Abstract

PELVIC PAIN AND LOW BACK PAIN IN PREGNANT WOMEN

*Hanan Jasim Mohammed and Dhamyaa Yousif Fattah

Abstract

Low back pain (LBP) is a common complaint amongst women during pregnancy, having a great impact on their quality of life. Low back pain during pregnancy has been known and recognized for many centuries and was described by Hippocrates, Vesalius, Pineau, Hunter, Velpeau and many others. In 1962 Walde was the first who recognized the differences between Pelvic Girdle pain (PGP) and Lumbar pain (LP). Later, Ostgaard et al. set the criteria for the differentiation between these two entities.[1] It has been estimated that about 50% of pregnant women will suffer from some kind of low back pain at some point during their pregnancies or during the postpartum period.[2-4] Pregnancy-related low back pain seems to be a result of quite a few factors, such as mechanical, hormonal and other.[2, 3, 5-12] PGP and LP are two different patterns of LBP during pregnancy, although, a small group of women suffer from combined pain. PGP is common during pregnancy and postpartum period and approximately four times as prevalent as LP. It is described as deep, stabbing, unilateral or bilateral, recurrent or continuous pain, presenting between the posterior iliac crest and the gluteal fold, possibly radiating to the posterolateral thigh, to the knee and calf, but not to the foot.[13] PGP is more intense during pregnancy than during postpartum period and may convert the natural discomfort of pregnancy into a pathophysiologic condition, which minimizes physical activity, and causes withdrawal from social interactions14. Pain provocation tests are the best tests available for differentiating PGP from other conditions. The posterior pain provocation test (PPT) is positive, in case of PGP.[2,3,6,15,16] LP during pregnancy is very similar to lumbar pain experienced by women who are not pregnant and it appears as pain over and around the lumbar spine, above the sacrum, making the differentiation between PGP and LP easy. LP may or may not radiate to the foot, in contrast with PGP. Tenderness over paravertebral muscles is a common finding.[14] LP aggravates at postpartum period and usually exacerbates by certain activities and postures (e.g. prolong sitting) but it seems to be less disabling than PGP.[14] The posterior pain provocation test is negative.[3]

Keywords: Low back pain, pelvic girdle pain, pregnancy, review Prevalence.