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INTRODUCTION

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MODE OF DELIVERY AND


PERSISTENCE OF PELVIC GIRDLE
SYNDROME 6 MONTHS
POSTPARTUM
Presenter :
dr. Danil Armand
Moderator:
dr. H. A. Abadi, SpOG(K)
Opponents
dr. Aswin Boy Pratama
dr. Mirzah Tindar Fathimah
dr. Ratih Sari Putri

INTRODUCTION
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INTRODUCTION

METHODS

RESULT

DISCUSSION

Persistent Pelvic Girdle Syndrome


(PGS) defined as pain in the anterior
pelvis and in the bilateral posterior
pelvis

INTRODUCTION
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INTRODUCTION

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RESULT

DISCUSSION

The pelvis is the largest bony part of the skeleton and contains three
joints: the pubic symphysis, and two sacroiliac joints.

INTRODUCTION
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INTRODUCTION

METHODS

Cesarean section rates are consistently increasing by


maternal requests for planned cesarean section without
medical or obstetrical indication.
One in 5 women report pelvic girdle pain during
pregnancy. 2-3% of all women report significant
symptoms 1 year after delivery

RESULT

DISCUSSION

Pelvic girdle pain during pregnancy increased planned


cesarean section rates

INTRODUCTION
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Cesarean section may increase the risk of complications


for the mother and the newborn in pregnancies with no
medical or obstetrical indication, compared with
vaginal delivery.
Whether or not mode of delivery affects the prognosis
of pelvic girdle pain after delivery has been
insufficiently studied

DISCUSSION

Decisions about planned cesarean section should be


based on solid evidence.

OBJECTIVE
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Study the association between mode of


delivery and persistent pelvic girdle
syndrome (PGS) 6 months after
delivery.

METHODS
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DISCUSSION

Time : 1999 through 2008


Place : 50 hospitals in Norway that recruited
for Norwegian Mother and Child Cohort
Study
Participants : women were recruited in
connection with the routine ultrasound
examination in pregnancy weeks 17-18.

METHODS
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Primary data
(Questionnaire
sent by mail)

INTRODUCTION

2nd trimester : sociodemographic factors,


general health
3rd trimester : maternal health status during
pregnancy
After delivery : maternal health status after
delivery

METHODS

RESULT

Secondary
data
(Medical Birth
Registry of
Norway)

DISCUSSION

mode of delivery

DATA ANALYSIS
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RESULT

DISCUSSION

Group differences were examined by X2


tests.
The associations of mode of delivery with
the presence of PGS and severe PGS 6
months after delivery were estimated as
crude and adjusted odds ratios (ORs) with
95% confidence intervals (CIs) using logistic
regression analyses.
SPSS version 17.0, significance level 5%

TABLE 1
Maternal characteristics of the study sample (n 10,400)

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DISCUSSION

Characteristics
No. (%)
Mean (SD)
Maternal age, y
30.1 (4.5)
.........................................................................................................................................................
Body mass index in pregnancy wk 17,a kg/m2
26.1 (4.6)
.........................................................................................................................................................
Parity
.........................................................................................................................................................
Para 0
3187 (30.6)
.........................................................................................................................................................
Para 1
7213 (69.4)
.........................................................................................................................................................
Mode of delivery
.........................................................................................................................................................
Unassisted vaginal delivery
8307 (79.9)
.........................................................................................................................................................
Instrumental vaginal delivery
695 (6.7)
.........................................................................................................................................................
Emergency cesarean section
753 (7.2)
.........................................................................................................................................................
Planned cesarean section
645 (6.2)
.........................................................................................................................................................
a n 9942.
Bjelland. Mode of delivery and pelvic girdle syndrome. Am J Obstet Gynecol 2013.

TABLE 2
Mode of delivery and preference for cesarean section (n 10,400)
No use of
crutches
n

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DISCUSSION

Use of crutches
n
%

P value

Variabel
.....................................................................................................................................................................
Mode of delivery
.....................................................................................................................................................................
Unassisted vaginal delivery
6256
80.4
2051
78.4
.001
.............................................................................................................................................................
Instrumental vaginal delivery
547
7.0
148
5.7
.............................................................................................................................................................
Emergency cesarean section
543
7.0
210
8.0
.............................................................................................................................................................
Planned cesarean section
439
5.6
206
7.9
.....................................................................................................................................................................
Preference for cesarean section
.....................................................................................................................................................................
No
6775
87.0
2190
83.7
.001
.....................................................................................................................................................................
Yes
875
11.2
363
13.9
.....................................................................................................................................................................
Missing
135
1.7
62
2.4
.....................................................................................................................................................................
Bjelland. Mode of delivery and pelvic girdle syndrome. Am J Obstet Gynecol 2013.

RESULTS
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RESULT

DISCUSSION

Planned cesarean section was associated


with the presence of severe PGS 6 months
postpartum (adjusted odds ratio [OR], 2.3;
95% confidence interval [CI], 1.4 3.9).
In women who used crutches during
pregnancy, emergency (adjusted OR, 2.0;
95% CI, 1.04.0) and planned (adjusted
OR, 3.3; 95% CI, 1.9 5.9) cesarean
section were each associated with severe
PGS.

DISCUSSION
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RESULT

DISCUSSION

The present study is the first to report an


increased risk of persistent pelvic girdle pain
after delivery among women who had a
cesarean section compared with unassisted
vaginal delivery
Emergency and planned cesarean sections
among women who used crutches in
pregnancy were associated with a 2-fold and
3-fold increased risk, respectively, for
reporting severe PGS after delivery.

DISCUSSION
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Pelvic girdle pain in general is not an


indication for cesarean section
INTRODUCTION

METHODS

RESULT

DISCUSSION

Women with severe pelvic girdle pain and


dysfunction, preference for a planned
cesarean section may seem reasonable

The increased risk of reporting persistent


severe pain after cesarean section may be a
result of increased pain sensitivity in these
women

DISCUSSION
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DISCUSSION

Limitation of this study :


Outcome measure was based on self-reported
pain location and intensity random error
deflated estimation
The participation rate low sample may not
be representative for the general population

CONCLUSIONS
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DISCUSSION

The results suggest an increased risk of


severe PGS 6 months postpartum in women
who underwent a cesarean section vs women
who had an unassisted vaginal delivery.
When deciding the mode of delivery,
clinicians should be aware of the increased,
rather than decreased, risk of nonrecovery
after cesarean section among women
presenting with severe pelvic girdle pain

CRITICAL APPRAISAL PROGNOSTIC


1. Are the represented sample have
the same condition regarding their
disease?
INTRODUCTION
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No

METHODS

2. Are sample followed up


RESULT
completely and prolonged?

Yes, 1999 through


2008

DISCUSSION

3. Are result criteria got blinded?

No, Outcome measure


was based on selfreported pain location
and intensity

CRITICAL APPRAISAL PROGNOSTIC


4. If subgroup found with different
prognosis, are they performed
adjustment on important prognostic
INTRODUCTION
factors ?
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No

METHODS

5. How about result tendency on


RESULT
certain duration ?

Unclear

DISCUSSION

6. How accurate prognostic


prediction?

P < 0.001

CRITICAL APPRAISAL PROGNOSTIC


7. Could you applicate valid
important prognostic evidence from
your patient?
INTRODUCTION
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8. Are important clinical evidence


affect your conclusion for advising
RESULT
or explaining your patient ?

DISCUSSION

Yes

Yes, pelvic girdle pain


in general is not an
indication for cesarean
section

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