1. BACKACHE IN PREGNANCY
Prof. M.C. Bansal
MBBS., MS. MICOG. FICOG.
Ex Principal and Controller
Jhalawar Medical College & Hospital.
MGMC & Hospital. Sitapura, Jaipur.
2. • The Life incidence of low back pain ranges from 50-
70 %.Sciatica is less common , with life time
incidence of 10-40 %.
• All structures of lower spine , pelvis ,e.g. the
muscles , ligaments .joints , Inter vertebral discs and
nerve root can cause back pain.
• It is very common in pregnancy, often patients
ignore it, though it worsens and disability develops
due to increasing lordosis. 50 -80 % women do have
discomfort but seldom take medication, a few of
them have such limited mobility as to be at risk of
venous thrombosis due to prolonged bed rest.
• Back pain most frequently presents between 20 –
28 weeks of gestation.
3.
4. Types of Back Pain
• 1. Lumber.
• 2. Sacral / pelvic.
(1) Lumber pain tends to be central over the lover
lumber vertebrae but may be associated with
radiation of pain in to legs,. Usually aggravated by
prolong maintenance of same position , be it be
sitting in chair or standing.
(2) Sacral / pelvic pain is 4 times more common.
Women describes it on sacral region ,may radiate to
buttocks , back of thighs and pubic area. Pain is not
eased by short period of rest .Rolling over the bed ,
rising from seat and climbing stairs tend to make the
pain worse.
5. Causes of back pain in General
1. Mechanical
Muscle pain , prolapse of inter vertebral disk,
Spondyolisthesis , lumber spondylosis ,
fibromyelgia , osteoarthrits ,spinal stenosis .
2. Traumatic
Fracture of vertebra ,soft tissue injury , shot
pallets .
3 .Inflammatory
Rheumatoid arthritis , ankylosing spondilytis .
Reiter’s syndrome , psoriatic arthritis.
4. Infective
Osteomyelitis ,tuberculosis.
6. Causes of Backache in General
5. Metabolic
osteomalacia , Paget’s disease of bone ,
osteoporosis and vertebral collapse,
6 . Tumours
Primary of bone –benign / malignant , secondary's
, Multiple myloma.
7. Haematological
Sickle cell disease .
8 . Referred from other organs
Gastric ulcer , duodenal ulcer , gall bladder
disease , pancreatitis ,renal infection-stones or
tumours .
9 . Vascular Aneurysm .
7. Cause of low backache in pregnancy
• Relaxation effect of hormones on joints.
• Postural changes.
• Change in center of gravity.
Imaging has shown that the lordosis of the lumber vertebrae in reality
decreases in latter half of the pregnancy.
• Obesity, smoking , H/O sudden lifting weight ,
• Wrong posture, pre pregnancy backache may also
be noted . Most pregnancy related back pains
resolve in post partum period by proper diet ,
exercise, change in posture habit and appropriate
rehabilitation .
• One third will continue to have pain for 4 weeks
after delivery and 1/6th up to 9 weeks post partum .
8. Management-
• History of pre existing backache , its diagnosis and
treatment given / still taking .
• Clinical examination , orthopedic consultation ,and
require investigations avoiding radiation exposure to
mother and fetus.
• Pain killers / muscle relaxant if necessary . Calcium
and vit D supplementation , adequate rest till pain is
intolerable ,Physiotherapy and Exercise to
strengthen the back muscles e.g. swimming ,
correction of posture , avoiding prolong sitting or
standing .
• Avoidance of aggravating factors ,wearing shoes
with low / no heels .
9. Management
• To avoid litigation , proper documentation is
mandatory.
10. Diagnosis should never be missed ---
1. Acute lumber disc prolapse
2. Cauda Equina Syndrome.
Magnetic resonance (MR) can safely be done in pregnancy
