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Postpartum Lower Abdominal Pain

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Abstract

Pains after labor can be as severe as those experienced during labor, particularly the commonly occurring lower abdominal “after-pains” that are associated with prolonged uterine contractions during breast feeding. Other causes of lower abdominal pain may not be physiologically based but are either direct complications of parturition, such as genital infection, or fortuitous, such as appendicitis. Although the focus of pain control during pregnancy has been on labor and delivery, pain thresholds decrease postpartum. Maternity services have identified postpartum pain symptomatology to be a current health care issue. Anesthesiologists and physical health therapists must therefore develop an active role in this neglected area of women’s health.

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References and Recommended Reading

  1. Audit Commission:First Class Delivery: improving maternity services in England and Wales. London: Audit Commission; 1997. This is a government report from the United Kingdom based on an audit of maternity services in a cross section of hospitals. These findings resulted in recommendations for the postpartum period to be targeted for improvements in maternity services.

    Google Scholar 

  2. Robbins A, Berkley KJ, Sato Y: Estrous cycle variation of afferent fibres supplying reproductive organs in the female rat. Brain Res 1992, 596:353–356.

    Article  CAS  PubMed  Google Scholar 

  3. Frye CA, Duncan JE: Progesterone metabolites, effective at the GABA receptor complex, attenuate pain sensitivity in rats. Brain Res 1994, 643:194–203.

    Article  CAS  PubMed  Google Scholar 

  4. Majewska MD, Harrison NL, Schwartz RD, et al.: Steroid hormone metabolites are barbiturate-like modulators of the GABA receptor. Science 1986, 232:1004–1007.

    Article  CAS  PubMed  Google Scholar 

  5. Bacigalupo G, Riese S, Rosendahl, Saling E: Quantitative relationships between pain intensities during labor and betaendorphin and cortisol concentrations in plasma. Decline of the hormone concentrations in the early postpartum period. J Perinat Med 1990, 18:289–296.

    Article  CAS  PubMed  Google Scholar 

  6. Raisanen I: Plasma levels and diurnal variation of beta-endorphin, beta-lipotropin and corticotropin during pregnancy and early puerperium. Eur J Obstet Gynecol Reprod Biol 1988, 27:13–20.

    Article  CAS  PubMed  Google Scholar 

  7. Steinbrook RA, Carr DB, Datta S, et al.: Dissociation of plasma and cerebrospinal fluid beta-endorphin-like immunoreactivity levels during pregnancy and parturition. Anesth Analg 1982, 61:893–897.

    Article  CAS  PubMed  Google Scholar 

  8. Cogan R, Spinnato JA: Pain and discomfort thresholds in late pregnancy. Pain 1986, 27:63–68.

    Article  CAS  PubMed  Google Scholar 

  9. Sander HW, Gintzler AR: Spinal cord mediation of the opioid analgesia of pregnancy. Brain Res 1987, 408:389–393.

    Article  CAS  PubMed  Google Scholar 

  10. Whipple B, Josimovich JB, Komisaruk BR: Sensory thresholds during the antepartum, intrapartum and postpartum periods. Int J Nurs Stud 1990, 27:214–221.

    Article  Google Scholar 

  11. Eisenach JC: Labor pain. Pain 1990, 5 (suppl):S261.

    Article  Google Scholar 

  12. Jarvis S, McLean KA, Chirnside J, et al.: Opioid-mediated changes in nociceptive threshold during pregnancy and parturition in the sow. Pain 1997, 72:153–159. This article reports on a study wherein thermal thresholds were measured in sows through parturition and into the postpartum period. Findings in the sow confirm changes in pain thresholds observed in rats and humans. There is a clear reduction in pain thresholds postpartum.

    Article  CAS  PubMed  Google Scholar 

  13. Melzack R, Taenzer P, Feldman P, Kinch RA. Labor is still painful after prepared childbirth. Can Med J 1981, 125:357–363.

    CAS  Google Scholar 

  14. Audit Commission: First Class Delivery: A National Survey of Women’s Views of Maternity Care. London: Audit Commission and the Perinatal Epidemiology Unit; 1998. This publication offers findings based on a representative sample of women surveyed 4 months after delivery. The majority of the respondents reported having left hospital in discomfort.

    Google Scholar 

  15. Holdcroft A, Plaat F: First Class Delivery. Int J Obst Anesth 1999, in press. This editorial based on the findings of the United Kingdom’s Audit Commission on First Class Delivery emphasizes that most women suffered painful disorders after birth and that the expertise of anesthesiologists as pain specialists should be utilized in postpartum pain management.

  16. Merskey H, Bogduk N: Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. Ed 2. Seattle, WA: International Association for the Study of Pain; 1994.

    Google Scholar 

  17. Murray A, Holdcroft A: Incidence and intensity of postpartum lower abdominal pain. BMJ 1989, 298:1619.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Melzack R: The McGill Pain Questionnaire: major properties and scoring methods. Pain 1975, 1:277–279.

    Article  CAS  PubMed  Google Scholar 

  19. Berkley KJ: Female vulnerability to pain and the strength to deal with it. Behavioural Brain Sci 1997, 20:473–479.

    Google Scholar 

  20. Giamberardino MA, Berkley KJ, Iezzi S, et al.: Variations of pain thresholds in parietal tissues as a function of menstrual cycle, segmental site and tissue depth in non-dysmonorrheic women, dysmenorrheic women and men. Pain 1997, 71:187–198.

    Article  CAS  PubMed  Google Scholar 

  21. Enkin M, Enkin E, Chalmers I, et al.: Prophylactic antibiotics in association with caesarean section. In Effective Care in Pregnancy and Childbirth, vol 2. Edited by Chalmers I, Enkin M, Keirse MJNC. Oxford: Oxford University Press; 1989.

    Google Scholar 

  22. HMSO Department of Health: Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1991–1993. London: HMSO Department of Health; 1996.

    Google Scholar 

  23. Scriven MW, Jones DA, McKnight L: The importance of pubic pain following childbirth: a clinical and ultrasonographic study of diastasis of the pubic symphysis. J R Soc Med 1995, 88:28–30.

    PubMed Central  CAS  PubMed  Google Scholar 

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Holdcroft, A. Postpartum Lower Abdominal Pain. Current Review of Pain 3, 137–143 (1999). https://doi.org/10.1007/s11916-999-0038-5

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