Pelvic girdle pain persists postpartum despite cesarean section

By Christopher Walsh, medwireNews Reporter

Women who experience pelvic girdle syndrome (PGS) during pregnancy and undergo cesarean section are still at an increased risk for PGS 6 months after childbirth, research shows.

Despite the fact that women who experience pelvic girdle pain during pregnancy are more likely to request a cesarean section than those who experience no pain, these current findings "do not suggest that caesarean section represents a benefit for the process of recovery from pelvic girdle pain," caution lead investigator Elisabeth Bjelland (Norwegian Institute for Public Health, Oslo) and co-authors.

They add: "When deciding the mode of delivery, clinicians should be aware of the increased, rather than decreased, risk of nonrecovery after caesarean section among women presenting with severe pelvic girdle pain."

The investigators obtained data from three self-administered questionnaires answered by women recruited into the Norwegian Mother and Child Cohort study between 1999 and 2008. The responses allowed the investigators to classify the degree and location of any pelvic girdle pain at pregnancy week 30 and at 6 months postpartum.

The current follow-up study, described in the American Journal of Obstetrics and Gynecology, included 10,400 women with singleton deliveries reporting PGS at pregnancy week 30.

At 6 months postpartum, 3.1% of women who underwent planned cesarean section reported severe PGS versus 1.1% of women who had unassisted vaginal delivery, representing a two-fold increased risk for severe PGS (adjusted odds ratio [OR]=2.3).

Neither planned nor emergency cesarean section were associated with increased prevalence of PGS, but there was an increased prevalence of severe PGS in women who underwent instrumental vaginal delivery or emergency cesarean section. However, neither increase was significant, say the researchers.

The researchers also observed an association between the use of crutches at pregnancy week 30 and the persistence of pain 6 months after delivery, and the association was more pronounced in women who underwent planned (8.7%) and emergency (5.7%) cesarean section than in women who had unassisted vaginal delivery (2.9%; adjusted ORs=3.3 and 2.0, respectively).

Although, according to the researchers, "no previous study of this magnititude has examined the association between mode of delivery and persistence of pelvic girdle pain after delivery," they do admit some limitations. The original cohort may not have been representative of the general population of Norway, and thus the occurrence of PGS in the current study may have been underestimated, they explain.

Nevertheless, they point out, it is unlikely that the direction of the associations is biased.

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