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Study Design.: An analysis was made of the self-reported medical histories of patients with peripartum pelvic pain. Objectives.: To compile an inventory of the disabilities of patients with peripartum pelvic pain, analyze factors associated with the risk for development of the disease, and to formulate a hypothesis on pathogenesis and specific preventive and therapeutic measures. Summary of Background Data.: Pregnancy is an important risk factor for development of chronic low back pain. Understanding the pathogenesis of pelvic and low back pain during pregnancy and delivery could be useful in understanding and managing nonspecific low back pain. Methods.: By means of a questionnaire, background data were collected among patients of the Dutch Association for Patients With Pelvic Complaints in Relation to Symphysiolysis. Results were compared with the general population. Subgroups were compared with each other. Results.: Peripartum pelvic pain seriously interferes with many activities of daily living such us standing, walking, sitting, and all other activities in which the pelvis is involved. Most patients experience a relapse around menstruation and during a subsequent pregnancy. Occurrence of peripartum pelvic pain was associated with twin pregnancy, first pregnancy, higher age at first pregnancy, larger weight of the baby, forceps or vacuum extraction, fundus expression, and a flexed position of the woman during childbirth; a negative association was observed with cesarean section. Conclusions.: It is hypothesized that peripartum pelvic pain is caused by strain of ligaments in the pelvis and lower spine resulting from a combination of damage to ligaments (recently or in the past), hormonal effects, muscle weakness, and the weight of the fetus. Pregnancy and childbirth elicit important psychosocial and physical changes. Pain in the pelvic or low back region is a possible complication. A clear diagnosis can be made in only a small percentage of these patients (e.g., radicular compression, meralgia). In most, the problems cannot be defined by objective methods, frequently resulting in suggestive and nonsense lables such us “pregnancy sciatica” and “pelvic insufficiency.” When objective signs are found, such as separation of the public bones or enlarged mobility of the pelvic girdle, the relation with symptoms remains speculative. The authors prefer to use the descriptive term “peripartum pelvic pain” (PPPP), defined as pain in the pelvic region (with or without irradiation) Article Tools Article as PDF (26508KB) Complete Reference Abstract Reference Print Preview Email Jumpstart Email PDF Jumpstart Email Article Text Save Article Text Add to My Projects Export All Images to PowerPoint Annotate Find Citing Articles Find Similar About this Journal Request Permissions 360 Link Outline • Abstract • [black small square] Materials and Methods • [black small square] Results • [black small square] Discussion ◦ Localization of Peripartum Pelvic Pain ◦ Kinds of Complaints ◦ Factors Associated With Peripartum Pelvic Pain ◦ Therapeutic Measures ◦ Causes of Peripartum Pelvic Pain • [black small square] Conclusions • Acknowledgments • References • IMAGE GALLERY Search Journals Books Multimedia My Workspace Primal Pictures Page 1 of 9 Ovid: Understanding Peripartum Pelvic Pain: Implications of a Patient Survey. 11-06-2015 http://ovidsp.tx.ovid.com/sp-3.15.1b/ovidweb.cgi?QS2=434f4e1a73d37e8ce55b227ffaae... that started during pregnancy or within the first 3 weeks after delivery and for which no clear diagnosis is available to explain the symptoms. The reported period-prevalence of pelvic and back pain during pregnancy ranges between 48% and 56%.3,11,21,25 The pain is considered severe in 9-15% of cases.3,21 In a longitudinal study, pain at the time of delivery was reported by 67% of the women and by 37% 18 months postpartum, whereas 22% had ongoing back pain before pregnancy.24 In retrospective studies among young and middle-aged women with chronic low back pain, 10-28% stated that their first episode of back pain occurred during a pregnancy.4,36 Pelvic pain is prominent around the sacroiliac joints and the symphysis. It frequently extends to other parts of the pelvis, the upper legs, and, exceptionally, the lower legs.11,25 Peripartum pelvic pain is influenced by a variety of postures and movements.1,10,21 Many patients show a characteristic waddling gait. Except for heavy physical loading and previous low back pain, no predisposing factors are known.3,25 The idea that an increased lumbar lordosis during pregnancy is responsible for PPPP is persistent 10,11,16,18; however, in most women, lordosis is smaller during pregnancy than postpartum.9,33 It is still tempting to speculate that complaints arising during pregnancy are, at least in part, caused by the weight of the fetus and uterus, altering the load on muscles, tendons, and joints. Muscle weakness and insufficiency of pelvic ligaments could contribute to overload and pain.11 An additional explanation could be increased laxity of ligaments because of hormones.32 MacLennan et al found a higher serum relaxin level in pregnant women with PPPP than in control subjects.20 Mobility of the peripheral joints measured at the finger joints increases during pregnancy; it reaches higher levels in multiparous women than during the first pregnancy.7,26 Increased mobility and widening of the pubic symphysis were well documented before the hazards of irradiation were realized.1,14,17,19,37 Anatomic studies in former days, when mortality during pregnancy and labor was not exceptional, show increased mobility of the sacroiliac joints; often an increased amount of articular fluid was found.2,5,29 Such an increase influences the stability of the sacroiliac joints because in these joints friction is important for stability.39,40 If complaints start immediately after a vaginal delivery, the obvious assumption is that PPPP is caused by mechanical forces acting on the pelvic ring. On computed tomography scan performed within 24 hours of an uncomplicated vaginal delivery, widening of the pubic symphysis was present in 42%, and intra-articular gas was seen in the symphysis in 28% and in the sacroiliac joints in 42% of the women. This implies that the joints underwent stretching.13 Mechanical forces may also cause bleeding or synovial effusion into the joints.12 Recommendations to treat PPPP vary widely: rest, the use of a pelvic belt, local injections in the symphysis, and, for severe cases, symphysiodesis with or without additional fusion of one or both sacroiliac joints.1,3,23,28,31,38 The results of muscle and postural training and ergonomic advice are highly divergent.9,22,28 The authors conclude that no consensus exists on the pathogenesis, management, and prevention of PPPP. A prospective study on the efficacy of therapy and prevention would be useful, but first, several questions have to be answered. The current study focuses on the following: 1. The kinds and severity of complaints of patients with PPPP; 2. Factors associated with the risk for development of PPPP; and 3. Therapeutic measures. Clarification of these points will assist in formulating a hypothesis on the pathogenesis of PPPP, and specific preventive and therapeutic measures.