Abstract
Aims: To study the natural history and treatment of chronic skeletal pelvic pain following childbirth. Methods: 53 patients were studied, of which 13 had surgery to the symphysis pubis (11 fusion, 2 stabilisation). A detailed history was recorded and an examination carried out. Investigations included pelvic X-rays with stress views and MRI of the symphysis pubis in a selected group. Results: Mean age at onset 30.6 years, gestation 39.3 weeks (36–42). 16 of the 17 subsequent pregnancies were associated with recurrence of symptoms. Long term disability showed no relation to type of delivery (p> 0.5). Pain was worse before menstruation. 55% of patients beneþted from conservative management. This did not relate to the site of pain (p> 0.1). Stress views of the symphysis: 39, mean vertical shift 2.2mm. There was no correlation between shift and symptoms. MRI of the symphysis:17, 6 were normal and 11 revealed non-speciþc changes. Surgery:mean age at surgery 34.8 y, time to operation 4.2 y and follow up 23.6 m. Outcome: 7 good, 6 no beneþt. There was a strong reverse correlation between disability and outcome (r=−0.84) while the site of pain had no effect on outcome (p> 0.8). Conclusions: Chronic skeletal pelvic pain following pregnancy is poorly understood and under-diagnosed. It tends to be recurrent and its onset is related to hormonal and mechanical factors in pregnancy. The type of delivery is unlikely to be important although care should be taken with leg and patient positioning. There is no relationship between shift and severity. Conservative treatment is the main standby. Surgery, on the basis of this small study, is useful in those with moderate disability but contraindicated in those with severe disability.
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
