Pelvic alignment changes during the perinatal period
Autoři:
Saori Morino aff001; Mika Ishihara aff002; Fumiko Umezaki aff003; Hiroko Hatanaka aff003; Mamoru Yamashita aff003; Tomoki Aoyama aff004
Působiště autorů:
Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan
aff001; Pilates Studio Wohl, Aichi, Japan
aff002; Kishokai Medical Corporation, Aichi, Japan
aff003; Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
aff004
Vyšlo v časopise:
PLoS ONE 14(10)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0223776
Souhrn
Background
The function of the pelvic bones is to transfer load generated by body weight. Proper function of the pelvic bones can be disturbed by alignment changes that occur during pregnancy. Further, misalignment of the pelvic bones can lead to pain, urinary incontinence, and other complications. An understanding of the timing and nature of pelvic alignment changes during pregnancy may aid in preventing and treating these complications.
Objective
To investigate the changes in pelvic alignment during pregnancy and one month after childbirth.
Methods
This is a prospective, longitudinal cohort study. Pelvic measurements were obtained for 201 women at 12, 24, 30, and 36 weeks of pregnancy, and 1 month after childbirth. The anterior and posterior width of the pelvis (the distance between the bilateral anterior superior iliac spines and the bilateral posterior superior iliac spines), the anterior pelvic tilt, and pelvic asymmetry (the mean left and right pelvic tilt degrees and the bilateral difference of the anterior pelvic tilt) were measured. For the change in pelvic alignment, a Friedman test was conducted to determine any significant difference in the measurements over time.
Results
The anterior and posterior width of the pelvis became significantly wider with pregnancy progress and the anterior width of the pelvis at 1 month after childbirth remained wider than that at 12 weeks of pregnancy (p < 0.001). The anterior pelvic tilt increased during pregnancy and decreased after childbirth (p < 0.05).
Conclusion
Some changes in pelvic alignment occur continuously during the perinatal period. Changes in the anterior width of the pelvis are not recovered at one month post-childbirth. Understanding these perinatal changes may help clinicians avert complications due to pelvic misalignment.
Klíčová slova:
Body weight – Incontinence – Labor and delivery – Lower back pain – Pelvis – Pregnancy – Skeletal joints – Management of high-risk pregnancies
Zdroje
1. Borg-Stein J, Dugan SA. Musculoskeletal disorders of pregnancy, delivery and postpartum. Phys Med Rehabil Clin N Am. 2007;18: 459–476. doi: 10.1016/j.pmr.2007.05.005 17678762
2. Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database Syst Rev. 2015;9. doi: 10.1002/14651858.CD001139.pub4 26422811
3. Sipko T, Grygier D, Barczyk K, Eliasz G. The occurrence of strain symptoms in the lumbosacral region and pelvis during pregnancy and after childbirth. J Manipulative Physiol Ther. 2010;33: 370–377. doi: 10.1016/j.jmpt.2010.05.006 20605556
4. Snijders CJ, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and legs Part 2: Loading of the sacroiliac joints when lifting in a stooped posture. Clin Biomech. 1993;8: 295–301. doi: 10.1016/0268-0033(93)90003-Z
5. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 548: weight gain during pregnancy. Obstet Gynecol. 2013;121: 210–212. doi: http://10.1097/01.AOG.0000425668.87506.4c 23262962
6. Kharrazi FD, Rodgers WB, Kennedy JG, Lhowe DW. Parturition-induced pelvic dislocation: a report of four cases. J Orthop Trauma. 1997;11: 277–81; discussion 281–282. doi: 10.1097/00005131-199705000-00009 9258826
7. Schauberger CW, Rooney BL, Goldsmith L, Shenton D, Silva PD, Schaper A. Peripheral joint laxity increases in pregnancy but does not correlate with serum relaxin levels. Am J Obstet Gynecol. 1996;174: 667–671. doi: 10.1016/s0002-9378(96)70447-7 8623804
8. Franklin ME, Conner-Kerr T. An analysis of posture and back pain in the first and third trimesters of pregnancy. J Orthop Sports Phys Ther. 1998;28: 133–138. doi: 10.2519/jospt.1998.28.3.133 9742469
9. Mitchell DA, Esler DM. Pelvic instability—Painful pelvic girdle in pregnancy. Aust Fam Physician. 2009;38: 409–410. 19521584
10. Morino S, Ishihara M, Umezaki F, Hatanaka H, Aoyama T, Yamashita M, et al. Pelvic alignment risk factors associated with sacroiliac joint pain during pregnancy. Clin Exp Obstet Gynecol. 2018;45: 850–4. doi: 10.12891/ceog4268.2018
11. Vleeming A, Stoeckart R, Volkers AC, Snijders CJ. Relation between form and function in the sacroiliac joint. Part II: biomechanical aspects. Spine (Phila Pa 1976). 1990;15: 133–136.
12. Al-Eisa E, Egan D, Deluzio K, Wassersug R. Effects of pelvic skeletal asymmetry on trunk movement: three-dimensional analysis in healthy individuals versus patients with mechanical low back pain. Spine. 2006;31: E71–79. doi: 10.1097/01.brs.0000197665.93559.04 16449891
13. The Malalignment Syndrome. In: Schamberger W, editor. Implications for Medicine and Sport. London, Churchill Livingstone, 2002. p. 29.
14. Lee D, Lee L-J. Stress urinary incontinence–a consequence of failed load transfer through the pelvic girdle? The 5th World Interdisciplinary Congress on Low Back and Pelvic Pain; Melbourne, Australia 2004. p. 1–14.
15. Casagrande D, Gugala Z, Clark SM, Lindsey RW. Low Back Pain and Pelvic Girdle Pain in Pregnancy. J Am Acad Orthop Surg. 2015;23: 539–549. doi: 10.5435/JAAOS-D-14-00248 26271756
16. Urbankova I, Grohregin K, Hanacek J, Krcmar M, Feyereisl J, Deprest J, et al. The effect of the first vaginal birth on pelvic floor anatomy and dysfunction. Int Urogynecol J. 2019. doi: 10.1007/s00192-019-04044-2 31327032.
17. Gyhagen M, Akervall S, Molin M, Milsom I. The effect of childbirth on urinary incontinence: a matched cohort study in women aged 40–64 years. American journal of obstetrics and gynecology. 2019. doi: 10.1016/j.ajog.2019.05.022 31121136.
18. Yamaguchi M, Morino S, Nishiguchi S, Fukutani N, Tashiro Y. Comparison of Pelvic Alignment among Never-Pregnant Women, Pregnant Women, and Postpartum Women (Pelvic Alignment and Pregnancy). J Womens Health Care. 2016;5. doi: 10.4172/2167-0420.1000309
19. Gnat R, Saulicz E, Biały M, Kłaptocz P. Does Pelvic Asymmetry always Mean Pathology? Analysis of Mechanical Factors Leading to the Asymmetry. J Hum Kinet. 2009;21: 23–32. doi: 10.2478/v10078-09-0003-8
20. Azevedo DC, Santos H, Carneiro RL, Andrade GT. Reliability of sagittal pelvic position assessments in standing, sitting and during hip flexion using palpation meter. J Bodywork Move Ther. 2014;18: 210–214. doi: 10.1016/j.jbmt.2013.05.017 24725788
21. MacLennan AH. The role of the hormone relaxin in human reproduction and pelvic girdle relaxation. Scand J Rheumatol Suppl. 1991;88: 7–15 2011710
22. Nygaard I. Pelvic floor recovery after childbirth. Obstet Gynecol. 2015;125: 529–530. doi: 10.1097/AOG.0000000000000705 25730211
23. Arner JW, Albers M, Zuckerbraun BS, Mauro CS. Laparoscopic Treatment of Pubic Symphysis Instability With Anchors and Tape Suture. Arthrosc Tech. 2018;7:e23–e7. doi: 10.1016/j.eats.2017.08.045 29379710; PubMed Central PMCID: PMC5786148.
24. Stein TA, Kaur G, Summers A, Larson KA, DeLancey JO. Comparison of bony dimensions at the level of the pelvic floor in women with and without pelvic organ prolapse. American journal of obstetrics and gynecology. 2009;200:241 e1–5. doi: 10.1016/j.ajog.2008.10.040 19254580; PubMed Central PMCID: PMC2866149.
25. Mens JM, Pool-Goudzwaard A, Stam HJ. Mobility of the pelvic joints in pregnancy-related lumbopelvic pain: a systematic review. Obstet Gynecol Surv. 2009;64: 200–208. doi: 10.1097/OGX.0b013e3181950f1b 19228440
26. Vleeming A, Buyruk HM, Stoeckart R, Karamursel S, Snijders CJ. An integrated therapy for peripartum pelvic instability: a study of the biomechanical effects of pelvic belts. American J obstet and gynec. 1992;166: 1243–1247. doi: 10.1016/S0002-9378(11)90615-2
27. Fishburn S. Pelvic girdle pain: updating current practice. Pract Midwife. 2015;18: 12–15.
28. Mens JM. Does a pelvic belt reduce hip adduction weakness in pregnancy-related posterior pelvic girdle pain? A case-control study. Eur J Phys Rehabil Med. 2017; 53: 575–581. doi: 10.23736/S1973-9087.17.04442-2 28251846
29. Pedrazzini A, Bisaschi R, Borzoni R, Simonini D, Guardoli A. Post partum diastasis of the pubic symphysis: a case report. Acta Biomed. 2005;76: 49–52.
30. 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 Musculoskelet Disord. 2016; 17: 276. doi: 10.1186/s12891-016-1154-0 27406174
31. Damen L, Buyruk HM, Guler-Uysal F, Lotgering FK, Snijders CJ, Stam HJ. Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints. Acta Obstet Gynecol Scand. 2001;80: 1019–1024. doi: 10.1034/j.1600-0412.2001.801109.x 11703199
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