Red herring: Acute back pain after combined spinal epidural for labor analgesia
Autor: | Kian Hian Tan, Yoong Chuan Tay |
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Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
medicine.medical_specialty
030219 obstetrics & reproductive medicine Vaginal delivery Symphysis business.industry Forceps Analgesic Urinary incontinence Surgery lcsh:RD78.3-87.3 03 medical and health sciences 0302 clinical medicine Anesthesiology and Pain Medicine medicine.anatomical_structure lcsh:Anesthesiology Anesthesia Orthopedic surgery medicine Back pain Gestation 030212 general & internal medicine medicine.symptom business |
Zdroj: | Egyptian Journal of Anaesthesia, Vol 34, Iss 2, Pp 67-69 (2018) |
ISSN: | 1110-1849 |
Popis: | Symphysis pubis diastases complicate 1:300 to 1:30,000 pregnancies. Peripartum pain in chronological sequence with labor epidural analgesia often attracts instinctive causation and distress. Predisposing risk factors include macrosomia, short second stage of labor, forceps use, multiparity, small pelvis, intense uterine contractions, previous pelvic ring pathology and trauma. A gestational diabetic primigravid parturient presents with acute post-partum back pain after an uneventful analgesic labor epidural. Her pain distributed over the right paravertebral L5-S1 region without radiculopathy, worsened with positional change and accompanied by urinary incontinence, precluding child care. Spine imaging incidentally revealed a 38 mm symphysis pubis diastasis. A pelvic binder by orthopaedics aided physiotherapy and ambulation. Pubic diastases are usually conservatively managed, unless separation exceeds 5 cm when early surgery may improve functional outcomes. Although symptoms may recur in subsequent pregnancies, it does not preclude vaginal delivery. Early recognition and prompt management aim to reduce parturient morbidity and promote resumption of activity. Keywords: Symphysis pubis diasthesis, Pubic symphysis diasthesis, Post-epidural pain, Labor epidural pain, Post-partum pain |
Databáze: | OpenAIRE |
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