BACKACHE IN PREGNANCY Prof. M.C. Bansal MBBS., MS. MICOG. FICOG. Ex Principal and ControllerJhalawar Medical College & Hospital. MGMC & Hospital. Sitapura, Jaipur.
• The Life incidence of low back pain ranges from 50- 70 %.Sciatica is less common , with life time incidence of 10-40 %.• All structures of lower spine , pelvis ,e.g. the muscles , ligaments .joints , Inter vertebral discs and nerve root can cause back pain.• It is very common in pregnancy, often patients ignore it, though it worsens and disability develops due to increasing lordosis. 50 -80 % women do have discomfort but seldom take medication, a few of them have such limited mobility as to be at risk of venous thrombosis due to prolonged bed rest.• Back pain most frequently presents between 20 – 28 weeks of gestation.
Types of Back Pain • 1. Lumber. • 2. Sacral / pelvic. (1) Lumber pain tends to be central over the lover lumber vertebrae but may be associated with radiation of pain in to legs,. Usually aggravated by prolong maintenance of same position , be it be sitting in chair or standing. (2) Sacral / pelvic pain is 4 times more common. Women describes it on sacral region ,may radiate to buttocks , back of thighs and pubic area. Pain is not eased by short period of rest .Rolling over the bed , rising from seat and climbing stairs tend to make the pain worse.
Causes of back pain in General 1. Mechanical Muscle pain , prolapse of inter vertebral disk, Spondyolisthesis , lumber spondylosis , fibromyelgia , osteoarthrits ,spinal stenosis . 2. Traumatic Fracture of vertebra ,soft tissue injury , shot pallets . 3 .Inflammatory Rheumatoid arthritis , ankylosing spondilytis . Reiter’s syndrome , psoriatic arthritis. 4. Infective Osteomyelitis ,tuberculosis.
Causes of Backache in General 5. Metabolic osteomalacia , Paget’s disease of bone , osteoporosis and vertebral collapse, 6 . Tumours Primary of bone –benign / malignant , secondarys , Multiple myloma. 7. Haematological Sickle cell disease . 8 . Referred from other organs Gastric ulcer , duodenal ulcer , gall bladder disease , pancreatitis ,renal infection-stones or tumours . 9 . Vascular Aneurysm .
Cause of low backache in pregnancy • Relaxation effect of hormones on joints. • Postural changes. • Change in center of gravity. Imaging has shown that the lordosis of the lumber vertebrae in reality decreases in latter half of the pregnancy. • Obesity, smoking , H/O sudden lifting weight , • Wrong posture, pre pregnancy backache may also be noted . Most pregnancy related back pains resolve in post partum period by proper diet , exercise, change in posture habit and appropriate rehabilitation . • One third will continue to have pain for 4 weeks after delivery and 1/6th up to 9 weeks post partum .
Management- • History of pre existing backache , its diagnosis and treatment given / still taking . • Clinical examination , orthopedic consultation ,and require investigations avoiding radiation exposure to mother and fetus. • Pain killers / muscle relaxant if necessary . Calcium and vit D supplementation , adequate rest till pain is intolerable ,Physiotherapy and Exercise to strengthen the back muscles e.g. swimming , correction of posture , avoiding prolong sitting or standing . • Avoidance of aggravating factors ,wearing shoes with low / no heels .
Management • To avoid litigation , proper documentation is mandatory.
Diagnosis should never be missed --- 1. Acute lumber disc prolapse 2. Cauda Equina Syndrome. Magnetic resonance (MR) can safely be done in pregnancy