Musculoskeletal findings on MRI among postpartum women with persistent pelvic pain
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ORIGINAL ARTICLE
Musculoskeletal findings on MRI among postpartum women with persistent pelvic pain Fernanda Pipitone 1
&
Mary E. Duarte Thibault 1 & Kara Gaetke-Udager 2 & Dee E. Fenner 1 & Carolyn W. Swenson 1
Received: 27 May 2020 / Accepted: 9 July 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis Persistent postpartum pelvic pain affects one in six women, and its source is often unexplained in the absence of obvious clinical findings. Musculoskeletal injuries during childbirth are common and can be detected using MRI or US; however, pelvic imaging is not standard of care in evaluating women with persistent pain. We hypothesize that clinical symptoms in women with unexplained persistent postpartum pelvic pain will correlate with musculoskeletal abnormalities identified on MRI in > 50% of cases. Methods Retrospective cohort study of women with persistent postpartum pelvic pain who underwent a pelvic MRI for this indication. Chart review was performed. MRI findings were classified as major (bone fracture, levator ani avulsion) or minor (edema, inflammation or partial levator ani defect). Descriptive statistics were used to describe the study population. Results Of the 252 women seen for postpartum pelvic pain, 18 patients met our study criteria. Half of women were primiparous (55.6%, n = 10). Operative delivery occurred in 27.8% (n = 5), 22.2% (n = 4) had anal sphincter lacerations, and 38.9% (n = 7) had prolonged second stage of labor. Median time from delivery to MRI was 4.5 ± 5.13 (IQR) months. Musculoskeletal abnormalities were found in 94.4% (n = 17) of cases; 38.8% (n = 7) were major and 55.6% (n = 10) were minor abnormalities. All findings correlated with presenting symptoms. Conclusion Of women with persistent postpartum pelvic pain, 94.4% had musculoskeletal abnormalities supporting their clinical symptoms. Pelvic floor imaging should be considered in women with unexplained persistent postpartum pelvic pain to accurately manage the source of their pain. Keywords Postpartum pain . Pelvic pain . Childbirth injury . Magnetic resonance imaging
Introduction Pelvic pain during pregnancy and following childbirth is present in up to one third of all childbearing women and is often viewed as an expected or normal aspect of postpartum recovery. In the majority of cases, pelvic pain resolves by 6 weeks postpartum [1, 2]. However, persistent pain lasting beyond the 6-week postpartum period has been reported to occur in 17% of women at 3 months [2] and 9% at 24 months after delivery
* Fernanda Pipitone [email protected] 1
Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E Medical Center Dr. Ann Arbor MI 48109 USA
2
Department of Radiology, Michigan Medicine, Ann Arbor MI USA
[3]. In addition to adversely affecting quality of life, persistent postpartum pelvic pain has an economic impact due to increased utilization of healthcare and sick leave [4–6]. A possible explanation for persistent postpartum pelvic pain is unresolved or untreate
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