LOW BACK PAIN IN PREGNANCY

BACKGROUND Low back pain in pregnancy can be defined as pain between the 12th rib and the gluteal folds/ pubic symphysis may radiate to the posterolateral thigh, to the knee and calf during the course of pregnancy. It has been estimated that about 50% - 80% of pregnant women will suffer from some kind of low back pain at some point during their pregnancies or during the postpartum period. Unfortunately, there is limited research available regarding low back pain in pregnancy and its management. This study was conducted to find out prevalence of low back pain during pregnancy, possible risk factors and its outcome. MATERIALS AND METHODS We have done observational study of 510 pregnant women, who came to the Department of Obstetrics and Gynaecology, BMC, Sagar, during April 2016 to May 2017. Of these, 290 women complained of back pain. After taking consent, we took detailed history of their age, parity, duration of pregnancy (trimester), height, Hb% (for nutritional status), history of back pain during previous pregnancy and before pregnancy, any other risk factors, history of subsided or persistent pain 12 weeks after delivery. All these women were sent to the Department of Orthopaedics for determining the exact sites of pain, its type (whether pelvic girdle pain, lumbar pain or both), severity (determine by visual analogue pain scale), aggravating and relieving factor and any pathological cause of pain. Of these 290 cases, 39 women have known pathological causes of low back pain. We have excluded these cases and remaining 251 cases were included in this study. RESULTS In our study, we found that out of 510 pregnant women 290 (56.86%) women suffer from back pain. Of these 290 cases, 251 (86.55%) cases have no pathological cause of back pain detected. 87 were primigravida and 164 were multigravida. 92 (56.09%) women have low back pain during her previous pregnancy. 106 (42.23%) women have Hb% below 10 gm%. 59 (23.50%) women have persistent pain even after 12 weeks of delivery. 106 (42.23%) women have pelvis girdle pain, while 63 (25.09%) have lumbar and 82 (32.66%) have both pelvic girdle and lumbar pain. 72 (28.68%) women have first episode of pain that appears at 1st trimester, while 134 (53.38%) have 2nd and 45 (17.92%) have pain first appearing at 3rd trimester. 62 (21.37%) women complain of severe pain (visual analogue pain scale- 6 or more), of these 58 (20%) women required analgesics for pain relief during their course of pregnancy. 228 (78.62%) women complain of mild-to-moderate pain (visual analogue pain scale- 5 or less) and their pain responding to conservative treatment like lifestyle modification, rest, posture change, physiotherapy and local gel application. CONCLUSION LBP is the most common musculoskeletal complaints of pregnant women. Our study demonstrates that more than half (56.86%) of pregnant women suffer from low back pain. Unfortunately, there is limited research available regarding risk factors, physical therapy intervention for pregnant women experiencing low back pain, so a homogenous approach tends to be used. However, back pain is not homogenous; therefore, special considerations and precautions should be taken while treating this population. Our study try to find out risk factor associated with low back pain in pregnancy. This study is small. Further larger studies of longer durations are required for better understanding of risk factors in order to make protocol for prevention and treatment options.