Bekkensmerter under svangerskap

             Stefan Malmqvist, stipendiat ved Universitetet i Stavanger.

En norsk studie om bekkensmerter i andre halvdel av svangerskapet ble publisert i BMJ Open tidligere i år. Stefan Malmqvist er førsteforfatter, og med seg på laget har han flere av våre kollegaer, deriblant Inger Kjærmann, Knut Andersen og Anne Marie Gausel. 

Om studien:

Tittel, forfattere, publikasjonsdata Malmqvist S, Kjaermann I, Andersen K, et al. Can a bothersome course of pelvic pain from mid-pregnancy to birth be predicted? A Norwegian prospective longitudinal SMS-Track study BMJ Open 2018;8:e021378. Studien i sammendrag The objective of this prospective longitudinal cohort study was to explore if pregnant women with pelvic girdle pain (PGP), subgrouped following results from two clinical tests with high validity and reliability, differ in demographic characteristics and weekly amount of days with bothersome symptoms through the second half of pregnancy.

Enrolled participants were pregnant women arriving consecutively at the obstetric outpatient clinic, Stavanger University Hospital, Norway, due for their second-trimester routine ultrasound examination. Women reporting pelvic and lumbopelvic pain completed a questionnaire on demographic and clinical features. They were clinically examined following a test procedure recommended in the European guidelines for the diagnosis and treatment of PGP. Women without pain symptoms completed a questionnaire on demographic data. All women were followed weekly through an SMS-Track survey until delivery.

Outcome measures were results from clinical diagnostic tests for PGP and the number of days per week with bothersome pelvic pain.

503 women participated of which 42% (212/503) reported pain in the lumbopelvic region and 39% (196/503) fulfilled the criteria for a probable PGP diagnosis. 27% (137/503) reported both the posterior pelvic pain provocation (P4) and the active straight leg raise (ASLR) tests positive at baseline in week 18, revealing 7.55 (95% CI 5.54 to 10.29) times higher mean number of days with bothersome pelvic pain compared to women with both tests negative. They presented the highest scores for workload, depressed mood, pain level, body mass index, Oswestry Disability Index and the number of previous pregnancies. Exercising regularly before and during pregnancy was more common in women with negative tests.

Studiens betydning for klinisk praksis

If both ASLR and P4 tests are positive at a clinical examination in mid-pregnancy, a course ofpersistent bothersome pelvic pain for more than 5 days per week throughout pregnancy may be predicted. The number of days per week with bothersome pelvic pain increases for every added pregnancy, but individual control over work situation and regular exercise may work as a PGP prophylactic since it invigorates a positive impact on optimal force closure of the pelvis, reduces risk of instability in the pelvic joints and enhances overall well-being.

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