Ocorrência de dor combinada na coluna lombar, cintura pélvica e sínfise púbica entre gestantes do extremo sul do Brasil

Meucci, Rodrigo Dalke; Perceval, Aline Henriques; Lima, Daniele Ramos de; Cousin, Ewerton; Marmitt, Luana Patrícia; Pizzato, Paula; Silva, Priscila Arruda da; Jesien, Stèphanie; César, Juraci Almeida

doi:10.1590/1980-549720200037

Cited by 5 publications

(4 citation statements)

References 27 publications

(21 reference statements)

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“…pregnancy-induced low back pain [144], posterior pelvic girdle pain (PPGP) [145], and pregnancy-related pelvic girdle pain [146]. Although the term PGP may be somewhat too narrow, focusing solely on the -pain associated with this condition without considering how it affects a woman's activity level and participation in daily activities, we chose to employ this term in our remaining studies since it is the term recommended by the European guidelines [7].…”

Section: Discussionmentioning

confidence: 99%

The prevalence, implications, and clinical course of pregnancy-related pelvic girdle pain

Malmqvist¹

2021

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Pelvic girdle pain (PGP) during pregnancy is common and, indeed, has always been considered normal. It is commonly associated with moderate to severe pain that impairs everyday activities such as getting up from a chair, bending, walking, working in the home and caring for children, as well as, of course, paid employment. Also, PGP is a frequent cause of sick leave during pregnancy. The aetiology of PGP is poorly understood and there is no official nomenclature, no effective evidence- based preventive measures or treatment, known risk factors or detailed knowledge of the clinical course of the various subgroups of this condition. Objectives The objectives for this project were to determine the prevalence of PGP during pregnancy in a random population of women, detect factors associated with the development of this condition, explore what influences taking sick leave due to PGP, and examine whether pregnant women with PGP, who have been sub-grouped on the basis of two clinical tests, differ with regards to demographic characteristics and/or the clinical course of PGP during the second half of their pregnancy. Methods The thesis consists of three papers, based on two separate data collections at Stavanger University Hospital. Paper I and II originate from a retrospective cohort study conducted in 2009, in which women giving birth at Stavanger University hospital in a 4-month period were asked to fill in a questionnaire on demographic features, pain, disability, PGP, pain-related activities of daily living, sick leave in general and for PGP, frequency of exercising before and during pregnancy, and Oswestry Disability Index. Inclusion criteria were singleton pregnancy of at least 36 weeks and competence in the Norwegian language. Drawings of the pelvic and low back area were used for the localization of pain. PGP intensity was then rated retrospectively on a numerical rating scale. Non-parametric tests, multinomial logistic regression and sequential linear regression analysis were used in the statistical analysis. Paper III originate from a prospective longitudinal cohort study carried out in 2010. Inclusion criteria were the as for the retrospective data collection and took place at the second-trimester routine ultrasound examination. All eligible women (n=503) filled in questionnaires and answered a weekly SMS question during pregnancy until delivery. Women with pain in the pelvic area underwent a clinical examination following a test procedure recommended in the European guidelines for the diagnosis and treatment of PGP. Results Paper I report that nearly 50% of the women experienced moderate and severe PGP during pregnancy. Approximately half of them had PGP syndrome, whereas the other half experienced lumbopelvic pain. Ten percent of the women experienced moderate and severe LBP alone. These pain syndromes increased sick leave and impaired general level of function during pregnancy. Approximately 50% of women with PGP had pain in the area of the symphysis pubis. The analysis of risk factors did not present a unidirectional and clear picture. In Paper II PGP is reported to be a frequent and major cause of sick leave during pregnancy among Norwegian women, which is also reflected in activities of daily living as measured with scores on all Oswestry disability index items. In the multivariate analysis of factors related to sick leave and PGP were work satisfaction, problems with lifting and sleeping, and pain intensity risk factors for sick leave. Also, women with longer education, higher work satisfaction and fewer problems with sitting, walking, and standing, were less likely to take sick leave in pregnancy, despite the same pain intensity as women being on sick leave. In Paper III, 42% (212/503) reported pain in the lumbopelvic region and 39% (196/503) fulfilled the criteria for a probable PGP diagnosis. 27% (137/503) reported both the posterior pelvic pain provocation (P4) and the active straight leg raise (ASLR) tests positive at baseline in week 18, revealing 7.55 (95% CI 5.54 to 10.29) times higher mean number of days with bothersome pelvic pain compared with women with both tests negative. They presented the highest scores for workload, depressed mood, pain level, body mass index, Oswestry Disability Index and the number of previous pregnancies. Exercising regularly before and during pregnancy was more common in women with negative tests. Conclusions Pelvic pain in pregnancy is a health care challenge in which moderate and severe pain develops rather early and has important implications for society. The observed associations between possible causative factors and moderate and severe LBP and PGP in the analysis of the retrospective data may, together with results from other studies, bring some valuable insights into their multifactorial influences and provide background information for future studies. Some pregnant women with PGP show a higher pain tolerance, most likely dependant on education, associated with work situation and/or work posture, which decreases sick leave. These issues are recommended to be further examined in a prospective longitudinal study since they may have important implications for sick leave frequency during pregnancy. If both P4 and ASLR tests were positive mid-pregnancy, a persistent bothersome pelvic pain of more than 5 days per week throughout the remainder of pregnancy could be predicted. Increased individual control over work situation and an active lifestyle, including regular exercise before and during pregnancy, may serve as a PGP prophylactic.

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Section: Discussionmentioning

confidence: 99%

The prevalence, implications, and clinical course of pregnancy-related pelvic girdle pain

Malmqvist¹

2021

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“…The prevalence of PRPP is around 20%, depending on the method used in the study 9,10 . In Brazil, the occurrence of pelvic girdle pain alone or combined with low back pain during pregnancy is 23.7% 11 . Pregnant women with PRPP often have impaired mobility, requiring the use of crutches or wheelchairs between 7 and 12.5% of the cases 12 , and is associated with greater disability than low back pain 13 .…”

Section: Discussionmentioning

confidence: 99%

“…There is an important association between depression and pregnancy-related low back pain, which can negatively affect mental health and cause limitations in the pregnant woman's daily life activities. On the other hand, persistent pain in the prenatal period can be a triggering factor for chronic pain, which is commonly associated with depression and anxiety 11 . The development of PRPP is multifactorial, and it can be associated to hormonal, biomechanical, traumatic, metabolic, genetic or degenerative factors that are present during pregnancy 8 .…”

Section: Discussionmentioning

confidence: 99%

“…It is controversial, but higher maternal age seems to be associated with increased risk of pelvic pain. It is known that with aging the joint flexibility decreases, and the distension of the pelvic girdle joints may cause more pain among older pregnant women 11 . In pregnant women with PRPP, a good anamnesis and physical examination are necessary, with the objective of excluding other causes of pain, differentiating low back pain and pelvic pain, disability level and proposing individualized treatment.…”

Section: Discussionmentioning

confidence: 99%

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Sacroiliac infiltration in pregnant women guided by ultrasound. Case report

de-Aragão¹

2021

Brazilian Journal of Pain

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BACKGROUND AND OBJECTIVES: Pregnancy-related pelvic pain (PRPP) is one of the most frequent causes of pain during pregnancy, which can result in significant physical disability. It is often undertreated, as it is a condition considered normal during pregnancy and there is fear that the treatment may cause changes in the pregnant woman and the fetus. The objective of this study was to report a case of PRPP, its treatment with sacroiliac joint infiltration guided by ultrasound and to perform a literature review. CASE REPORT: Pregnant woman at 35 weeks of gestation, developing PRPP originating from the left sacroiliac joint. She underwent ultrasound-guided joint infiltration with 5mL of 0.5% ropivacaine and 20mg of methylprednisolone. The patient had no pain after the procedure and remained so after delivery. CONCLUSION: Despite the few cases described in the literature, the use of pain intervention treatment in pregnant women seems safe and effective.

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Risk factors for pregnancy-related pelvic girdle pain: a scoping review

Wuytack

Begley

Daly

2020

BMC Pregnancy Childbirth

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Background Pregnancy-related Pelvic Girdle Pain (PPGP) is a common complaint. The aetiology remains unclear and reports on risk factors for PPGP provide conflicting accounts. The aim of this scoping review was to map the body of literature on risk factors for experiencing PPGP. Methods We searched the databases PubMed, Embase, CINAHL, PsycINFO, MIDIRS, and ClinicalTrial.gov (3 August 2020). We selected studies with two reviewers independently. Observational studies assessing risk factors for PPGP were included. Studies examining specific diagnostic tests or interventions were excluded. Results We identified 5090 records from databases and 1077 from ClinicalTrial.gov. Twenty-four records met the inclusion criteria. A total of 148 factors were examined of which only 14 factors were examined in more than one study. Factors that were positively associated with PPGP included a history of low back or pelvic girdle pain, being overweight/obese, already having a child, younger age, lower educational level, no pre-pregnancy exercise, physically demanding work, previous back trauma/disease, progestin-intrauterine device use, stress, depression and anxiety. Conclusions A large number of factors have been examined as potential risk factors for PPGP, but there is a lack of repetition to be able to draw stronger conclusions and pool studies in systematic reviews. Factors that have been examined in more than five studies include age, body mass index, parity and smoking. We suggest a systematic review be conducted to assess the role of these factors further in the development of PPGP.

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Ocorrência de dor combinada na coluna lombar, cintura pélvica e sínfise púbica entre gestantes do extremo sul do Brasil

Cited by 5 publications

References 27 publications

The prevalence, implications, and clinical course of pregnancy-related pelvic girdle pain

The prevalence, implications, and clinical course of pregnancy-related pelvic girdle pain

Sacroiliac infiltration in pregnant women guided by ultrasound. Case report

Risk factors for pregnancy-related pelvic girdle pain: a scoping review

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