Symphysitis during pregnancy

Symphysitis in pregnancy refers to a common pathology that affects about half of the female population during pregnancy. In addition, it is worth considering that if the first pregnancy was diagnosed with "symphysitis", then in the case of a subsequent pregnancy, he will also be present.

In medical practice, the concept of "symphysis" is the articulation of the pubic bones. In the process of pregnancy and growth of the uterus, stretching of this area is observed, which further provokes an increase in the mobility of the joint.

Do not worry, because such a process is physiological, necessary for labor. Symphysitis is noted due to the development of excessive mobility due to the strong softening of the articulation.

As a result, symphysitis is characterized by the appearance of such clinical manifestations as pain syndrome, discomfort in the perineal region and puffiness of the joint.

Similar symptoms are mainly observed, beginning with the second half of pregnancy, when there is difficulty in climbing the stairs, walking and turning on its side in a lying position.

[1], [2], [3]

The causes of symphysitis in pregnancy

This pathology is associated with softening of the articulation site between the pubic pelvic bones. Out of pregnancy, the symphysis is a practically immobile joint of the bones, forming a joint.

At the basis of normal support of the tone of the joint is an important role played by the hormone - relaxin. Under its influence, softening of tissues occurs, as a result of which the joint acquires greater mobility.

The causes of symphysitis in pregnancy are not fully understood to date. After all, in one woman during pregnancy the joint is stretched slightly, while others suffer from symphysitis and its clinical manifestations. In addition, he can accompany a woman who has already given birth for a long time.

There are various assumptions and causes of symphysitis in pregnancy. First, the lack of calcium in the pregnant woman may be adversely affected by the articulation, resulting in a low content of calcium in the bones.

Secondly, it is possible that symphysitis is associated with hormone relaxin and its level is raised in the body. Because of this, excessive stretching of the articulation, its puffiness and the appearance of characteristic symptoms occur.

The remaining group of causes are predisposing factors, for example, the presence of pathology of bones, joints before pregnancy, individual anatomical features of the structure of each woman, or genetic predisposition.

To date, it is impossible to say exactly why the given disease develops in women bearing a child. Causes of symphysitis during pregnancy are not fully understood, but certain thoughts of the medical profession, nevertheless, speak on this matter.

• Low level of calcium in the maternity.
• Avitaminosis.
• An excess of the hormone relaxin, which is often observed during pregnancy. Excessive presence of this hormone leads to softening of bone tissues. Growth of the fetus leads to stretching of the symphysis, and after a certain moment, a crack appears on it, which provokes a break in the joint of the womb in the period of independent birth. •
• Hereditary predisposition.
• In the anamnesis, the abnormalities of the musculoskeletal system are seen in the pregnant woman.

Symptoms of symphysitis in pregnancy

Most often, clinical manifestations of pathology begin to bother after the 4th month of pregnancy, when the fetus begins to gain weight rapidly and the uterus increases significantly.

The symptoms of symphysitis during pregnancy are most intense in recent months. It is characterized by an increase in puffiness in the articulation area, intense pain in the perineal region, as well as a crunch when palpation of the pubic joint.

In addition, it should be noted the spread of pain in the pelvic region, coccyx and hips. An increase in the intensity of pain is observed with a rapid change in position, for example, when turning, rising from a chair or on a ladder.

The symptoms of symphysitis during pregnancy do not allow you to raise your straight leg in a supine position, provide a "duck" gait and a sense of heaviness when climbing the stairs.

As the gestation period increases, further progression of the symphysitis occurs, in which the pain syndrome worries even at rest.

In order not to aggravate the situation, it is necessary to be very careful about your body, because during the period of gestation the woman is responsible not only for her health, but also for the health of her unborn child. Therefore, it is worthwhile to know the symptoms of symphysitis during pregnancy, having found out in oneself which it is necessary to inform the doctor who is observing the pregnancy without fail.

• Mostly, this symptomatology appears in a woman in the third trimester of pregnancy. During the second trimester, it is rare.
• In the area of the pubic joint begins to appear at first a slight, and then all the increasing puffiness - a sign of the inflammatory process.
• The pregnant woman receives a so-called "duck" gait.
• When palpating in this area, the woman feels a sharp piercing pain. Pressing may cause clicks.
• Painful sensations reach the woman and with a change in the position of the body.
• Pregnant begins to intuitively semen when walking, leading to a minimum sharp change in the position of the hip area.
• Feeling of heaviness in the lower abdomen.
• An important problem is the need to raise a straightened leg.
• When climbing the stairs, the pregnant woman feels discomfort and pain in the hip area.

The symptoms of symphysitis during pregnancy tend to progress and over time the pain becomes even more expressive. The pain will begin to pursue the woman not only during the movement, but also in the period of rest, when she sits or quietly lies on the couch.

What is the danger of symphysitis in pregnancy?

In order to completely disassemble all the threats of the symphysitis, it is necessary to separately identify the danger to the pregnant woman and the fetus. So, what is the danger of symphysitis in pregnancy for a future mother?

It can not be said for sure that this pathology is absolutely safe for a pregnant woman, since an excessive increase in the mobility of the joint can lead to serious consequences.

Of course, it is worth mentioning those uncomfortable sensations and pain that plague a pregnant woman after the 4th-5th month of bearing the fetus. In addition, the choice of the route of delivery depends on the degree of activity of the symphysitis: caesarean section or through natural birth canals.

In addition to symphysitis, one should take into account the course of pregnancy itself, the presence of toxicosis, gestosis, fetal size, the presence and number of previous births, in general, all factors that affect the course of labor.

What is dangerous Symphysitis in pregnancy for the fetus? That's just for the baby symphysitis does not pose any threat. However, do not forget about the emotional state of the pregnant woman in the presence of a constant pain syndrome and uncomfortable sensations in the perineum. All stressful situations of the future mother negatively affect the fetus.

In most cases, this pathology is diagnosed at the reception of an obstetrician - gynecologist and, as a rule, in the third trimester of pregnancy. If the pregnant woman starts complaining about the unpleasant burning sensation in the pubic area, the pain symptoms of the pelvic organs, it is worth more carefully to check the woman's body for symphysitis. What is dangerous Symphysitis in pregnancy? It is impossible to call this disease harmless, because it is caused not only by the inflammation of the pubic zone, but also by the subsequent weakening and loosening of its structure, which in time can lead to a divergence and then a break in the symphysis.

This development of pathology brings to the woman quite severe suffering. The degree of pathology, as well as other parameters (the weight of the baby, the number of previous births, the course of pregnancy), can significantly affect the question of how the pregnant woman will give birth: independently, naturally or will have to resort to caesarean section.

If a pregnant woman goes to a gynecological clinic for childbirth, having such a diagnosis, the obstetrician-gynecologist should be necessarily aware of the presence of such a diagnosis in the mother. After all, the presence of a symphysitis in a woman's anamnesis significantly increases the risk of getting pelvic fractures in the process of delivery. Such, to put it mildly, a nuisance, is fraught with a long postnatal recovery period, as well as a bed rest, which mostly lasts about two weeks.

Having a newly born child in his arms, performing the necessary curative gymnastics course, walking through various specialists is not the best additional burden for a woman who has just delivered birth. Knowing this, no qualified expert will venture to let a woman into a natural birth. Therefore symphysitis is practically guaranteed direction to cesarean section. To risk and let a woman into natural childbirth a doctor can only if the crack in the womb has spread by no more than ten millimeters, while the baby is small, and the size and location of the pelvic bones is within the norm. During the passage of the birth canal, the child does not experience significant discomfort in this pathology.

Diagnosis of symphysitis in pregnancy

Over time, during pregnancy, the fetus begins to gain weight intensively, starting from the 5th month. In addition, the uterus also significantly increases in size, resulting in such a combination provokes an increase in the lengthening of the pubic articulation.

Diagnosis of symphysitis during pregnancy is based on a woman's questioning about her symptoms and the course of the illness. So, characteristic for symphysitis is the pain syndrome in the beginning when walking, acquiring a "duck" gait, while climbing the stairs, and then at rest.

In addition, the pregnant woman senses pain and discomfort at the palpation of the pubic articulation, which as the pathology progresses increases in size due to swelling.

A comprehensive diagnosis of symphysitis in pregnancy is difficult, since it is not recommended to use an X-ray study. As a result, the doctor is available only objective examination and palpation of the painful area.

Sometimes computer or magnetic resonance imaging is allowed, but only for vital indications. Assessment of the degree of manifestation of symphysitis is necessary for determining the tactics of conducting labor and treating a pregnant woman.

[4], [5],

Symphysitis in pregnancy on ultrasound

In addition to examining and analyzing the complaints of the future mother, it is most likely to diagnose symphysitis during pregnancy on ultrasound.

The results of ultrasound differentiate the pathology:

• The first degree of pathology is the divergence of the fracture of the pubic joint from five to nine millimeters. In the absence of another pathology, an obstetrician can allow a woman to give birth alone.
• The second degree of manifestation of the disease - the gap diverged by 10 - 20 mm. Mostly the woman "shines" the direction of the caesarean section.
• The third degree of pathology - the distance increases by more than 20 mm. Perhaps, it is necessary to observe in the hospital. Delivery only through caesarean section.

Symphysitis and natural delivery

The choice of the route of delivery should be considered taking into account the degree of symphysis stretching, the condition of the pregnant woman (presence of preeclampsia and concomitant pathology), the size of the fetus and other factors that influence decision making.

Symphysitis and natural childbirth can provoke excessive stretching of the connection of pubic bones until the rupture. As a result, it is possible to spend the next few weeks in bed. In addition, this condition requires special therapy against the background of the constant presence of pain syndrome.

Thus, happy motherhood for a month can turn into inpatient treatment and the minimum amount of time spent with the baby. At the moment, the child will suffer, too, since breastfeeding, which can not be carried out, is very important in the period of newborns.

Still, in some cases, symphysitis and natural childbirth are possible. This conclusion can be made only when conducting a survey of a pregnant woman. The index for conducting labor through natural ways is to expand the joint to the 1-centimeter. In addition, the pelvis of the woman should be quite wide, and the fetus - of normal size (small) and is in the head position.

Cesarean section and symphysitis

Before deciding on the choice of the method of delivery, a thorough examination of the pregnant woman should be made and the presence of symphysitis must necessarily be taken into account. This pathology can become an obstacle to physiological birth.

In the case of a pronounced symphysitis degree, the risk of rupture of the pubic joint, which connects the pubic bones, increases during the passage of the fetus along the generic pathways.

Caesarean section and symphysitis go inseparable in case of an increase in the gap between the bones of the bones more than 1 cm. The remaining indicators can no longer be taken into account. However, if the joint is less than 10 millimeters, but the fetus is large, or the woman has a narrow pelvis, or the fetus is in the pelvic position, or the condition of the pregnant woman does not allow her to give birth, then it is necessary to perform cesarean section.

Most important in solving this issue is the proper diagnosis and choice of the method of delivery. Examination of the pregnant woman is difficult in view of the fact that it is undesirable to perform an X-ray photograph.

In this regard, the diagnosis is established based on the complaints of the pregnant woman. In addition, a gynecological examination and ultrasound are performed. In some cases it is impossible to confirm symphysitis without computer or magnetic resonance imaging.

[6], [7], [8], [9], [10]

Symphysitis treatment in pregnancy

Primarily it is worthwhile to reassure pregnant women who have been diagnosed with symphysiopathy, that this pathology does not in any way affect fetal development. The treatment of symphysitis during pregnancy is usually limited to this period. Because after the birth, this pathology will "resolve" independently. But in fact up to this point it is still necessary to live. Medicines aimed at suppressing the foci of inflammation, almost all have pronounced toxicity, which adversely affects the development and future health of the fetus. Hence their limited use in pregnancy.

It is quite difficult to combat symphysiopathy. Therefore, the fastest way to stop this problem in the period of gestation will not succeed. According to the results of ultrasound, an obstetrician who watches a woman in childbirth will only make a decision: Caesar or to let a woman into natural childbirth. The only thing a doctor can do in this case is by available techniques to reduce pain symptoms and discomfort.

1. The doctor will appoint a woman in labor with a vitamin complex with a calcium dominant or a calcium monopreparation. But here we get a "double-edged sword". After calcium on the late stages of pregnancy, on the contrary, is limited in nutrition to avoid a number of other complications. Calcium strengthens the bones, giving the woman some relief, but at the same time strengthening the bone tissue can cause burdened delivery, because during the period of obstetrics they should be much more elastic. A large amount of calcium makes the skull of the baby also more durable and firm, which is undesirable when it passes through the birth canal.
2. In this situation, a specialist can offer pregnant only general recommendations that will help reduce the pain and make the discomfort feel less noticeable. In general, this is a special therapeutic gymnastics and minor household tricks.

The main direction in the treatment of symphysitis is the arrest of the stretching process and the reduction in the severity of clinical manifestations.

Treatment of symphysitis during pregnancy includes limiting physical activity, but it is necessary to perform a special set of exercises. Thanks to it, the pelvic, lumbar and femoral muscles are strengthened and prevent further stretching of the pubic joint.

An indispensable condition for effective treatment is the use of a bandage that keeps all the pelvic structures in place. Do not forget about vitamin complexes, in particular, about calcium and anti-inflammatory therapy.

Treatment of symphysitis during pregnancy should be conducted in specialized medical institutions, since pregnant women require special attention. It is necessary to monitor the correctness of their performance of a special set of physical exercises.

In addition, it is necessary to monitor the intake of calcium, since its use at the latest time can lead to undesirable consequences in the process of labor. This can strengthen the bones of the skull of the fetus, which will facilitate difficult passage through the birth canal.

Exercises with symphysitis in pregnancy

In order to somehow make the course of pregnancy in a woman with symphysiopathy more comfortable, doctors offer her daily several times to make special exercises with symphysitis during pregnancy, which will strengthen the muscles of the pelvis, sacrum, waist and hips.

• It is necessary to lie very carefully on the mat with your back down. At the same time, the legs are bent at the knees, and the feet are moved so that they touch the buttocks (if it is not possible to put them so closely, it's not worth to get upset, we put it as it turned out). We begin synchronously, very slowly, without jerks, to grow our knees in different directions. A little lie down in this position, and then return the knees to the place, connecting with each other. Do this exercise at least six times.
• The starting position is similar to the previous one, but the feet are so that the calf muscles are perpendicular to the floor. Very smoothly and slowly begin to raise the buttocks up. At the same time it is not worth heroing. The ideal bridge from the pregnant one does not require, it is enough to lift the buttocks up a few centimeters. Gently begin to descend, but at the moment when the coccyx already touches the surface, it is necessary to delay a little, keeping the touch as far as possible. Make six such repetitions.
• And now the exercise "cat", loved by many women. For this, the future mummy needs to stand on all fours, as much as possible relaxing her back. The spine, head and neck should be one line. Maximally smoothly bend the spine upward. The head and tailbone thus go downwards, and the muscle of the hips and groin strains. Slowly return to the original. Make two or three such waves.

This complex should be made pregnant several times throughout the day, especially at times of pain.

[11], [12], [13], [14]

Preventive maintenance of symphysitis during pregnancy

Symphysitis does not threaten the life of a pregnant woman, but in combination with other factors, for example, a large fetus, its pelvic presentation or a narrow pelvis of a woman, can lead to a mass of problems in the process of labor.

Prevention of symphysitis during pregnancy is the use of vitamin complexes, regular visits to the pool and exercise. Of course, heavy physical activity during pregnancy is contraindicated, but specially designed exercises will not only prevent the development of symphysitis, but also help in the process of labor.

Preventive maintenance of symphysitis during pregnancy also includes frequent changes in body position, especially sitting in front of the computer, putting a foot on the leg and bending in the back. This position of the body leads to stagnation of blood in the lower limbs and a small pelvis.

In addition, it is necessary to control the calcium content in the body. Having enriched your diet with products with a large volume of this trace element, you can reduce the likelihood of developing symphysitis.

However, it is worth to be extremely attentive, since excess amount of calcium on the last terms can provoke a different nature of the problem in the process of delivery. Thus, the bones of the skull of the fetus become more dense, which complicates the movement of the baby through the birth canal.

To facilitate the physical condition of the future mother, the prevention of symphysitis during pregnancy is reduced to following a few simple recommendations.

• During the third trimester of pregnancy, a woman should wear a special supporting bandage.
• It is necessary to somewhat restrict its physical activity.
• The daily exercise set out above.
• In severe cases, you can attract help:
  • Special walkers.
  • Cane.
  • A wheelchair.
• If necessary, lie down, first carefully sit on the bed. Then lay sideways on the surface of the upper body, then lift both feet pressed together to each other and lay them on the bed.
• If you want to get up, it's worth using the reverse sequence. Adhering to these simple rules can significantly reduce discomfort and avoid pain intensification, which is invariable with a sharp rise.
• If there is a need to roll over from one side to the other, the legs should also be kept together.
• If possible, minimize the use of stairs.
• It is necessary to avoid both very soft, and too hard seats.
• When moving, the steps should be small, the movements smooth.
• Need to get into the car? First, plant the ass, and then at the same time make the legs pressed to each other in the salon.
• A positive effect also has a swimming in warm water.
• In the period of sleep, in order to relieve tension, it is necessary to put a small pad between the hips.
• It is necessary to avoid asymmetric positions of the body:
  • Do not start one leg on the other.
  • You do not have to carry the whole load on one leg.
  • Do not lean on one hand or side.
• To exclude a long sitting, thus knees should not be above a basin.
• Do not walk and stand for a long time. It is necessary to alternate walking with rest.
• It is necessary to minimize fetal pressure on the lumbar-pelvic region and pubis:
  • You can put a roller under the buttocks, lifting the pelvis.
  • Put your feet on the hill.
• It is necessary to carefully monitor the increase in weight, avoiding excesses.

When these simple rules are fulfilled, the condition should stabilize, and the pains not so intensively get. If the relief does not come, it is necessary to say this during the planned appointment to your doctor.

Symphysitis prognosis for pregnancy

This pathology can contribute to the development of serious complications in the process of childbirth. Thus, ruptures of the pubic articulation during labor activity are possible.

The prognosis of symphysitis during pregnancy depends on the severity of the pathology. In case the extension of this compound is not more than 1 centimeter, then symphysitis does not pose a threat to the pregnant woman and the fetus. However, if the distance between the pubic bones exceeds 1 centimeter, then the issue of conducting cesarean section is being decided.

The prognosis of symphysitis during pregnancy is quite favorable, provided that all the rules for preventing further divergence of bones are observed. To do this, you need to perform a certain set of physical exercises, use a bandage that keeps all the structures of the pelvis in a normal position, and adhere to the proper diet.

It is not necessary to treat Symphysitis alone during pregnancy, as only a specialist can select the right therapeutic methods and prescribe an effective treatment.