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.
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F. Pipitone: Project development, data collection, data analysis, manuscript writing.
M.E. Duarte Thibault: Data collection, data analysis, manuscript writing.
K. Gaetke-Udager: Manuscript writing, manuscript editing.
D.E. Fenner: Manuscript editing.
C.W. Swenson: Project development, manuscript writing, manuscript editing.
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Investigator support for C.W.S. was provided by the National Institute of Child Health and Human Development WRHR Career Development Award # K12 HD065257. Otherwise, the authors report no financial disclaimer or conflicts of interest.
This work was presented at 45th IUGA Annual Meeting, 2020, and Pelvic Floor Disorders Week (AUGS), 2020.
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Pipitone, F., Duarte Thibault, M.E., Gaetke-Udager, K. et al. Musculoskeletal findings on MRI among postpartum women with persistent pelvic pain. Int Urogynecol J 32, 1779–1783 (2021). https://doi.org/10.1007/s00192-020-04441-y
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DOI: https://doi.org/10.1007/s00192-020-04441-y