Symptom‐giving pelvic girdle relaxation of pregnancy, postnatal pelvic joint syndrome and developmental dysplasia of the hip

MacLennan, Alastair H.; MacLennan, Suzanna C

doi:10.3109/00016349709024343

Cited by 68 publications

(33 citation statements)

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“…In another study of Norwegian women with pregnancy-initiated pelvic pain, the incidence of DDH in the children was 45 [300], 7 times normal [179]. Women with pelvic joint instability and pain have higher serum relaxin levels compared to those without pelvic pain [301] in the third trimester which may explain these associations; others refute this [302, 303].…”

Section: Resultsmentioning

confidence: 99%

The Epidemiology and Demographics of Hip Dysplasia

2011

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The etiology of developmental dysplasia of the hip (DDH) is unknown. There are many insights, however, from epidemiologic/demographic information. A systematic medical literature review regarding DDH was performed. There is a predominance of left-sided (64.0%) and unilateral disease (63.4%). The incidence per 1000 live births ranges from 0.06 in Africans in Africa to 76.1 in Native Americans. There is significant variability in incidence within each racial group by geographic location. The incidence of clinical neonatal hip instability at birth ranges from 0.4 in Africans to 61.7 in Polish Caucasians. Predictors of DDH are breech presentation, positive family history, and gender (female). Children born premature, with low birth weights, or to multifetal pregnancies are somewhat protected from DDH. Certain HLA A, B, and D types demonstrate an increase in DDH. Chromosome 17q21 is strongly associated with DDH. Ligamentous laxity and abnormalities in collagen metabolism, estrogen metabolism, and pregnancy-associated pelvic instability are well-described associations with DDH. Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. Swaddling is strongly associated with DDH. Amniocentesis, premature labor, and massive radiation exposure may increase the risk of DDH. Associated conditions are congenital muscular torticollis and congenital foot deformities. The opposite hip is frequently abnormal when using rigorous radiographic assessments. The role of acetabular dysplasia and adult hip osteoarthritis is complex. Archeological studies demonstrate that the epidemiology of DDH may be changing.

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Section: Resultsmentioning

confidence: 99%

The Epidemiology and Demographics of Hip Dysplasia

2011

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“…We support this risk, as 84.1% of females in the study had DDH. The cause of this association has been widely investigated before, and attributed to potentiation by endogenous estrogens produced by the female infant and the transiently increased ligamentous laxity in the perinatal period caused by high levels of circulating maternal hormones [20]. First-born babies carry a high risk of DDH, and form more than 50% [16,21,22].…”

Section: Discussionmentioning

confidence: 99%

Associated risk factors in children who had late presentation of developmental dysplasia of the hip

Hassan

Shannak

2007

Journal of Children's Orthopaedics

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Purpose The purpose of this study was to assess the role of clinical examination, associated risk factors and plain radiograph of the pelvis in children who had late presentation of DDH. Methods We report on a 7-year prospective study, in children who had late presentation of developmental dysplasia of the hip (DDH). For this purpose, 740 hips in 370 referred children, age range 3-7 months (mean 3.44 months) were clinically and radiologically assessed, and the associated risk factors recorded. Results Female sex, first born, positive family history and breech presentation were confirmed as risk factors for DDH. Significant findings were an increased risk for vaginal delivery over caesarean section for breech presentation (P = 0.002). There was an increased risk for caesarean section in the absence of breech presentation. Multiple births and preterm births had a reduced risk. For breech presentation, the risk of DDH was estimated to be at least 1.6% for girls and 3.4% for boys; a combination of factors increased the risk. Limitation of abduction (43.2%) and asymmetry of the groin skin folds (72.7%) were found to be the two most common clinical findings associated with DDH. Bilateral acetabular dysplasia is more common than unilateral dysplasia. Foot deformities were rarely encountered in children with acetabular dysplasia. Conclusions The percentage of first-born babies who had DDH is lower than reported in the literature (34%), but still shows significant risk. We did find that bilateral acetabular dysplasia is more common than unilateral dysplasia. Torticollis and foot deformities are rarely found to be associated with DDH. All these findings needs further evaluation in children who had surgical treatment for DDH, to see if they are different from dysplastic groups. Limitation of abduction is an important clinical finding, but is not always associated with DDH. Asymmetry of the skin folds in the groin were found to be an important clinical finding associated with DDH for all age groups. As clinical examination depends on many factors, and most DDH cases are of the dysplastic type, it is mandatory to depend on further diagnostic tools for confirmation of DDH.

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“…Therefore, there are only a very small number of studies of foetal skeletal tissues. Mahmoodian et al (2009) reported that the talar cartilage of two foetuses between 30-32 weeks had a stiffness (aggregate modulus of 150 kPa) an order of magnitude lower than that of adult articular cartilage and permeability (2.01 × 10 -14 m 4 N -1 s -1 ) an order of magnitude greater than adult cartilage, suggesting that foetal cartilage is likely to deform and relax to larger extents than adult cartilage. In a follow-up study, Mahmoodian et al (2011) tested the mechanical properties of seven foetal talus anlagen over a range of gestational ages between 20 and 36 gestational weeks, and found that stiffness increased by a factor of roughly 2.5 (from 59.9 to 148 kPa), and permeability decreased by 20 % (from 2.64 × 10 -14 to 2.06 × 10 -14 m 4 N -1 s -1 ) over the age range studied.…”

Section: Nc Nowlan Biomechanics Of Foetal Movementmentioning

confidence: 99%

“…These changes in mechanical properties were associated with an increase in collagen content and integrity, and a decrease in proteoglycan content (Mahmoodian et al, 2011). A study of the chondroepiphysis of the foetal proximal femur (Brown and Singerman, 1986) ) and Poisson's ratio than the aforementioned foetal talus studies (Mahmoodian et al, 2009;, which could reflect either differences in experimental design, differences between the properties of the two rudiments, or a combination of these factors. McPherson and Kriewall (1980b) performed three-point bending tests on foetal cranial bone, and found that the elastic moduli of the ossified specimens oriented parallel to the grain pattern of the bone increased from an average of 1.65 × 10³ MPa in foetuses from 24-30 gestational weeks to 3.86 × 10³ MPa in foetuses from 36-40 weeks.…”

Section: Nc Nowlan Biomechanics Of Foetal Movementmentioning

confidence: 99%

“…Genetic risk factors include female gender (Chan et al, 1997) and positive family history (Stevenson et al, 2009;Wynne-Davies, 1970). It is thought that female babies are at higher risk due to their susceptibility to the maternal hormone relaxin, which may contribute to ligamentous laxity in the hip joint (Maclennan and Maclennan, 1997). There is limited information on what genes may be responsible for the familial incidence of DDH, with most studies proposing an association between a genetic or chromosome variant and DDH being focussed on individual families or single ethnicities (Dai et al, 2008;Feldman et al, 2010;Feldman et al, 2012;Hao et al, 2014;Rouault et al, 2010;Tian et al, 2012), limiting their impact on the wider population.…”

Section: Risk Factorsmentioning

confidence: 99%

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Biomechanics of foetal movement

Nowlan¹

2015

eCM

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Foetal movements commence at seven weeks of gestation, with the foetal movement repertoire including twitches, whole body movements, stretches, isolated limb movements, breathing movements, head and neck movements, jaw movements (including yawning, sucking and swallowing) and hiccups by ten weeks of gestational age. There are two key biomechanical aspects to gross foetal movements; the first being that the foetus moves in a dynamically changing constrained physical environment in which the freedom to move becomes increasingly restricted with increasing foetal size and decreasing amniotic fluid. Therefore, the mechanical environment experienced by the foetus affects its ability to move freely. Secondly, the mechanical forces induced by foetal movements are crucial for normal skeletal development, as evidenced by a number of conditions and syndromes for which reduced or abnormal foetal movements are implicated, such as developmental dysplasia of the hip, arthrogryposis and foetal akinesia deformation sequence. This review examines both the biomechanical effects of the physical environment on foetal movements through discussion of intrauterine factors, such as space, foetal positioning and volume of amniotic fluid, and the biomechanical role of gross foetal movements in human skeletal development through investigation of the effects of abnormal movement on the bones and joints. This review also highlights computational simulations of foetal movements that attempt to determine the mechanical forces acting on the foetus as it moves. Finally, avenues for future research into foetal movement biomechanics are highlighted, which have potential impact for a diverse range of fields including foetal medicine, musculoskeletal disorders and tissue engineering.Keywords: Foetal movement, fetal movement, bone development, joint development, developmental dysplasia of the hip, arthrogryposis, biomechanical models, computational simulation, mechanical properties of foetal tissues, mechanical properties of fetal tissues.

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Symptom‐giving pelvic girdle relaxation of pregnancy, postnatal pelvic joint syndrome and developmental dysplasia of the hip

Cited by 68 publications

References 10 publications

The Epidemiology and Demographics of Hip Dysplasia

The Epidemiology and Demographics of Hip Dysplasia

Associated risk factors in children who had late presentation of developmental dysplasia of the hip

Biomechanics of foetal movement

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