بررسی عوامل خطر مرتبط با ایجاد درد لگنی در دوران بارداری

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی سبزوار، سبزوار، ایران.

2 استادیار گروه ارتوپدی، دانشکده پزشکی، دانشگاه علوم پزشکی سبزوار، سبزوار، ایران.

3 استادیار گروه بیهوشی، دانشکده پزشکی، دانشگاه علوم پزشکی سبزوار، سبزوار، ایران.

4 دانشجوی پزشکی، دانشکده پزشکی، دانشگاه علوم پزشکی سبزوار، سبزوار، ایران.

10.22038/ijogi.2022.20421

چکیده

مقدمه: حدود 70% زنان باردار به کمردردهای دوران بارداری مبتلا می‌شوند. ﻓﺮآﯾﻨﺪﻫﺎی ﻓﯿﺰﯾﻮﻟﻮژﯾکی که ﻣﻨﺠﺮ ﺑﻪ اﯾﻦ درد می‌شوند، ﻧﺎﻣﺸﺨص هستند. با توجه به شیوع بالای این درد، مطالعه حاضر با هدف بررسی عوامل خطر مرتبط با ایجاد درد لگنی در دوران حاملگی در زنان باردار مراجعه‌کننده به بیمارستان شهیدان مبینی شهر سبزوار انجام شد.
روشکار: این مطالعه مورد شاهدی در سال 1397 بر روی 120 زن باردار که 12 نفر (10%) آنها در سه ماه اول بارداری و 108 نفر (90%) در سه ماهه سوم بارداری بودند، در بیمارستان شهیدان مبینی سبزوار انجام شد. جهت جمع‌آوری داده‌ها از پرسشنامه محقق‌ساخته که روایی و پایایی آن به تأیید رسید و چک‌لیست استاندارد استفاده شد. پرسشنامه شامل دو بخش مشخصات دموگرافیک نمونه‌ها و سؤالات مرتبط با عوامل خطر و چک‌لیست نیز شامل نتیجه معاینات نمونه‌ها برای تعیین برخی عوامل خطر بود. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزارSTATA انجام شد.
یافتهها: در بین زنان باردار مبتلا به درد لگن، 4 نفر (10%) شلی لیگامانی خفیف، 3 نفر (5/7%) سابقه تروما به کمربند لگنی، 17 نفر (5/42%) سابقه کمردرد در حاملگی قبلی، 20 نفر (50%) سابقه کمردرد قبل از حاملگی و 10 نفر (25%) فعالیت جنسی نارضایت‌بخش را ذکر کردند. در این مطالعه بین رابطه جنسی نارضایت‌بخش (008/0=p)، سابقه کمردرد قبل از حاملگی (001/0=p) و یا در حاملگی قبلی (001/0=p) با درد لگن در دوره بارداری ارتباط آماری معنی‌داری وجود داشت، در‌حالی‌که بین محل سکونت، سیگاری بودن، شلی لیگامانی، شغل و سایر عوامل خطر مورد بررسی با درد لگن ارتباط معنی‌داری وجود نداشت (05/0≤p).
نتیجهگیری: در این مطالعه سابقه کمردرد در حاملگی قبلی، سابقه کمردرد قبل از حاملگی و همچنین فعالیت جنسی نارضایت بخش به‌عنوان عوامل خطر درد لگنی شناخته شدند. شناسایی این عوامل خطر می‌تواند در کنترل عوامل تشدید‌‌کننده درد لگنی در دوره بارداری و پیشگیری از محدودیت‌های حرکتی در زنان پس از زایمان، کمک‌کننده باشد.

کلیدواژه‌ها


عنوان مقاله [English]

Risk factors related to development of pelvic pain during pregnancy

نویسندگان [English]

  • Jila Agah 1
  • Seyyed Mehdi Mir Mohammadi 2
  • Mohammad Nemat Shahi 3
  • Sajjad Valizadeh Ahlimani 4
1 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
2 Assistant Professor, Department of Orthopedics, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
3 Assistant Professor, Department of Anesthesiology, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
4 Medical Student, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
چکیده [English]

Introduction: About 70&% of women suffer of pelvic pain during pregnancy. The physiological processes characterizing this clinical entity remain obscure. Given the high prevalence of this pain, this study was performed aimed to investigate the risk factors associated with pelvic pain during pregnancy in pregnant women referred to Shahidan Mobini Hospital in Sabzevar.Methods: This case-control study was done in 2018 on 120 pregnant women, of which 12 (10%) were at first trimester of pregnancy and 108 (90%) were at third trimester of pregnancy, in Shahidan Mobini Sabzevar Hospital. A researcher-made questionnaire that its validity and reliability were confirmed and standard checklist were used for data collection. The questionnaire consisted of two parts: demographic characteristics of the samples and questions related to the risk factors, and the checklist included the results of the samples' examinations to determine some risk factors. Data were analyzed using STATA software.Results: Among pregnant women with pelvic pain, 4 (10%) reported mild ligamentous looseness, 3 (7.5%) had a history of pelvic girdle trauma, 17 (43.1%) had a history of low back pain in previous pregnancy, 20 (50%) had a history of low back pain before pregnancy and 10 (25%) had unsatisfactory sexual activity. Results showed that there was a significant relationship between unsatisfactory sexual relations (P=0.008), history of low back pain before pregnancy (P=0.001) or in previous pregnancy (P=0.001) or pelvic pain during pregnancy. However, there was no significant relationship between pelvic pain and place of residence, smoking, ligamentous looseness, occupation and other risk factors (P≥0.05).Conclusion: In this study, history of low back pain in previous pregnancy, history of low back pain before pregnancy, and unsatisfactory sexual activity were identified as risk factors for pelvic pain. Identification of these risk factors can be helpful in controlling the factors exacerbating pelvic pain during pregnancy and preventing movement restrictions in postpartum women.

کلیدواژه‌ها [English]

  • Pelvic Pain
  • pregnancy
  • Risk Factor
  1. Ostgaard HC, Andersson GB, Karlsson K. Prevalence of back pain in pregnancy. Spine (Phila Pa 1976) 1991; 16(5):549-52.
  2. Jain S, Eedarapalli P, Jamjute P, Sawdy R. Symphysis pubis dysfunction: a practical approach to management. The Obstetrician & Gynaecologist 2006; 8(3):153-8.
  3. Wuytack F, Begley C, Daly D. Risk factors for pregnancy-related pelvic girdle pain: a scoping review. BMC pregnancy and childbirth 2020; 20(1):1-4.
  4. Goli Sh, Shayanmanesh M, Moeinimehr M. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Health Syst Res 2014; 10(2):226-34.
  5. Berek JS. Berek and Novak's Gynecology. 16nd Lippincott Williams & Wilkins; 2022.
  6. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 2008; 17(6):794-819
  7. Mousavi SJ, Parnianpour M, Vleeming A. Pregnancy related pelvic girdle pain and low back pain in an Iranian population. Spine (Phila Pa 1976). 2007; 32(3):E100-4.
  8. Kanakaris NK, Roberts CS, Giannoudis PV. Pregnancy-related pelvic girdle pain: an update. BMC Med 2011; 9:15.
  9. Wu WH, Meijer OG, Bruijn SM, Hu H, van Dieën JH, Lamoth CJ, van Royen BJ, Beek PJ. Gait in Pregnancy-related Pelvic girdle Pain: amplitudes, timing, and coordination of horizontal trunk rotations. Eur Spine J 2008; 17(9):1160-9.
  10. Mogren IM. BMI, pain and hyper-mobility are determinants of long-term outcome for women with low back pain and pelvic pain during pregnancy. Eur Spine J 2006; 15(7):1093-102.
  11. Albert H, Godskesen M, Westergaard J. Prognosis in four syndromes of pregnancy-related pelvic pain. Acta Obstet Gynecol Scand 2001; 80(6):505-10.
  12. Turgut F, Turgut M, Cetinşahin M. A prospective study of persistent back pain after pregnancy. Eur J Obstet Gynecol Reprod Biol 1998; 80(1):45-8.
  13. Norén L, Ostgaard S, Johansson G, Ostgaard HC. Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. Eur Spine J 2002; 11(3):267-71.
  14. Zahedpour F, Mohammadi M, Damavandi M, Agah J. The effect of core stability training on postpartum lumbar lordosis and low back pain in nulliparous women. Iran J Obstet Gynecol Infertil 2017; 20(3):89-97.
  15. Elden H, Gutke A, Kjellby-Wendt G, Fagevik-Olsen M, Ostgaard HC. Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study. BMC musculoskeletal disorders 2016; 17(1):1-3.
  16. MacLennan AH, MacLennan SC. Symptom-giving pelvic girdle relaxation of pregnancy, postnatal pelvic joint syndrome and developmental dysplasia of the hip. The Norwegian Association for Women with Pelvic Girdle Relaxation (Landforeningen for Kvinner Med Bekkenløsningsplager). Acta Obstet Gynecol Scand 1997; 76(8):760-4.
  17. Stuge B. Pelvic girdle pain: examination, treatment, and the development and implementation of the European guidelines. Journal of the Association of Chartered Physiotherapists in Womens Health 2012; 111:5.
  18. Colla C, Paiva LL, Thomaz RP. Therapeutic exercise for pregnancy low back and pelvic pain: a systematic review. Fisioterapia em Movimento 2017; 30:399-411.
  19. Kordi R, Abolhasani M, Rostami M, Hantoushzadeh S, Mansournia MA, Vasheghani-Farahani F. Comparison between the effect of lumbopelvic belt and home based pelvic stabilizing exercise on pregnant women with pelvic girdle pain; a randomized controlled trial. Journal of back and musculoskeletal rehabilitation 2013; 26(2):133-9.
  20. Stuge B, Holm I, Vøllestad N. To treat or not to treat postpartum pelvic girdle pain with stabilizing exercises? Man Ther 2006; 11(4):337-43.
  21. Østensen ME, Skomsvoll JF. Anti-inflammatory pharmacotherapy during pregnancy. Expert opinion on pharmacotherapy 2004; 5(3):571-80.
  22. Khan M, Mahmood T. Prolonged epidural analgesia for intractable lumbo-sacral pain in pregnancy. J Obstet Gynaecol 2008; 28(3):350-1.
  23. Bastiaenen CH, de Bie RA, Wolters PM, Vlaeyen JW, Leffers P, Stelma F, et al. Effectiveness of a tailor-made intervention for pregnancy-related pelvic girdle and/or low back pain after delivery: short-term results of a randomized clinical trial [ISRCTN08477490]. BMC Musculoskelet Disord 2006; 7:19.
  24. Bjelland EK, Kristiansson P, Nordeng H, Vangen S, Eberhard-Gran M. Hormonal contraception and pelvic girdle pain during pregnancy: a population study of 91 721 pregnancies in the Norwegian Mother and Child Cohort. Human reproduction 2013; 28(11):3134-40.
  25. Robinson HS, Veierød MB, Mengshoel AM, Vøllestad NK. Pelvic girdle pain--associations between risk factors in early pregnancy and disability or pain intensity in late pregnancy: a prospective cohort study. BMC Musculoskelet Disord 2010; 11:91.
  26. Stendal Robinson H, Lindgren A, Bjelland EK. Generalized joint hypermobility and risk of pelvic girdle pain in pregnancy: does body mass index matter?. Physiotherapy Theory and Practice 2021: 1-8.
  27. Mogren IM. Physical activity and persistent low back pain and pelvic pain post partum. BMC Public Health 2008; 8(1):1-5.
  28. Ng BK, Kipli M, Abdul Karim AK, Shohaimi S, Abdul Ghani NA, Lim PS. Back pain in pregnancy among office workers: risk factors and its impact on quality of life. Horm Mol Biol Clin Investig 2017; 32(3).
  29. Qim Hassan Khani E, Peyvandi MT. The effect of lumbar care program on low back pain during pregnancy. Iran J Obstet Gynecol Infertil 2004; 7(1):60-65.
  30. Mohseni-Bandpei MA, Fakhri M, Ahmad-Shirvani M, Bagheri-Nessami M, Khalilian AR, Shayesteh-Azar M, et al. Low back pain in 1,100 Iranian pregnant women: prevalence and risk factors. The spine journal 2009; 9(10):795-801
  31. Wang SM, Dezinno P, Maranets I, Berman MR, Caldwell-Andrews AA, Kain ZN. Low back pain during pregnancy: prevalence, risk factors, and outcomes. Obstet Gynecol 2004; 104(1):65-70.
  32. Bjelland EK, Eberhard-Gran M, Nielsen CS, Eskild A. Age at menarche and pelvic girdle syndrome in pregnancy: a population study of 74 973 women. BJOG 2011; 118(13):1646-52.