Changes in late pregnancy in the spine of pregnant female:
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As a fetus grows, a lot of changes appear in a pregnant body. The lumbar and thoracic spine curvature changes, pain in the pelvic region and low back can increase. The center of gravity of the pregnant moves towards the abdomen, leading to an increase in posterior tilt of the sacrum, lumbar lordosis and movement of the head to the back to compensate for the increased weight as the fetus grows reaching a peak in the severity in the third trimester
About 50 to 80% of pregnant women experience back pain. Because the connection between back pain and pregnancy is not fully understood, access to the right treatment can be a challenge. Fortunately, pregnancy-related spine pain typically has a short life span—most cases go away shortly after your baby’s birth
What Influences Pain Intensity During Pregnancy?
While age and smoking status has been not been shown to increase pain levels, higher body mass, more pregnancies, a previous history of back pain, and a previous history of pain during pregnancy have been connected to an increase in peripartum pain.
Also, younger women tend to have more intense pain when compared to older women. Studies have reported that approximately 10% of women said back pain during pregnancy prevented them from working, and more than 80% said it affects their ability to do daily tasks.
What Causes Spine Pain During Pregnancy?
The cause of pregnancy-related back pain is likely related to a combination of mechanical, metabolic, circulatory, and psychosocial contributing factors. However, most of the causes can be grouped into the following areas:
While age and smoking status has been not been shown to increase pain levels, higher body mass, more pregnancies, a previous history of back pain, and a previous history of pain during pregnancy have been connected to an increase in peripartum pain.
Also, younger women tend to have more intense pain when compared to older women. Studies have reported that approximately 10% of women said back pain during pregnancy prevented them from working, and more than 80% said it affects their ability to do daily tasks.
What Causes Spine Pain During Pregnancy?
The cause of pregnancy-related back pain is likely related to a combination of mechanical, metabolic, circulatory, and psychosocial contributing factors. However, most of the causes can be grouped into the following areas:
Weight gain: Women typically gain between 20 and 40 pounds throughout pregnancy, which puts additional pressure on the spine. This added pressure may result in lower back pain.
Shift in center of gravity: As you gain weight and your belly grows, your ability to maintain proper posture becomes challenged. Posture changes from pregnancy have been connected to lordosis and herniated discs, which may contribute to low back pain.
Hormonal changes: While most women start experiencing back pain between during the fifth and seventh months, some report back pain in the first trimester. Since the baby isn’t large enough to cause any physical stress to the spine, it may be hormonal changes causing pain. Pregnant women produce relaxin, a hormone that relaxes spinal and pelvic ligaments and joints to facilitate childbirth. Relaxin may cause some spinal instability, and this can cause low back pain. In fact, certain hormones produced during pregnancy can cause sacroiliac joint dysfunction, a condition that causes low back pain.
Increased stress: Pregnancy is an exciting and special time for many women, but it can also be stressful. Stress can worsen back pain—or even cause it. Finding ways to manage stress during pregnancy may help ease your pain.
Back Pain During Pregnancy
As your belly grows, so may your spine pain woes
Written by Harry Lockstadt, MD
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About 50 to 80% of pregnant women experience back pain. Because the connection between back pain and pregnancy is not fully understood, access to the right treatment can be a challenge. Fortunately, pregnancy-related spine pain typically has a short life span—most cases go away shortly after your baby’s birth.
Pregnant woman with painful back on the sofa in her living room
Women typically experience pregnancy-related pain in the lower spine—the low back, sacrum, and pelvic regions. Photo Source: 123RF.com.Pregnancy-related back pain is often localized to a specific area of the spine and not widespread. Back pain tends to arise between the fifth and seventh months of pregnancy, though it can begin much earlier.
Pregnancy-Related Spine and Pelvic Pain
Women typically experience pregnancy-related pain in the lower spine—the low back, sacrum, and pelvic regions. Pain in the pelvic region, for which a clear-cut diagnosis has not been made, is called peripartum pelvic pain. Peripartum refers to the period surrounding childbirth—typically a few weeks before birth and a few weeks after birth.
Pain presents itself most commonly in the following areas:
sacroiliac joints at the posterior superior iliac spine
the groin areas
coccyx
pubic symphysis anteriorly
Occasionally, other areas of the pelvis and upper legs are affected, but rarely does pain occur below the knee. Pain tends to be influenced by posture and is associated with a waddling gait.
What Influences Pain Intensity During Pregnancy?
While age and smoking status has been not been shown to increase pain levels, higher body mass, more pregnancies, a previous history of back pain, and a previous history of pain during pregnancy have been connected to an increase in peripartum pain.
Also, younger women tend to have more intense pain when compared to older women. Studies have reported that approximately 10% of women said back pain during pregnancy prevented them from working, and more than 80% said it affects their ability to do daily tasks.
What Causes Spine Pain During Pregnancy?
The cause of pregnancy-related back pain is likely related to a combination of mechanical, metabolic, circulatory, and psychosocial contributing factors. However, most of the causes can be grouped into the following areas:
Weight gain: Women typically gain between 20 and 40 pounds throughout pregnancy, which puts additional pressure on the spine. This added pressure may result in lower back pain.
Shift in center of gravity: As you gain weight and your belly grows, your ability to maintain proper posture becomes challenged. Posture changes from pregnancy have been connected to lordosis and herniated discs, which may contribute to low back pain.
Hormonal changes: While most women start experiencing back pain between during the fifth and seventh months, some report back pain in the first trimester. Since the baby isn’t large enough to cause any physical stress to the spine, it may be hormonal changes causing pain. Pregnant women produce relaxin, a hormone that relaxes spinal and pelvic ligaments and joints to facilitate childbirth. Relaxin may cause some spinal instability, and this can cause low back pain. In fact, certain hormones produced during pregnancy can cause sacroiliac joint dysfunction, a condition that causes low back pain.
Increased stress: Pregnancy is an exciting and special time for many women, but it can also be stressful. Stress can worsen back pain—or even cause it. Finding ways to manage stress during pregnancy may help ease your pain.
Treatment
Most treatments for pregnancy-related back pain involve lifestyle modifications, such as:
Avoiding excessive weight gain: A healthy diet is among the best ways to keep a healthy weight during pregnancy, and some foods have been linked to easing spinal inflammation (a common cause of low back pain). Eating 5 or more daily servings of fruits and vegetables will provide essential nutrients. Other good choices include nuts and fatty fish, such as salmon, which pack a healthy dose of omega-3 fatty acids to fight inflammation.
Exercising to strengthen the back and core muscles: In general, pregnant women should avoid the extremes when it comes to activity: Too much activity and too little can both cause an increase in back pain during pregnancy. Walking, swimming, and yoga are great ways to condition yourself throughout pregnancy, but always first talk to your doctor about how to safely exercise while pregnant.
Reducing stress: Finding ways to manage your stress throughout your pregnancy has physical as well as emotional benefits. A prenatal massage, relaxing with a heating pad against your low back, and getting plenty of rest are excellent ways to manage stress while helping your spine.
Maintaining correct posture: Talk to your doctor about ways you can keep good posture as your pregnancy progresses.
Investing in a pregnancy pillow to provide support during sleep: Sound sleep and pregnancy don’t always mix, but a supportive pillow may deliver more restful mornings.
Wearing sensible shoes: Footwear and spine care are connected. Avoid high heels and flip flops, and purchase new footwear if your shoe size changes during pregnancy.
Shift in center of gravity: As you gain weight and your belly grows, your ability to maintain proper posture becomes challenged. Posture changes from pregnancy have been connected to lordosis and herniated discs, which may contribute to low back pain.
Hormonal changes: While most women start experiencing back pain between during the fifth and seventh months, some report back pain in the first trimester. Since the baby isn’t large enough to cause any physical stress to the spine, it may be hormonal changes causing pain. Pregnant women produce relaxin, a hormone that relaxes spinal and pelvic ligaments and joints to facilitate childbirth. Relaxin may cause some spinal instability, and this can cause low back pain. In fact, certain hormones produced during pregnancy can cause sacroiliac joint dysfunction, a condition that causes low back pain.
Increased stress: Pregnancy is an exciting and special time for many women, but it can also be stressful. Stress can worsen back pain—or even cause it. Finding ways to manage stress during pregnancy may help ease your pain.
Back Pain During Pregnancy
As your belly grows, so may your spine pain woes
Written by Harry Lockstadt, MD
About 50 to 80% of pregnant women experience back pain. Because the connection between back pain and pregnancy is not fully understood, access to the right treatment can be a challenge. Fortunately, pregnancy-related spine pain typically has a short life span—most cases go away shortly after your baby’s birth.
Pregnant woman with painful back on the sofa in her living room
Women typically experience pregnancy-related pain in the lower spine—the low back, sacrum, and pelvic regions. Photo Source: 123RF.com.Pregnancy-related back pain is often localized to a specific area of the spine and not widespread. Back pain tends to arise between the fifth and seventh months of pregnancy, though it can begin much earlier.
Pregnancy-Related Spine and Pelvic Pain
Women typically experience pregnancy-related pain in the lower spine—the low back, sacrum, and pelvic regions. Pain in the pelvic region, for which a clear-cut diagnosis has not been made, is called peripartum pelvic pain. Peripartum refers to the period surrounding childbirth—typically a few weeks before birth and a few weeks after birth.
Pain presents itself most commonly in the following areas:
sacroiliac joints at the posterior superior iliac spine
the groin areas
coccyx
pubic symphysis anteriorly
Occasionally, other areas of the pelvis and upper legs are affected, but rarely does pain occur below the knee. Pain tends to be influenced by posture and is associated with a waddling gait.
What Influences Pain Intensity During Pregnancy?
While age and smoking status has been not been shown to increase pain levels, higher body mass, more pregnancies, a previous history of back pain, and a previous history of pain during pregnancy have been connected to an increase in peripartum pain.
Also, younger women tend to have more intense pain when compared to older women. Studies have reported that approximately 10% of women said back pain during pregnancy prevented them from working, and more than 80% said it affects their ability to do daily tasks.
What Causes Spine Pain During Pregnancy?
The cause of pregnancy-related back pain is likely related to a combination of mechanical, metabolic, circulatory, and psychosocial contributing factors. However, most of the causes can be grouped into the following areas:
Weight gain: Women typically gain between 20 and 40 pounds throughout pregnancy, which puts additional pressure on the spine. This added pressure may result in lower back pain.
Shift in center of gravity: As you gain weight and your belly grows, your ability to maintain proper posture becomes challenged. Posture changes from pregnancy have been connected to lordosis and herniated discs, which may contribute to low back pain.
Hormonal changes: While most women start experiencing back pain between during the fifth and seventh months, some report back pain in the first trimester. Since the baby isn’t large enough to cause any physical stress to the spine, it may be hormonal changes causing pain. Pregnant women produce relaxin, a hormone that relaxes spinal and pelvic ligaments and joints to facilitate childbirth. Relaxin may cause some spinal instability, and this can cause low back pain. In fact, certain hormones produced during pregnancy can cause sacroiliac joint dysfunction, a condition that causes low back pain.
Increased stress: Pregnancy is an exciting and special time for many women, but it can also be stressful. Stress can worsen back pain—or even cause it. Finding ways to manage stress during pregnancy may help ease your pain.
Treatment
Most treatments for pregnancy-related back pain involve lifestyle modifications, such as:
Avoiding excessive weight gain: A healthy diet is among the best ways to keep a healthy weight during pregnancy, and some foods have been linked to easing spinal inflammation (a common cause of low back pain). Eating 5 or more daily servings of fruits and vegetables will provide essential nutrients. Other good choices include nuts and fatty fish, such as salmon, which pack a healthy dose of omega-3 fatty acids to fight inflammation.
Exercising to strengthen the back and core muscles: In general, pregnant women should avoid the extremes when it comes to activity: Too much activity and too little can both cause an increase in back pain during pregnancy. Walking, swimming, and yoga are great ways to condition yourself throughout pregnancy, but always first talk to your doctor about how to safely exercise while pregnant.
Reducing stress: Finding ways to manage your stress throughout your pregnancy has physical as well as emotional benefits. A prenatal massage, relaxing with a heating pad against your low back, and getting plenty of rest are excellent ways to manage stress while helping your spine.
Maintaining correct posture: Talk to your doctor about ways you can keep good posture as your pregnancy progresses.
Investing in a pregnancy pillow to provide support during sleep: Sound sleep and pregnancy don’t always mix, but a supportive pillow may deliver more restful mornings.
Wearing sensible shoes: Footwear and spine care are connected. Avoid high heels and flip flops, and purchase new footwear if your shoe size changes during pregnancy.
Anatomy of spinal anesthesia and changes in late pregnancy:
There are several changes in the anatomical landmarks during pregnancy due to exaggerated lumbar lordosis, which can increase the height of the intercristal line. Also the lumbar flexion is limited to perform the spinal anesthesia maneuvers due to the gravid uterus
There are several changes in the anatomical landmarks during pregnancy due to exaggerated lumbar lordosis, which can increase the height of the intercristal line. Also the lumbar flexion is limited to perform the spinal anesthesia maneuvers due to the gravid uterus
In the late pregnancy, the volume of lumbosacral subarachnoid space is reduced and the spread of spinal anesthesia is increased due to two mechanical factors. One factor is a distension of the vena cava by enlarged uterus which leads to engorgement of epidural blood vessels and results in a decrease in volume of the CSF. Another factor is anatomical configuration of the spinal column which is thought to influence the distribution of spinal anesthetic solution. There is a 25-40% decrease in the dose of local anesthetics
Definition and mechanism of spinal-induced hypotention (SIH) related to pregnancy:
Hypotension is defined as either a drop in mean arterial pressure more than 20% from baseline value or reading of systolic arterial blood pressure less than 90 mmHg after intrathecal injection of local anesthetic
There are a lot of suggested mechanisms for spinal anesthesia-induced hypotension including; the block of ascending medullary vasomotor, direct effects of local anesthetics on circulation, skeletal muscle paralysis, relative adrenal insufficiency, and concurrent respiratory insufficiency. However, the primary insult is the preganglionic sympathetic block due to spinal anesthesia. The extent of sympathetic blockade is determined by the block height which in turn determines the changes in cardiovascular parameters (Oh et al., 2014).
The spinal block produces vasodilatation in the blocked area and a reflex vasoconstriction within unblocked areas of the body which is mediated by carotid and aortic arch baroreceptors to maintain blood pressure. Imbalance between them is the most common cause of hypotension following spinal anesthesia especially in the presence of hypovolemia Sympathetic block causes hypotension due to its effects on preload, afterload, contractility, and HR through its effect on cardiac output and systemic vascular resistance. Preload is decreased secondary to venodilation, pooling of blood in the periphery. Aortocaval compression by gravid uterus also markedly influences venous return Afterload is decreased by sympathetic block, a decreased arterial vasomotor tone and decreased SVR especially in the presence of hypoxia and acidosis and may lead to cardiovascular collapse in high spinal anesthesia and cardiopulmonary support is mandatory (Hanss et al., 2005).
The cardiac output increased as a reflex to a decreased afterload. On the other side, CO may fall with decreased preload (.
The effect of sympathetic nervous system on the heart increases both contractility and heart rate. These actions are opposed by parasympathetic system by Vagus nerve. Hence, sympathetic block for high thoracic spinal anesthesia can affect cardiac contractility
The spinal block produces vasodilatation in the blocked area and a reflex vasoconstriction within unblocked areas of the body which is mediated by carotid and aortic arch baroreceptors to maintain blood pressure. Imbalance between them is the most common cause of hypotension following spinal anesthesia especially in the presence of hypovolemia Sympathetic block causes hypotension due to its effects on preload, afterload, contractility, and HR through its effect on cardiac output and systemic vascular resistance. Preload is decreased secondary to venodilation, pooling of blood in the periphery. Aortocaval compression by gravid uterus also markedly influences venous return Afterload is decreased by sympathetic block, a decreased arterial vasomotor tone and decreased SVR especially in the presence of hypoxia and acidosis and may lead to cardiovascular collapse in high spinal anesthesia and cardiopulmonary support is mandatory (Hanss et al., 2005).
The cardiac output increased as a reflex to a decreased afterload. On the other side, CO may fall with decreased preload (.
The effect of sympathetic nervous system on the heart increases both contractility and heart rate. These actions are opposed by parasympathetic system by Vagus nerve. Hence, sympathetic block for high thoracic spinal anesthesia can affect cardiac contractility
The effect on HR is complex, HR may increase by the baroreceptor reflex secondary to hypotension or may decrease (either by sympathetic block of cardiac accelerator fibers in T1–T4 spinal segments or reverse Bainbridge reflex). The reverse Bainbridge reflex is defined as a decrease in HR due to decreased venous return, which is detected by stretch receptors in the right atrium
Incidence and risk factors associated with spinal-induced hypotension in pregnancy
Women are likely to have maternal hypotension after spinal anesthesia if they have these risk factors:
• Advanced maternal age (over 40).
• Body mass index (BMI) ≥25 kg/m2.
• Multi- gravidity ≥4.
• History of hypotension.
• Increased infant birth weight.
• Baseline systolic blood pressure (SBP) < 120 mmHg.
• Baseline heart rate >100 beats/min.
• Anesthetic factors, for example: dose of local anesthetic, height of resultant block.
• Hypovolemia.
• High sensory block height
• Advanced maternal age (over 40).
• Body mass index (BMI) ≥25 kg/m2.
• Multi- gravidity ≥4.
• History of hypotension.
• Increased infant birth weight.
• Baseline systolic blood pressure (SBP) < 120 mmHg.
• Baseline heart rate >100 beats/min.
• Anesthetic factors, for example: dose of local anesthetic, height of resultant block.
• Hypovolemia.
• High sensory block height
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