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Ceska Gynekologie 2023There are many types of pelvic pain. Pelvic plexus pain, coccyx pain, pain from episiotomy scars, and vulvodynia are frequently seen in postpartum women. The aim of this...
OBJECTIVE
There are many types of pelvic pain. Pelvic plexus pain, coccyx pain, pain from episiotomy scars, and vulvodynia are frequently seen in postpartum women. The aim of this study was to conduct a systematic review of studies on pelvic pain in postpartum women to assess the effect of physiotherapy interventions on each type of pain.
METHODS
A comprehensive literature review was conducted by searching on PubMed, Ovid Embase and Scopus Web of Science using the key words - pelvic pain, women after childbirth, pelvic girdle pain, coccygodynia, episiotomy, vulvodynia, and physiotherapy. The author reviewed all the identified articles and selected articles for inclusion according to relevance to the topic.
CONCLUSION
Based on the analysis of the above studies, it can be concluded that a comprehensive physiotherapy designed for postpartum women that includes manual techniques, behavioral techniques, relaxation of hypo-tonic and shortened muscles and strengthening of hypotonic muscles can positively affect a wide range of pain and associated dysfunctions of the pelvic floor and trunk muscles.
Topics: Female; Humans; Pregnancy; Parturition; Pelvic Pain; Physical Therapy Modalities; Postpartum Period; Vulvodynia
PubMed: 37344188
DOI: 10.48095/cccg2023214 -
Irish Journal of Medical Science Dec 2022Mutations in the alpha-sarcoglycan gene cause limb-girdle muscular dystrophy 2D, an autosomal recessive muscle wasting disorder primarily affecting the muscles of the...
BACKGROUND
Mutations in the alpha-sarcoglycan gene cause limb-girdle muscular dystrophy 2D, an autosomal recessive muscle wasting disorder primarily affecting the muscles of the shoulder and pelvic girdles. To date, no previous study has collated all known mutations in alpha-sarcoglycan and mapped these to the associated phenotypes.
AIMS
To examine for correlations between mutation locations, or mutation type, and the phenotype caused in all reported mutations in alpha-sarcoglycan.
METHODS
We present a systematic literature review examining correlations between mutation locations, or mutation type, and the phenotype caused in all reported cases of limb-girdle muscular dystrophy 2D.
RESULTS
From 134 unique genotypes collated, a strong prevalence of missense mutations (64% of all unique mutations) was found in this gene. Mutation hotspots were noted in exon three and the extracellular domain, with mutation densities varying significantly between both exons and protein domains (p ≤ 0.01). All compound heterozygous limb-girdle muscular dystrophy 2D patients with cardiac involvement contained at least one mutation in exon three, a novel finding. All non-sense mutations in alpha-sarcoglycan give a severe phenotype, as do genotypes involving a combination of exons four and five. This study confirms on a large, diverse cohort the extremely high prevalence of the c.229C > T mutation.
CONCLUSIONS
This study demonstrates the vast variation in disease severity seen between patients possessing the same mutation, highlighting the difficulty identifying genotype-phenotype correlations in this condition. Novel findings including the involvement of exon three in all compound heterozygous patients who suffered from cardiomyopathy, and the severity of mutations involving exons four and five may help to guide investigations and therapeutic decisions in an era of personalised medicine.
Topics: Humans; Sarcoglycanopathies; Sarcoglycans; Exons; Phenotype; Mutation; Genetic Association Studies
PubMed: 35040091
DOI: 10.1007/s11845-021-02855-1 -
BMC Pregnancy and Childbirth Jul 2019Low back pain (LBP) and pelvic girdle pain (PGP) are commonly reported during pregnancy and are known to affect pregnant women's well-being. Still, these conditions are...
BACKGROUND
Low back pain (LBP) and pelvic girdle pain (PGP) are commonly reported during pregnancy and are known to affect pregnant women's well-being. Still, these conditions are often considered to be a normal part of pregnancy. This study assesses the prevalence and severity of LBP and/or PGP among pregnant Nepalese women, as well as exploring factors associated with LBP and PGP.
METHODS
A cross-sectional study with successive recruitment of pregnant women was conducted at two district hospitals in Nepal from May 2016 to May 2017. The data was collected using self-reported questionnaires. Univariate and multivariate logistic regression were used to assess the associations between independent variables and LBP and/or PGP.
RESULTS
A total of 1284 pregnant women were included in the study. The reported prevalence of pregnancy-related LBP and/or PGP was 34%. Pain intensity was high with a mean score (standard deviation) of 6 (2). The median (25th-75th percentiles) disability scores according to the total Pelvic Girdle Questionnaire and Oswestry Disability Index were 20 (10-32) and 30 (21-38), respectively. Even though only 52% of the women believed that the pain would disappear after delivery, concern about LBP and/or PGP was reported to be low (median 2 (0-4) (Numeric Rating Scale 0-10)). In the final model for women with LBP and/or PGP the adjusted odds ratios were for body mass index (20-24, 25-30, > 30) 0.7 (95% confidence interval (CI), 0.44-1.21), 1.1 (95% CI, 0.66-1.83), and 1.5 (95% CI, 0.78-2.94) respectively, for pelvic organ prolapse symptoms 6.6 (95% CI, 4.93-8.95) and for women with educated husbands (primary or secondary, higher secondary or above) 1.1 (95% CI, 0.53-2.16) and 1.7 (95% CI, 0.84-3.47), respectively.
CONCLUSIONS
Pregnant Nepalese women commonly report LBP and/or PGP. The women experienced low disability despite severe pain intensity and poor beliefs in recovery after delivery.
Topics: Adult; Cross-Sectional Studies; Female; Humans; Logistic Models; Low Back Pain; Nepal; Pelvic Girdle Pain; Pregnancy; Pregnancy Complications; Prevalence; Risk Factors; Self Report; Severity of Illness Index
PubMed: 31307421
DOI: 10.1186/s12884-019-2398-0 -
Rheumatology (Oxford, England) Mar 2021PMR is an inflammatory rheumatic disease of elderly people characterized by pain and stiffness in the neck, shoulder and pelvic girdles. No specific diagnostic... (Review)
Review
PMR is an inflammatory rheumatic disease of elderly people characterized by pain and stiffness in the neck, shoulder and pelvic girdles. No specific diagnostic confirmatory tests exist and clinical symptoms, as well as increased acute phase reactants, are unspecific. The diagnostic value of imaging including ultrasound, MRI and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) with/without CT for PMR is increasingly studied. These techniques, particularly FDG-PET/CT, may help to detect underlying GCA in PMR patients with an incomplete response to glucocorticoids and/or recurrent relapses. Recent imaging studies provide novel insights into the anatomical basis of inflammation in PMR, particularly at hip and spine, which may help to distinguish this disease from other mimicking conditions. In this review, we discuss novel insights into the pathoanatomy of PMR, compare the diagnostic values of different imaging techniques and summarize current data on the role of imaging for monitoring and outcome prediction.
Topics: Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Polymyalgia Rheumatica; Positron Emission Tomography Computed Tomography; Ultrasonography
PubMed: 33200216
DOI: 10.1093/rheumatology/keaa646 -
Journal of Midwifery & Women's Health Mar 2021Persistent pelvic girdle pain (PGP) and the resulting consequences may occur for more than 10 years after birth. The purpose of this meta-synthesis is to provide a new... (Review)
Review
INTRODUCTION
Persistent pelvic girdle pain (PGP) and the resulting consequences may occur for more than 10 years after birth. The purpose of this meta-synthesis is to provide a new interpretation and deeper understanding of women's experience of living with PGP postpartum.
METHODS
A literature review of CINAHL, PsycINFO, PubMed, Scopus, and ProQuest dissertations was conducted for any qualitative study addressing PGP after birth and published in English from 2000 to 2019. A meta-synthesis using Noblit and Hare's meta-ethnography approach was performed.
RESULTS
Seven studies were found describing the experiences of women living with PGP from birth to 13 years after birth. Six themes emerged that represented women's experience: invisible pain, life being restrained, failure to perform the maternal role, experiencing downward emotional spiral, need for active social support, and adaptation to a new conditional life.
DISCUSSION
The experiences of women living with PGP after birth highlight the need for holistic care. Interventions by health care providers should support the ability of women to perform daily functions and adapt to their new reality instead of a disease-focused intervention. In addition, women with PGP emphasize the importance of active social support from family members and health care providers. Future research that examines the differences between PGP during the first 3 months postpartum versus that which persists later is needed to develop targeted interventions.
Topics: Delivery, Obstetric; Female; Humans; Parturition; Pelvic Girdle Pain; Postpartum Period; Pregnancy; Qualitative Research; Social Support
PubMed: 33314586
DOI: 10.1111/jmwh.13167 -
Spine Jul 2021Cross-sectional study conducted between December 2017 and October 2019.
STUDY DESIGN
Cross-sectional study conducted between December 2017 and October 2019.
OBJECTIVE
To determine the prevalence and risk factors associated with pregnancy-related pelvic girdle pain (PPGP) in Australia.
SUMMARY OF BACKGROUND DATA
PPGP is a common condition worldwide yet the prevalence and associated risk factors are not known in Australia.
METHODS
A random sample of pregnant women (N = 780) of (mean [SD]) 31 (5) years of age between 14 and 38 weeks gestation attending ante-natal care in a tertiary referral hospital in Sydney, Australia was conducted. The main outcome measure was point-prevalence of PPGP as classified by recommended guidelines including a physical examination. A number of potential risk factors, including socio-demographic characteristics, country of birth, ethnicity, history of low back pain (LBP) and PPGP, family history of PPGP, occupational factors, and physical activity were investigated with logistic regression.
RESULTS
The point-prevalence of PPGP in a random sample of 780 Australian women was 44% with the odds of having PPGP increasing with each additional week of gestation (odds ratio [OR]) (OR 1.02). Increasing parity (P = 0.03, OR 1.15), country of birth (P = 0.03), and greater duration of time spent standing (P = 0.009, OR 1.06) were associated with PPGP. The strongest predictors of PPGP were previous LBP and/or PPGP both pregnancy (P < 0.001, OR 4.35) and not pregnancy related (P < 0.001, OR 2.24), and a family history of PPGP (P < 0.001, OR 3.76).
CONCLUSION
The prevalence of PPGP in Australian women was high with almost half the sample classified with PPGP, matching data reported worldwide. The identified risk factors associated with PPGP can be included in routine ante-natal care to screen women and identify those at risk of this common and disabling condition.Level of Evidence: 1.
Topics: Adult; Australia; Cross-Sectional Studies; Female; Humans; Pelvic Girdle Pain; Pregnancy; Pregnancy Complications; Risk Factors
PubMed: 33492087
DOI: 10.1097/BRS.0000000000003954 -
Zoology (Jena, Germany) Jun 2021Postcranial skeletal pneumaticity (i.e., epithelial-lined, air-filled bones) is a condition unique to birds among extant tetrapods. Previous research reveals extensive...
Postcranial skeletal pneumaticity (i.e., epithelial-lined, air-filled bones) is a condition unique to birds among extant tetrapods. Previous research reveals extensive variation in the expression of this trait in different bird species, from taxa that pneumatize nearly the entire skeleton to others that do not pneumatize a single bone. These studies, however, have primarily focused on aquatic/semi-aquatic birds, specifically Anseriformes (screamers, ducks, geese, swans) and Aequorlitornithes (loons, gulls, penguins, storks, etc.). This is the first clade-centric study of pneumaticity in an exclusively terrestrial clade (i.e., a group without any proclivities for water), Cuculidae. Given the variation in body size and ecology exhibited by cuckoos, they represent an ideal group for evaluating previously established trends in pneumaticity patterns. Similar to previous studies, our results indicate that cuckoos do exhibit extensive postcranial skeletal pneumaticity but with much more limited variation in expression. Of the surveyed species, 30 of 41 display an identical expression pattern, pneumatizing all postaxial vertebrae, the humerus, sternum, and pelvic girdle. The remaining species (11/41) deviate from this pattern by no more than two elements (i.e., the femur or the scapula/coracoid). All variable species expand upon the basic cuckoo pattern, with five species pneumatizing the femur and the remaining six taxa pneumatizing both the scapula and coracoid. Furthermore, most variation occurs in early diverging clades, with distinct subclades associated with specific anatomical expansions in pneumaticity (e.g., pneumatic femora in Neomorphinae and pneumatic scapulae/coracoids in select members of Couinae and Centropodinae). Limited variation noted in Cuculidae may be the result of the relatively high base level of pneumaticity when compared with previously sampled groups of water-oriented birds. Additional analyses indicate a positive relationship between body mass and pneumaticity, with possible (i.e., non-quantifiable) relationships noted between the limited expansions from the basic cuckoo pattern and specific locomotor behaviors (e.g., pneumatic femora present in species with enhanced cursorial behavior). These basic trends have also been observed in other densely sampled neognath clades. Taken together, the data presented herein supports the hypothesis that changes in pneumaticity expression may be correlated with shifts in biomechanical loading regimes rather than solely as a weight saving (i.e., density-altering) mechanism.
Topics: Animals; Body Size; Bone and Bones; Passeriformes; Respiratory System
PubMed: 33730625
DOI: 10.1016/j.zool.2021.125907 -
BMC Musculoskeletal Disorders Oct 2022Pelvic girdle pain (PGP) is a type of pregnancy-related lumbopelvic pain. This study aimed to examine the prevalence, severity, and factors associated with postpartum... (Observational Study)
Observational Study
BACKGROUND
Pelvic girdle pain (PGP) is a type of pregnancy-related lumbopelvic pain. This study aimed to examine the prevalence, severity, and factors associated with postpartum PGP in a selected group of postpartum women in Poland.
METHODS
This was a prospective, observational study. In phase 1, 411 women were recruited 24-72 h postpartum. The prevalence of PGP was assessed by a physiotherapist using a series of dedicated tests. Pelvic floor muscle function and presence of diastasis recti were assessed via palpation examination. Age, education, parity, mode of delivery, infant body mass, body mass gain during pregnancy, the use of anesthesia during delivery and were recorded. In a phase 2, 6 weeks postpartum, the prevalence of PGP and its severity were assessed via a self-report.
RESULTS
In phase 1 (shortly postpartum), PGP was diagnosed in 9% (n = 37) of women. In phase 2 (6 weeks postpartum), PGP was reported by 15.70% of women (n = 42). The univariable analyses showed a higher likelihood of PGP shortly postpartum in women who declared PGP during pregnancy (OR 14.67, 95% CI 4.43-48.61) and among women with abdominal midline doming (OR 2.05, 95% CI 1.04-4.06). The multivariable regression analysis showed significant associations in women with increased age (OR 1.12, 95% CI 1.01-1.21) and declaring PGP during pregnancy (OR 14.83, 95% CI 4.34-48.72).
CONCLUSION
Although the prevalence of postpartum PGP among women in Poland is lower than reported in other countries, it is experienced by almost every tenth women shortly postpartum and every sixth can report similar symptoms 6 weeks later. Age, PGP during pregnancy and abdominal midline doming were associated with experiencing PGP shortly postpartum.
Topics: Humans; Pregnancy; Female; Pelvic Girdle Pain; Prevalence; Prospective Studies; Poland; Postpartum Period; Pregnancy Complications
PubMed: 36266709
DOI: 10.1186/s12891-022-05864-y -
Physiotherapy Theory and Practice Dec 2022Women with generalized joint hypermobility may be at increased risk of pregnancy-related pelvic girdle pain, but evidence is inconclusive.
BACKGROUND
Women with generalized joint hypermobility may be at increased risk of pregnancy-related pelvic girdle pain, but evidence is inconclusive.
OBJECTIVES
In this prospective cohort study of 283 pregnant women in Norway, we aimed to study the association of generalized joint mobility with pelvic girdle pain, and to evaluate if pre-pregnancy body mass index was a modifier of the association.
METHODS
Generalized joint hypermobility was defined as a score of ≥5/9 positive tests on the Beighton score measured in early pregnancy. Primary outcome was evening pain intensity in gestation week 30, measured by a 100 mm visual analogue scale. We applied linear regression analyses to estimate age-adjusted unstandardized beta coefficients.
RESULTS
Evening pain intensity was similar among women with Beighton score ≥ 5/9 and women with Beighton score < 5/9 (age-adjusted mean difference 2.8 mm; 95% CI: -9.2 to 14.9 mm). Women with Beighton score ≥ 5/9 and pre-pregnancy body mass index ≥ 25 kg/m, reported higher evening pain than women with Beighton score < 5/9 and pre-pregnancy body mass index <25 kg/m (age-adjusted mean difference 28.7 mm; 95% CI: 14.3-43.1 mm).
CONCLUSIONS
Overall, evening pain intensity was similar among pregnant women with and without generalized joint hypermobility. However, women with a combination of generalized joint hypermobility and body mass index ≥25 kg/m reported higher evening pain compared to women with normal joint mobility and body mass index <25 kg/m, suggesting that body mass index may modify the association. The estimates could be imprecise due to the small study sample, and our findings should be interpreted with caution.
Topics: Female; Humans; Pregnancy; Pelvic Girdle Pain; Joint Instability; Body Mass Index; Prospective Studies; Pain Measurement
PubMed: 33849378
DOI: 10.1080/09593985.2021.1913774 -
Cureus Oct 2021Pregnancy-related pain in the sacroiliac joint (SIJ), lumbosacral region, pubic symphysis, or in any combination of these joints has been coined as pelvic girdle pain... (Review)
Review
Pregnancy-related pain in the sacroiliac joint (SIJ), lumbosacral region, pubic symphysis, or in any combination of these joints has been coined as pelvic girdle pain (PGP) and has been estimated to affect almost half of all pregnant women. SIJ dysfunction in pregnancy is due to multiple biomechanical mechanisms, such as increased weight, change in posture, increased abdominal and intrauterine pressure, and laxity of the spine and pelvic structures. Moreover, when compared to men, women have increased SIJ mobility due to increased pubic angle and decreased SIJ curvature. These differences may assist in parturition where hormones, such as relaxin and estrogen, cause symphysiolysis. A retrospective review of the literature was conducted in the PubMed database using the search term "pregnancy-related sacroiliac joint pain." All peer-reviewed studies were included. Around 8%-10% of women with PGP continue to have pain for one to two years postpartum. Patients that were treated with SIJ fusion show statistically significant improvement in pain scores when compared to patients that had non-operative treatment. Although we have a number of studies following patients after sacroiliac (SI) joint fusion for pelvic pain with SI joint dysfunction, further research is needed to study sacroiliac fusion for SI joint dysfunction in postpartum women to better tailor and optimize surgical outcomes for this patient population.
PubMed: 34786225
DOI: 10.7759/cureus.18619