Can a bothersome course of pelvic pain from mid-pregnancy to birth be predicted? A Norwegian prospective longitudinal SMS-Track study

Abstract

ObjectiveTo explore if pregnant women with pelvic girdle pain (PGP), subgrouped following the results from two clinical tests with high validity and reliability, differ in demographic characteristics and weekly amount of days with bothersome symptoms through the second half of pregnancy.DesignA prospective longitudinal cohort study.ParticipantsPregnant women with pelvic and lumbopelvic pain due for their second-trimester routine ultrasound examination.SettingObstetric outpatient clinic at Stavanger University Hospital, Norway.MethodsWomen reporting pelvic and lumbopelvic pain completed a questionnaire on demographic and clinical features. They were clinically examined following a test procedure recommended in the European guidelines for the diagnosis and treatment of PGP. Women without pain symptoms completed a questionnaire on demographic data. All women were followed weekly through an SMS-Track survey until delivery.Primary and secondary outcome measuresThe outcome measures were the results from clinical diagnostic tests for PGP and the number of days per week with bothersome pelvic pain.Results503 women participated. 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.ConclusionIf 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.

Subjective recovery from pregnancy-related pelvic girdle pain the first 6 weeks after delivery: a prospective longitudinal cohort study

“…This is an SMS-based, prospective, longitudinal cohort study of women during the final 10 weeks of pregnancy and the first 6 weeks after delivery. The women were included in the study at the routine ultrasound examination at 18 weeks of pregnancy at Stavanger University Hospital, Norway, from March to June 2010 [18].…”

Evaluating the Management of chronic Pelvic girdle Pain following pregnancy (EMaPP): study protocol for a randomised controlled feasibility trial to compare a customised pelvic orthosis with standard care

“…Often everyday activities are affected such as moving in bed, walking, driving, breast feeding (due to discomfort and the effect of analgesia in breast milk), continence (due to associated pelvic floor dysfunction) and safely caring for the child and siblings, especially as the child becomes more mobile 5. The emotional impacts of ‘living with enduring pain’, include anger and frustration and feelings of ‘being a burden’,6 with related abuse of analgesics highlighted 7 8. Work absenteeism contributes significantly to the economic consequences.…”

“…There is currently a wide range of ‘off the shelf’ pelvic orthoses available, however they have been shown to be of mixed benefit and often ineffective when pain is severe 17. Furthermore, women report wear-time issues due to discomfort, lack of ease of use, reduced aesthetics and impact on movement 8. Sufficient wear time is however crucial for orthotics as benefits gained are dependent on this.…”

Personality traits predict regression of pelvic girdle pain after pregnancy: a longitudinal follow-up study

“…The predictors and long-term outcomes of PGP associated with pregnancy have been studied. Increasing evidence indicates that many factors, such as demographic characteristics (e.g., age, occupation), pregnancy-related condition (e.g., PGP in early pregnancy), and low endurance of back flexors, are all related to the severity and regression of PGP [9][10][11][12]. However, these factors could not wholly explain why some pregnant women suffer more severe PGP or fail to recover from this condition.…”