2015] [Indexed: 11/18/2022] Open
Abstract
Sacral stress fractures are common in elderly people. However, sacral stress fracture should be always screened in the differential diagnoses of low back pain during the postpartum period. We present a case of sacral fracture in a thirty-six-year-old woman with low back pain and severe right buttock pain two days after cesarean section delivery of a 3.9 Kg baby. The diagnosis was confirmed by MRI and CT scan, while X-ray was unable to detect the fracture. Contribution of mechanical factors during the cesarean section is not a reasonable cause of sacral fracture. Pregnancy and lactation could be risk factors for sacral stress fracture even in atraumatic delivery such as cesarean section. Our patient had no risk factors for osteoporosis except for pregnancy and lactation. Transient or focal osteoporosis is challenging to assess and it cannot be ruled out even if serum test and mineral density are within the normal range.
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Prevalence of musculoskeletal dysfunctions among Indian pregnant women. J Pregnancy 2015; 2015:437105. [PMID: 25642349 PMCID: PMC4302374 DOI: 10.1155/2015/437105] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 12/18/2014] [Accepted: 12/19/2014] [Indexed: 12/01/2022] Open
Abstract
Background and Objectives. Pregnancy triggers a wide range of changes in a woman's body leading to various musculoskeletal dysfunctions. Most commonly reported musculoskeletal discomforts by pregnant women are low back pain and symphysis pubis pain. The culture and the environmental factors may influence the discomforts experienced by a pregnant woman. There is a dearth of literature in India, regarding the common musculoskeletal dysfunctions experienced by a pregnant woman, and hence this study. Method. A questionnaire to identify the musculoskeletal dysfunction was developed; content was validated and was translated to local languages through parallel back translation. 261 primiparous pregnant women participated in the study and filled the questionnaire in their native language. Results. Among the musculoskeletal dysfunctions reported by the pregnant women, 64.6% reported calf muscle cramps, 37.1% reported foot pain, and 33.7% experienced low back pain in their third trimester. In the second trimester, common musculoskeletal dysfunctions experienced by the women were that of calf pain (47.8%), low back pain (42%), and pelvic girdle pain (37%). Conclusion. Musculoskeletal dysfunctions and general discomforts very commonly affect the activities of daily living of pregnant women. Understanding the common discomforts during various trimesters of pregnancy will help to develop a comprehensive program for prevention and cure.
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Bhardwaj A, Nagandla K. Musculoskeletal symptoms and orthopaedic complications in pregnancy: pathophysiology, diagnostic approaches and modern management. Postgrad Med J 2014; 90:450-60. [DOI: 10.1136/postgradmedj-2013-132377] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
OBJECTIVE This article provides an overview of the typical appearance of biomechanical and physiologic changes in pregnancy and an update on related pathophysiology. Conditions occurring during the childbearing, delivery and postpartum periods will be reported separately. CONCLUSION Pregnancy causes biomechanical and physiologic changes that may be responsible for a wide spectrum of musculoskeletal disorders in the mother.
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Balık G, Sabri Balık M, Üstüner I, Kağıtcı M, Şahin FK, Güven ESG. Hand and wrist complaints in pregnancy. Arch Gynecol Obstet 2014; 290:479-83. [DOI: 10.1007/s00404-014-3244-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 04/01/2014] [Indexed: 11/29/2022]
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Evaluation and management of systemic lupus erythematosus and rheumatoid arthritis during pregnancy. Clin Immunol 2013; 149:225-35. [DOI: 10.1016/j.clim.2013.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 05/09/2013] [Accepted: 05/11/2013] [Indexed: 11/19/2022]
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Ribeiro AP, João SMA, Sacco ICN. Static and dynamic biomechanical adaptations of the lower limbs and gait pattern changes during pregnancy. ACTA ACUST UNITED AC 2013; 9:99-108. [PMID: 23241158 DOI: 10.2217/whe.12.59] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The purpose of this literature review is to evaluate the studies that have investigated static and dynamic biomechanical changes of the lower limbs and gait patterns during pregnancy. Original articles on this subject, published between 1934 and 2012, were considered. In general, pregnant women demonstrated greater hip flexion, more extended knees and less plantar flexion ankles. These changes could explain the gait patterns of pregnant women characterized by increased hip angles, decreased propulsion forces associated with increased durations of stance phase and changes in distributions of the plantar loads with increased loads in the forefoot and decreased ones in the rearfoot. This can lead to arthrokinematic deviations that, with time, contribute to the development of musculoskeletal discomfort. In summary, these findings showed the importance of further longitudinal studies to investigate the relationships between musculoskeletal discomfort in pregnant women in the lower limbs and gait changes observed throughout this period.
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Affiliation(s)
- Ana Paula Ribeiro
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânia, 51 Cidade Universitária, 05360-160 São Paulo, Brazil.
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Louati D, Zribi W, Chaabane K, Trigui K, Moalla S, Zribi M, Guermazi M. Fracture de contrainte du sacrum en fin de grossesse sans ostéoporose. IMAGERIE DE LA FEMME 2012. [DOI: 10.1016/j.femme.2012.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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[Is there a correlation between back pain and stability of the lumbar spine in pregnancy? A model-based hypothesis]. Schmerz 2012; 26:36-45. [PMID: 22366932 DOI: 10.1007/s00482-011-1125-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
During pregnancy approximately 50% of women suffer from low back pain (LBP), which significantly affects their everyday life. The pain could result in chronic insomnia, limit the pregnant women in their ability to work and produce a reduction of their physical activity. The etiology of the pain is still critically discussed and not entirely understood. In the literature different explanations for LBP are given and one of the most common reasons is the anatomical changes of the female body during pregnancy; for instance, there is an increase in the sagittal moments because of the enlarged uterus and fetus and the occurrence of hyperlordosis.The aim of this study was to describe how the anatomical changes in pregnant women affect the stability and the moments acting on the lumbar spine with the help of a simplified musculoskeletal model.A two-dimensional musculoskeletal model of the lumbar spine in the sagittal plane consisting of five lumbar vertebrae was developed. The model included five centres of rotation and three antagonistic pairs of paraspinal muscles. The concept of altered acting torques during pregnancy was explored by varying the geometrical arrangements. The situations non-pregnant, pregnant and pregnant with hyperlordosis were considered for the model-based approach. These simulations were done dependent on the stability of the erect posture and local countertorques of every lumbar segment.In spite of the simplicity of the model and the musculoskeletal arrangement it was possible to maintain equilibrium of the erect posture at every lumbar spinal segment with one minimum physiological cross-sectional area of all paraspinal muscles. The stability of the musculoskeletal system depends on the muscular activity of the paraspinal muscles and diminishing the muscular activity causes unstable lumbar segments.The relationship between the non-pregnant and the pregnant simulations demonstrated a considerable increase of acting segmental countertorques. Simulating an increased lordosis for the pregnant situation in the sagittal plane substantially reduced these acting countertorques and therefore the demand on the segmental muscles.It is assumed that hyperlordosis is a physiological adaptation to the anatomical changes during pregnancy to minimize the segmental countertorques and therefore the demand on the segmental muscles.Further, it can be expected that an enhanced muscle activity caused by selective activity of lumbar muscles increases the stability of the lumbar spine and may improve the situation with LBP during pregnancy.
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Bayliss AJ, Klene FJ, Gundeck EL, Loghmani MT. Treatment of a patient with post-natal chronic calf pain utilizing instrument-assisted soft tissue mobilization: a case study. J Man Manip Ther 2012; 19:127-34. [PMID: 22851875 DOI: 10.1179/2042618611y.0000000006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Musculoskeletal pain is commonly reported by pre- and postnatal women, with the most common complaint being low back pain. However, lower leg pain is also frequently reported by women particularly in the third trimester. The purpose of the case study is to illustrate how instrument-assisted soft tissue mobilization (ISTM) can be used to treat a patient with a 2-year history of chronic calf pain. The subject was a 35-year-old female who developed calf pain during the last trimester of her pregnancy following severe lower leg edema. The calf pain was present for the 2 years following delivery and was described as a dull ache, typically aggravated by direct pressure on the calf, prolonged standing, and stairs. An X-ray, magnetic resonance imaging (MRI) with contrast, and ultrasound Doppler study prior to referral ruled out tumors, vascular, lymphatic, or skeletal bone abnormalities. However, her MRI did show a dense superficial venous tissue asymmetry in the same location of her symptoms. Impairments were minimal; the only asymmetrical objective findings were calf length, strength, and soft tissue restrictions detected on palpation. After nine treatments incorporating an ISTM approach, soft tissue mobility, pain, calf strength, and lower extremity functional scale score all improved and her symptoms were abolished.
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Affiliation(s)
- Amy J Bayliss
- Department of Physical Therapy, Indiana University, Indianapolis, IN, USA
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Abstract
During pregnancy, hormonal fluctuations, fluid shifts, and musculoskeletal changes predispose women to carpal tunnel syndrome. While the clinical presentation is similar to other patients, the history obtained must include information regarding the pregnancy itself. Currently, the indication for electrodiagnostic testing is not clearly defined. Given that symptoms often improve with conservative treatment and abate after delivery, EMG/NCV testing can often be avoided. However, if symptoms are severe or persist, carpal tunnel release is indicated and is considered a safe procedure for both mother and fetus.
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Affiliation(s)
- Meredith Osterman
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Al-Sayegh NA, Salem M, Dashti LF, Al-Sharrah S, Kalakh S, Al-Rashidi R. Pregnancy-related lumbopelvic pain: prevalence, risk factors, and profile in Kuwait. PAIN MEDICINE 2012; 13:1081-7. [PMID: 22759220 DOI: 10.1111/j.1526-4637.2012.01424.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine prevalence and risk factors of pregnancy-related lumbopelvic pain (PRLPP) in women in Kuwait. DESIGN The study was designed as a multisite, cross-sectional design in which self-administered surveys were distributed. Setting and Participants. Public locations and health care facilities in Kuwait. Pregnant women (400) were invited to participate. OUTCOME MEASURES Demographics, history of PRLPP, risk factors for PRLPP, location of pain, absenteeism due to LPP, management of previous LPP, and functional disability due to PRLPP. RESULTS Two hundred eighty questionnaires were returned. Mean age was 29.5 years; mean body mass index (BMI) was 29.69 kg/m(2) . Of the participants, 91% reported LPP, 78.8% reported history of menstrual pain, and 58.7% reported previous LPP, and 59% reported PRLPP during previous pregnancies, 42.8% reported activities of daily living were limited. Risk factors included a history of back pain (P = 0.00), PRLPP in a previous pregnancy (P = 0.01), and being in the third trimester of pregnancy (P = 0.02). BMI was not associated with PRLPP. CONCLUSIONS Clinicians in Kuwait need to screen for risk factors and detect PRLPP early and intervene as needed. Although overweight and obesity may not contribute largely to PRLPP in women in Kuwait, weight control is a major concern for healthy pregnancy. Physical therapy has a role in preventing and addressing this condition.
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Affiliation(s)
- Nowall A Al-Sayegh
- Department of Physical Therapy, Faculty of Allied Health Sciences, Kuwait University, PO Box 31470, Sulaibikhat 90805, Kuwait.
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Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:1769-76. [PMID: 22310881 DOI: 10.1007/s00586-012-2162-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 01/11/2012] [Accepted: 01/18/2012] [Indexed: 01/13/2023]
Abstract
PURPOSE The present systematic review assessed the level of evidence for the association between relaxin levels and pregnancy-related pelvic girdle pain (PPGP) during pregnancy. METHODS PRISMA guidelines were followed to conduct this systematic review. Electronic search was carried out using six different databases. Observational cohorts, cross-sectional or case-control studies focused on the association between relaxin levels and PPGP during pregnancy were included. Studies selection was conducted by two reviewers who screened firstly for titles, then for abstracts and finally for full articles. Risk of bias was assessed using the Newcastle-Ottawa scale and the quality of evidence by the guidelines proposed by the Cochrane back review group. RESULTS 731 references were identified. Six articles met the inclusion criteria and were considered for this systematic review. The main reason for the studies exclusion was PPGP related to gynaecological reasons. Five studies were case-control and one study was a prospective cohort. Four studies were ranked as high while two were ranked as low quality. Among the high quality studies, three found no association between PPGP and relaxin levels. CONCLUSIONS Based on these findings, the level of evidence for the association between PPGP and relaxin levels was found to be low. PPGP assessment and controlling for risk factors were found to increase bias leaving uncertainty in interpretation of these findings and a need for further research.
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The association between pelvic girdle pain and pelvic floor muscle function in pregnancy. Int Urogynecol J 2012; 23:893-98. [DOI: 10.1007/s00192-011-1658-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 12/28/2011] [Indexed: 12/26/2022]
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Keene RR, Hillard-Sembell DC, Robinson BS, Novicoff WM, Saleh KJ. Occupational hazards to the pregnant orthopaedic surgeon. J Bone Joint Surg Am 2011; 93:e1411-5. [PMID: 22159863 DOI: 10.2106/jbjs.k.00061] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The number of female orthopaedic residents and orthopaedic surgeons has increased substantially. Concerns have been raised regarding the effect of the work environment on the health of the female orthopaedic surgeon and her fetus or neonate. Occupational risks, and specifically risks to the pregnant orthopaedic surgeon, are becoming an important issue in medicine. Such risks include exposure to methylmethacrylate (MMA), anesthetic gases, blood-borne pathogens, radiation, emotional stress, and physical stress. Awareness of and knowledge about such exposures are needed for the pregnant orthopaedic surgeon to make informed decisions about her occupational exposures and to be proactive about her own and her child's health.
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Affiliation(s)
- Roxanne R Keene
- Division of Orthopaedics, Department of Surgery, Southern Illinois University School of Medicine, 701 North 1st Street, Springfield, IL 62702, USA
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Keriakos R, Bhatta SRC, Morris F, Mason S, Buckley S. Pelvic girdle pain during pregnancy and puerperium. J OBSTET GYNAECOL 2011; 31:572-80. [DOI: 10.3109/01443615.2011.598970] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Morris F, Keriakos R, Mason S, Buckley S. Spontaneous bilateral femoral neck fractures in a young primigravida. J OBSTET GYNAECOL 2011. [DOI: 10.3109/01443615.2011.589013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Baratz MD, Gupta E, Yablon C, Rodriguez EK. Pyogenic Sacroiliac Arthritis Resulting in Septic Shock in a Postpartum Patient: A Rare Problem with a Rare Organism: A Case Report. JBJS Case Connect 2011; 1:e4. [PMID: 29252253 DOI: 10.2106/jbjs.cc.k.00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael D Baratz
- Massachusetts General Hospital, 55 Fruit Street, WHT 535, Boston, MA 02114.
| | - Erica Gupta
- Department of Radiology, Shapiro 4 (E.G. and C.Y.), and Department of Orthopaedic Surgery, Stoneman 10 (E.K.R.), Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215
| | - Corrie Yablon
- Department of Radiology, Shapiro 4 (E.G. and C.Y.), and Department of Orthopaedic Surgery, Stoneman 10 (E.K.R.), Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215
| | - Edward K Rodriguez
- Department of Radiology, Shapiro 4 (E.G. and C.Y.), and Department of Orthopaedic Surgery, Stoneman 10 (E.K.R.), Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215
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Lidder S, Lang K, Lee HJ, Masterson S, Kankate R. Bilateral Hip Fractures Associated with Transient Osteoporosis of Pregnancy. J ROY ARMY MED CORPS 2011; 157:176-8. [DOI: 10.1136/jramc-157-02-10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lin YC, Chen WS, Chang CC, Chen M, Yu CT. Aseptic necrosis of bilateral femoral heads after pregnancy. Taiwan J Obstet Gynecol 2011; 50:111-3. [DOI: 10.1016/j.tjog.2009.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2009] [Indexed: 11/16/2022] Open
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Fitzgerald CM, Wong CA. Pelvic Girdle and Low Back Pain in Pregnancy. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00097-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
Pregnancy, whether normal or complicated, induces change in nearly every system of the body. Because most rheumatologic disorders are multisystemic and often affect young women, it may be difficult to differentiate pregnancy-related change from new onset or exacerbation of rheumatic disease. Familiarity with common manifestations of pregnancy is important in evaluating young women of childbearing age,whether or not they have known rheumatologic disease. Presentation of new connective tissue disease during pregnancy is often associated with poorer prognosis, so it is especially important to distinguish between pregnancy-induced change and true autoimmune inflammation requiring prompt and aggressive therapy.
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Affiliation(s)
- Lisa R Sammaritano
- Rheumatology Division, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA.
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Al-Sayegh NA, George SE, Boninger ML, Rogers JC, Whitney SL, Delitto A. Spinal Mobilization of Postpartum Low Back and Pelvic Girdle Pain: An Evidence-Based Clinical Rule for Predicting Responders and Nonresponders. PM R 2010; 2:995-1005. [DOI: 10.1016/j.pmrj.2010.07.481] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 06/26/2010] [Accepted: 07/10/2010] [Indexed: 11/26/2022]
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Padua L, Pasquale AD, Pazzaglia C, Liotta GA, Librante A, Mondelli M. Systematic review of pregnancy-related carpal tunnel syndrome. Muscle Nerve 2010; 42:697-702. [DOI: 10.1002/mus.21910] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. Am J Obstet Gynecol 2010; 202:43.e1-8. [PMID: 19766977 DOI: 10.1016/j.ajog.2009.07.057] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 05/01/2009] [Accepted: 07/20/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To study osteopathic manipulative treatment of back pain and related symptoms during the third trimester of pregnancy. STUDY DESIGN A randomized, placebo-controlled trial was conducted to compare usual obstetric care and osteopathic manipulative treatment, usual obstetric care and sham ultrasound treatment, and usual obstetric care only. Outcomes included average pain levels and the Roland-Morris Disability Questionnaire to assess back-specific functioning. RESULTS Intention-to-treat analyses included 144 subjects. The Roland-Morris Disability Questionnaire scores worsened during pregnancy; however, back-specific functioning deteriorated significantly less in the usual obstetric care and osteopathic manipulative treatment group (effect size, 0.72; 95% confidence interval, 0.31-1.14; P = .001 vs usual obstetric care only; and effect size, 0.35; 95% confidence interval, -0.06 to 0.76; P = .09 vs usual obstetric care and sham ultrasound treatment). During pregnancy, back pain decreased in the usual obstetric care and osteopathic manipulative treatment group, remained unchanged in the usual obstetric care and sham ultrasound treatment group, and increased in the usual obstetric care only group, although no between-group difference achieved statistical significance. CONCLUSION Osteopathic manipulative treatment slows or halts the deterioration of back-specific functioning during the third trimester of pregnancy.
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Ho SSM, Yu WWM, Lao TT, Chow DHK, Chung JWY, Li Y. Effectiveness of maternity support belts in reducing low back pain during pregnancy: a review. J Clin Nurs 2009; 18:1523-32. [DOI: 10.1111/j.1365-2702.2008.02749.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Karadeli E, Uslu N. Postpartum Sacral Fracture Presenting as Lumbar Pain. J Womens Health (Larchmt) 2009; 18:663-5. [DOI: 10.1089/jwh.2008.1189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elif Karadeli
- Baskent University Faculty of Medicine, Radiology Department, Ankara, Turkey
| | - Nihal Uslu
- Baskent University Faculty of Medicine, Radiology Department, Ankara, Turkey
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Ho SS, Yu W, Lao TT, Chow DHK, Chung JW, Li Y. Comfort evaluation of maternity support garments in a wear trial. ERGONOMICS 2008; 51:1376-1393. [PMID: 18802820 DOI: 10.1080/00140130802116489] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This study aims to evaluate the wear comfort of eight commercially available maternity support garments. The thermophysiological, sensory/tactile and movement comfort were assessed in a wear trial using a 19-item questionnaire. Fourteen pregnant Chinese women aged 32.3 +/- 4.2 years were recruited from a local obstetric clinic. The results show that the tested garments generally provided greater sensory comfort than thermophysiological comfort. The thermophysiological comfort was mainly influenced by the fibre contents and breathability. Significant linear relationships were found between material appearance and hand feel (r = 0.86, p < 0.001), and between non-itchiness and no red mark (r = 0.78, p < 0.001). Movement comfort was influenced by the garment type and style features. Overall, the soft, good-fit, cotton/elastane maternity brief was perceived as the best product. The findings of comfort needs in pregnant women and the effects of various garment attributes would be helpful for the development of maternity support garment design criteria that are required to satisfy critical ergonomic needs. Low back pain during pregnancy is a common and significant health problem. A maternity support garment is regarded as a convenient and safe device to stabilise the lumbar spine so as to relieve pain. However, patient compliance is likely to be affected by discomfort and inconvenience. The results of this study provide guidance for the optimal design of maternity support clothing.
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Affiliation(s)
- S S Ho
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
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