Symphysitis in pregnancy

Symphysitis during pregnancy is a common pathology that affects approximately half of the female population during pregnancy. In addition, it is worth considering that if symphysitis was diagnosed during the first pregnancy, it will also be present in the case of a subsequent pregnancy.

In medical practice, the term "symphysis" is the articulation of the pubic bones. During pregnancy and uterine growth, this area is stretched, which subsequently provokes an increase in the mobility of the articulation.

There is no need to worry, because such a process is physiological, necessary for labor. Symphysitis is observed due to the development of excessive mobility due to severe softening of the joint.

As a result, symphysitis is characterized by the appearance of such clinical manifestations as pain syndrome, discomfort in the perineum and swelling of the joint.

Such symptoms are mainly observed starting from the second half of pregnancy, when difficulty appears in climbing stairs, walking and turning on the side when lying down.

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Causes of symphysitis during pregnancy

This pathology is associated with softening of the articulation area between the pubic bones of the pelvis. Outside of pregnancy, the symphysis is a virtually immobile connection of the pubic bones, forming a joint.

The hormone relaxin plays an important role in the basis of normal support of the articular tone. Under its influence, tissue softening occurs, as a result of which the joint acquires greater mobility.

The causes of symphysitis during pregnancy have not been fully studied to date. After all, in one woman, the joint is slightly stretched during pregnancy, while others suffer from symphysitis and its clinical manifestations. In addition, it can accompany a woman who has already given birth for a long time.

There are various assumptions and causes of symphysitis during pregnancy. Firstly, it is possible that the joint is negatively affected by insufficient calcium in the pregnant woman, resulting in low calcium content in the bones.

Secondly, symphysitis may be associated with the hormone relaxin and its elevated levels in the body. As a result, there is excessive stretching of the joint, its swelling and the appearance of characteristic symptoms.

The remaining group of causes is made up of predisposing factors, such as the presence of bone and joint pathology before pregnancy, individual anatomical features of each woman’s structure, or genetic predisposition.

To date, it is impossible to say for sure why this disease occurs and develops in women carrying a child. The causes of symphysitis during pregnancy have not been fully clarified, but doctors still express certain thoughts on this matter.

• Low calcium levels in the mother's body.
• Avitaminosis.
• Excess of the hormone relaxin, which is quite often observed during pregnancy. Excessive presence of this hormone leads to softening of bone tissue. The growth of the fetus leads to stretching of the symphysis, and after a certain moment, a crack appears on it, which provokes a rupture of the pubic joint during spontaneous labor.
• Hereditary predisposition.
• The pregnant woman's medical history shows musculoskeletal disorders.

Symptoms of symphysitis during pregnancy

Most often, clinical manifestations of the pathology begin to bother after the 4th month of pregnancy, when the fetus begins to rapidly gain weight and the uterus increases significantly.

Symptoms of symphysitis during pregnancy are most intense in the last months. It is characterized by increasing swelling of the joint area, intense pain in the perineum, and crunching when palpating the pubic joint.

In addition, it should be noted that the pain syndrome spreads to the pelvic area, coccyx and hips. An increase in pain intensity is observed with a rapid change in position, for example, when turning, getting up from a chair or up the stairs.

Symptoms of symphysitis during pregnancy do not allow you to lift your straight leg while lying down, causing a “duck-like” gait and a feeling of heaviness when climbing stairs.

As the pregnancy progresses, symphysitis progresses further, causing pain even at rest.

In order not to aggravate the situation, it is necessary to be very attentive to your body, because during the period of gestation, a woman is responsible not only for her health, but also for the health of her unborn child. Therefore, it is worth knowing the symptoms of symphysitis during pregnancy, having discovered which you must necessarily inform your doctor, who is monitoring the pregnancy.

• Mostly, these symptoms appear in women in the third trimester of pregnancy. During the second trimester, they are quite rare.
• In the area of the pubic junction, a slight swelling begins to appear, and then an ever-increasing swelling - a sign of an inflammatory process.
• The pregnant woman develops what is known as a "duck" gait.
• When palpating this area, the woman feels a sharp piercing pain. When pressing, clicks can be heard.
• The woman also experiences pain when changing her body position.
• The pregnant woman begins to intuitively mince when walking, minimizing the abrupt change in the position of the hip area.
• A feeling of heaviness in the lower abdomen.
• Another significant problem is the need to raise a straight leg.
• When climbing stairs, the pregnant woman feels discomfort and pain in the pelvic area.

Symptoms of symphysitis during pregnancy tend to progress and over time the pain becomes even more pronounced. The pain will begin to haunt the woman not only during movement, but also during rest, when she sits or lies quietly on the couch.

Why is symphysitis dangerous during pregnancy?

In order to fully analyze all the threats of symphysitis, it is necessary to separately highlight the danger for the pregnant woman and the fetus. So, how is symphysitis dangerous during pregnancy for the expectant mother?

It is impossible to say for sure that this pathology is absolutely safe for a pregnant woman, since an excessive increase in the mobility of the joint can lead to serious consequences.

Of course, it is worth mentioning the discomfort and pain that a pregnant woman experiences after the 4th-5th month of gestation. In addition, the choice of the delivery route depends on the degree of symphysitis activity: cesarean section or through the natural birth canal.

In addition to symphysitis, one should take into account the course of the pregnancy itself, the presence of toxicosis, gestosis, the size of the fetus, the presence and number of previous births, in general, all factors that influence the course of labor.

How is symphysitis dangerous for the fetus during pregnancy? Symphysitis does not pose any threat to the baby. However, one should not forget about the emotional state of the pregnant woman in the presence of constant pain syndrome and discomfort in the perineum. All stressful situations of the expectant mother negatively affect the condition of the fetus.

In most cases, this pathology is diagnosed at an appointment with an obstetrician-gynecologist and, as a rule, in the third trimester of pregnancy. If a pregnant woman begins to complain of an unpleasant burning sensation in the pubic area, painful symptoms of the pelvic organs, it is worth paying more attention to checking the woman's body for symphysitis. What is the danger of symphysitis during pregnancy? This disease cannot be called completely harmless, because it is caused not only by inflammation of the pubic area, but also by the subsequent weakening and loosening of its structure, which over time can lead to divergence, and then rupture of the symphysis.

Such development of pathology brings quite severe suffering to the woman. The degree of pathology, as well as other parameters (weight of the baby, number of previous births, course of pregnancy), can significantly affect the question of how the pregnant woman will give birth: independently, naturally, or will have to resort to a cesarean section.

If a pregnant woman is admitted to a gynecological clinic to give birth, having such a diagnosis, the obstetrician-gynecologist must be informed about the presence of such a diagnosis in the woman in labor. After all, the presence of symphysitis in a woman's history significantly increases the risk of getting pelvic ligament ruptures during childbirth. Such, to put it mildly, trouble is fraught with a long postpartum recovery period, as well as bed rest, which usually lasts about two weeks.

Having a newborn baby in your arms, performing a course of necessary therapeutic exercises, going to various specialists is not the best additional burden for a woman who has just given birth. Knowing this, no qualified specialist will risk letting a woman have a natural birth. Therefore, symphysitis is a virtually guaranteed referral for a cesarean section. The doctor can take a risk and let a woman have a natural birth only if the crack in the pubis has diverged no more than ten millimeters, while the baby is small, and the size and location of the pelvic bones are within normal limits. During the period of passing through the birth canal, the child does not experience significant discomfort with this pathology.

Diagnosis of symphysitis during pregnancy

Over time, during pregnancy, the fetus begins to gain weight rapidly, starting from the 5th month. In addition, the uterus also increases significantly in size, as a result of which such a combination provokes an increase in the stretching of the pubic symphysis.

Diagnosis of symphysitis during pregnancy consists of questioning the woman about her symptoms and the course of the disease. Thus, characteristic of symphysitis is pain syndrome at first when walking, acquiring a "duck" gait, when climbing stairs, and then at rest.

In addition, the pregnant woman notes pain and discomfort when palpating the pubic symphysis, which increases in size due to swelling as the pathology progresses.

A full diagnosis of symphysitis during pregnancy is difficult, since it is not recommended to use X-ray examination. As a result, the doctor only has access to an objective examination and palpation of the painful area.

Sometimes, computer or magnetic resonance imaging is allowed, but only for vital indications. Evaluation of the severity of symphysitis is necessary to determine the tactics of labor management and treatment of the pregnant woman.

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Symphysitis during pregnancy on ultrasound

In addition to examination and analysis of the complaints of the expectant mother, it is most likely to diagnose symphysitis during pregnancy using ultrasound.

The ultrasound results differentiate the pathology:

• The first degree of pathology is a divergence of the pubic junction fissure from five to nine millimeters. In the absence of other pathology, the obstetrician may allow the woman to give birth on her own.
• The second stage of the disease is when the gap has diverged by 10-20 mm. Mostly, the woman is referred for a cesarean section.
• The third degree of pathology - the distance increases by more than 20 mm. Possibly, observation in a hospital is necessary. Childbirth only by cesarean section.

Symphysitis and natural childbirth

The question of choosing the route of delivery must be considered taking into account the degree of stretching of the symphysis, the condition of the pregnant woman (the presence of gestosis and concomitant pathology), the size of the fetus and other factors influencing the decision.

Symphysitis and natural childbirth can provoke excessive stretching of the pubic bone joint up to rupture. As a result, it is possible to spend the next few weeks in bed. In addition, this condition requires special therapy against the background of the constant presence of pain syndrome.

Thus, happy motherhood for a month can turn into inpatient treatment and minimal time spent with the baby. At this point, the child will also suffer, since breastfeeding, which cannot be carried out, is very important in the neonatal period.

Symphysitis and natural childbirth are still possible in some cases. This conclusion can only be made by examining the pregnant woman. An indicator for natural childbirth is the expansion of the joint to 1 centimeter. In addition, the woman's pelvis should be quite wide, and the fetus should be of normal size (not large) and in the cephalic position.

Caesarean section and symphysitis

Before deciding on the method of delivery, a thorough examination of the pregnant woman should be carried out and the presence of symphysitis should be taken into account. This pathology can become an obstacle to physiological childbirth.

In the case of a severe degree of symphysitis, the risk of rupture of the pubic symphysis, which connects the pubic bones, increases during the passage of the fetus through the birth canal.

Caesarean section and symphysitis are inseparable in case of increase of the gap between pubic bones more than 1 centimeter. Other indicators can be ignored. However, if the joint has diverged less than 10 millimeters, but the fetus is large, or the woman has a narrow pelvis, or the fetus is in a breech position, or the condition of the pregnant woman does not allow her to give birth on her own, then it is necessary to perform a Caesarean section.

The most important thing in solving this issue is the correct diagnosis and choice of the method of delivery. Examination of a pregnant woman is complicated by the fact that it is undesirable for her to undergo an X-ray.

In this regard, the diagnosis is established based on the complaints of the pregnant woman. In addition, a gynecological examination and ultrasound examination are carried out. In some cases, it is impossible to confirm symphysitis without computed tomography or magnetic resonance imaging.

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Treatment of symphysitis during pregnancy

First of all, it is worth reassuring pregnant women who have been diagnosed with symphysiopathy that this pathology does not in any way affect the development of the fetus. Treatment of symphysitis during pregnancy is usually limited to this period. Since after obstetric care, this pathology will “resolve” on its own. But you still need to live to this point. Almost all medications aimed at suppressing inflammation foci have pronounced toxicity, which adversely affects the development and future health of the fetus. Hence their limited use during pregnancy.

It is quite difficult to fight symphysiopathy. Therefore, it is most likely impossible to stop this problem during the period of gestation. Based on the results of the ultrasound, the obstetrician observing the woman in labor will only make a decision: to perform a cesarean or to let the woman have a natural birth. The only thing the doctor can do in this case is to reduce the pain symptoms and discomfort using available methods.

1. The doctor will prescribe the woman in labor a vitamin complex with a calcium dominant or a calcium monodrug. But this is a "double-edged sword". After all, calcium in the late stages of pregnancy is, on the contrary, limited in the diet to avoid a number of other complications. Calcium strengthens bones, bringing some relief to the woman, but at the same time, strengthening bone tissue can cause a difficult birth, because during the period of obstetric assistance they should be much more elastic. A high calcium content also makes the baby's skull stronger and harder, which is undesirable when it passes through the birth canal.
2. In this situation, the specialist can offer the pregnant woman only general recommendations that will help reduce pain and make the discomfort less noticeable. Basically, these are special therapeutic exercises and minor household tricks.

The main direction in the treatment of symphysitis is to stop the stretching process and reduce the severity of clinical manifestations.

Treatment of symphysitis during pregnancy includes limiting physical activity, but it is necessary to perform a special set of exercises. Thanks to it, the pelvic, lumbar and femoral muscles are strengthened and prevent further stretching of the pubic symphysis.

An essential condition for effective treatment is the use of a bandage that holds all pelvic structures in place. Vitamin complexes, in particular calcium, and anti-inflammatory therapy should also not be forgotten.

Treatment of symphysitis during pregnancy should be carried out in specialized medical institutions, since pregnant women require special attention. It is necessary to monitor the correctness of their performance of a special set of physical exercises.

In addition, it is necessary to control the intake of calcium preparation, since its use in the last stages can lead to undesirable consequences during labor. It can strengthen the bones of the fetus's skull, which will contribute to difficult passage through the birth canal.

Exercises for symphysitis during pregnancy

In order to somehow make the course of pregnancy more comfortable for a woman with symphysiopathy, doctors suggest that she do special exercises for symphysiopathy during pregnancy several times a day, which will strengthen the muscles of the pelvis, sacrum, lower back and hips.

• You need to lie down very carefully on the mat with your back down. Your legs are bent at the knees, and your feet are moved so that they touch your buttocks (if you can’t get them that close, don’t worry, we’ll do it as best we can). We start to move our knees apart synchronously, very slowly, without jerking. Lie in this position for a while, and then return your knees to their place, connecting them to each other. This exercise must be done at least six times.
• The starting position is similar to the previous one, but the feet are positioned so that the calf muscles are perpendicular to the floor. Very smoothly and slowly, we begin to lift the buttocks up. However, there is no need to be a hero. No one requires a perfect bridge from a pregnant woman, it is enough to lift the buttocks up a few centimeters. Carefully begin to go down, but at the moment when the tailbone already touches the surface, it is necessary to pull back a little, holding the touch as long as possible. Do six such repetitions.
• And now the "cat" exercise, beloved by many women. To do this, the expectant mother needs to get on all fours, relaxing her back as much as possible. The spine, head and neck should form one line. Bend the spine upward as smoothly as possible. The head and tailbone go down, and the muscles of the thighs and groin tense up. Slowly return to the starting position. Make two or three such waves.

This complex should be done by a pregnant woman several times throughout the day, especially during periods of increasing pain.

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Prevention of symphysitis during pregnancy

Symphysitis does not threaten the life of a pregnant woman, but in combination with other factors, such as a large fetus, its breech presentation or a narrow pelvis of the woman, it can lead to a host of problems during labor.

Prevention of symphysitis during pregnancy consists of taking vitamin complexes, regularly visiting the pool and doing sports. Of course, heavy physical activity during pregnancy is contraindicated, but specially designed exercises will help not only prevent the development of symphysitis, but will also help during labor.

Prevention of symphysitis during pregnancy also includes frequent changes in body position, especially sitting in front of a computer, crossing your legs and bending your back. This body position leads to blood stagnation in the lower extremities and pelvis.

In addition, it is necessary to control the calcium content in the body. By enriching your diet with foods containing a large amount of this microelement, you can reduce the likelihood of developing symphysitis.

However, it is worth being extremely careful, since an excess of calcium in the last stages can provoke various problems during childbirth. Thus, the bones of the fetus's skull become denser, which complicates the baby's movement along the birth canal.

To ease the physical condition of the expectant mother, prevention of symphysitis during pregnancy comes down to following a few simple recommendations.

• During the third trimester of pregnancy, a woman should wear a special support bandage.
• It is necessary to limit her physical activity somewhat.
• The daily exercise routine is listed above.
• In severe cases, you can call in the following for assistance:
  • Special walkers.
  • Cane.
  • Wheelchair.
• If you need to lie down, you should first sit down carefully on the bed. Then lay the upper part of your body sideways on the surface, then lift both legs pressed together at the same time and lay them on the bed.
• If you want to get up, you should use the reverse sequence. By following these simple rules, you can significantly reduce discomfort and avoid increased pain, which is inevitable with a sharp rise.
• If it becomes necessary to turn from one side to the other, the legs must also be kept together.
• Minimize use of stairs whenever possible.
• Both very soft and very hard seats should be avoided.
• When moving, steps should be small and movements smooth.
• Need to get into a car? First sit your butt down, then simultaneously bring your legs into the car, pressed together.
• Swimming in warm water also has a positive effect.
• During sleep, to relieve tension, it is worth placing a small pillow between your thighs.
• It is necessary to avoid asymmetrical body positions:
  • Don't cross your legs.
  • There is no need to carry the entire load on one leg.
  • Do not lean on one arm or side.
• Avoid sitting for long periods of time, and your knees should not be higher than your pelvis.
• You shouldn't walk or stand for long periods of time. You need to alternate walking with rest.
• It is necessary to minimize the pressure of the fetus on the lumbopelvic region and pubis:
  • You can place a cushion under your buttocks, lifting your pelvis.
  • Place your feet on an elevated surface.
• It is necessary to carefully monitor weight gain, avoiding excesses.

If you follow these simple rules, your condition should stabilize and the pain should not be so intense. If relief does not occur, you should definitely tell your doctor about it during your scheduled appointment.

Prognosis of symphysitis during pregnancy

This pathology can contribute to the development of serious complications during labor. Thus, ruptures of the pubic symphysis are possible during labor.

The prognosis of symphysitis during pregnancy depends on the severity of the pathology. If the expansion of this joint is no more than 1 centimeter, then symphysitis does not pose a threat to the pregnant woman and the fetus. However, if the distance between the pubic bones exceeds 1 centimeter, then the question of performing a cesarean section is decided.

The prognosis for symphysitis during pregnancy is quite favorable, provided that all the rules for preventing further divergence of the bones are followed. To do this, it is necessary to perform a certain set of physical exercises, use a bandage that holds all pelvic structures in a normal position, and adhere to a proper diet.

You should not treat symphysitis on your own during pregnancy, as only a specialist can select the correct therapeutic methods and prescribe effective treatment.