Postpartum septic symphysitis, a rare condition with possible long-term consequences: a cohort study with long-term follow-up

Abstract Background Postpartum septic symphysitis (PPSS) is defined as acute onset of severe pain around the symphysis, restricted movement, fever, and elevated inflammatory parameters. It is a rare but serious condition requiring urgent diagnosis and treatment. The aim of this study was to describe...

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Autores principales:	Helen Elden, Monika Fagevik Olsen, Nasrin Farah Hussein, Lisa Wibeck Axelsson, Verena Sengpiel, Michael Ullman
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Lumbopelvic pain Osteitis pubis Osteomyelitis Pelvic girdle pain Postpartum septic symphysitis Postpartum septic arthritis Gynecology and obstetrics RG1-991
Acceso en línea:	https://doaj.org/article/171d016f95204122b6984b219ba7b9bc
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spelling	oai:doaj.org-article:171d016f95204122b6984b219ba7b9bc2021-11-21T12:32:52ZPostpartum septic symphysitis, a rare condition with possible long-term consequences: a cohort study with long-term follow-up10.1186/s12884-021-04023-w1471-2393https://doaj.org/article/171d016f95204122b6984b219ba7b9bc2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12884-021-04023-whttps://doaj.org/toc/1471-2393Abstract Background Postpartum septic symphysitis (PPSS) is defined as acute onset of severe pain around the symphysis, restricted movement, fever, and elevated inflammatory parameters. It is a rare but serious condition requiring urgent diagnosis and treatment. The aim of this study was to describe the incidence, symptoms, diagnosis, treatment, and long-term follow-up of PPSS. Methods This follow-up study included 19 out of 21 women diagnosed with PPSS from 1989 to 2017 at one tertiary care hospital in Sweden. Clinical data were retrieved from hospital records and compared to those retrieved from a regional registry. Women completed a postal questionnaire, and those who reported lumbopelvic pain (LPP) were offered a clinical examination. Results 1) PPSS was diagnosed after a normal postpartum period of 24 to 50 h by blood tests (n = 19/19), ultrasonography (n = 9 /19), computer tomography (n = 8/19) or magnetic resonance imaging (n = 16/19) Treatment included aspiration of symphyseal abscesses, i.v. antibiotics and different physiotherapeutic interventions. Women with PPSS more frequently were primiparous (n = 14/19, p = 0.001), had an instrumental delivery (n = 14/19, p = 0.003), longer time of active labour (p = 0.01) and second stage of labour (p = 0.001) than women in the regional registry. 2) Ten out of 19 (52%) women reported LPP at follow-up. These women more often suffered impaired function related to LPP (Pelvic Girdle Questionnaire, 27 versus 0, p < 0.0001), a poorer health-related quality of life (EuroQol-5 dimensions p = 0.001 and EuroQol-visual analogue scale, 65 mm versus 84 mm, p = 0.022) and higher levels of anxiety and depression (Hospital Anxiety Depression Scale (HADS) HADS-Anxiety, 7 versus 2, p = 0.010; and HADS-Depression, 1 versus 0, p = 0.028) than women with no pain. 3). Of the eight women who were clinically assessed, one had lumbar pain and seven had pelvic girdle pain (PGP). Conclusions In the largest cohort of patients with PPSS to date, primiparas and women with instrumental vaginal delivery were overrepresented, indicating that first and complicated deliveries might be risk factors. Approximately half of the women reported PGP at follow-up, with considerable consequences affecting health-related quality of life and function decades after delivery. Prospective multicentre studies are needed to establish risk factors, long-term consequences, and adequate treatment for this rare pregnancy complication.Helen EldenMonika Fagevik OlsenNasrin Farah HusseinLisa Wibeck AxelssonVerena SengpielMichael UllmanBMCarticleLumbopelvic painOsteitis pubisOsteomyelitisPelvic girdle painPostpartum septic symphysitisPostpartum septic arthritisGynecology and obstetricsRG1-991ENBMC Pregnancy and Childbirth, Vol 21, Iss 1, Pp 1-15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Lumbopelvic pain Osteitis pubis Osteomyelitis Pelvic girdle pain Postpartum septic symphysitis Postpartum septic arthritis Gynecology and obstetrics RG1-991
spellingShingle	Lumbopelvic pain Osteitis pubis Osteomyelitis Pelvic girdle pain Postpartum septic symphysitis Postpartum septic arthritis Gynecology and obstetrics RG1-991 Helen Elden Monika Fagevik Olsen Nasrin Farah Hussein Lisa Wibeck Axelsson Verena Sengpiel Michael Ullman Postpartum septic symphysitis, a rare condition with possible long-term consequences: a cohort study with long-term follow-up
description	Abstract Background Postpartum septic symphysitis (PPSS) is defined as acute onset of severe pain around the symphysis, restricted movement, fever, and elevated inflammatory parameters. It is a rare but serious condition requiring urgent diagnosis and treatment. The aim of this study was to describe the incidence, symptoms, diagnosis, treatment, and long-term follow-up of PPSS. Methods This follow-up study included 19 out of 21 women diagnosed with PPSS from 1989 to 2017 at one tertiary care hospital in Sweden. Clinical data were retrieved from hospital records and compared to those retrieved from a regional registry. Women completed a postal questionnaire, and those who reported lumbopelvic pain (LPP) were offered a clinical examination. Results 1) PPSS was diagnosed after a normal postpartum period of 24 to 50 h by blood tests (n = 19/19), ultrasonography (n = 9 /19), computer tomography (n = 8/19) or magnetic resonance imaging (n = 16/19) Treatment included aspiration of symphyseal abscesses, i.v. antibiotics and different physiotherapeutic interventions. Women with PPSS more frequently were primiparous (n = 14/19, p = 0.001), had an instrumental delivery (n = 14/19, p = 0.003), longer time of active labour (p = 0.01) and second stage of labour (p = 0.001) than women in the regional registry. 2) Ten out of 19 (52%) women reported LPP at follow-up. These women more often suffered impaired function related to LPP (Pelvic Girdle Questionnaire, 27 versus 0, p < 0.0001), a poorer health-related quality of life (EuroQol-5 dimensions p = 0.001 and EuroQol-visual analogue scale, 65 mm versus 84 mm, p = 0.022) and higher levels of anxiety and depression (Hospital Anxiety Depression Scale (HADS) HADS-Anxiety, 7 versus 2, p = 0.010; and HADS-Depression, 1 versus 0, p = 0.028) than women with no pain. 3). Of the eight women who were clinically assessed, one had lumbar pain and seven had pelvic girdle pain (PGP). Conclusions In the largest cohort of patients with PPSS to date, primiparas and women with instrumental vaginal delivery were overrepresented, indicating that first and complicated deliveries might be risk factors. Approximately half of the women reported PGP at follow-up, with considerable consequences affecting health-related quality of life and function decades after delivery. Prospective multicentre studies are needed to establish risk factors, long-term consequences, and adequate treatment for this rare pregnancy complication.
format	article
author	Helen Elden Monika Fagevik Olsen Nasrin Farah Hussein Lisa Wibeck Axelsson Verena Sengpiel Michael Ullman
author_facet	Helen Elden Monika Fagevik Olsen Nasrin Farah Hussein Lisa Wibeck Axelsson Verena Sengpiel Michael Ullman
author_sort	Helen Elden
title	Postpartum septic symphysitis, a rare condition with possible long-term consequences: a cohort study with long-term follow-up
title_short	Postpartum septic symphysitis, a rare condition with possible long-term consequences: a cohort study with long-term follow-up
title_full	Postpartum septic symphysitis, a rare condition with possible long-term consequences: a cohort study with long-term follow-up
title_fullStr	Postpartum septic symphysitis, a rare condition with possible long-term consequences: a cohort study with long-term follow-up
title_full_unstemmed	Postpartum septic symphysitis, a rare condition with possible long-term consequences: a cohort study with long-term follow-up
title_sort	postpartum septic symphysitis, a rare condition with possible long-term consequences: a cohort study with long-term follow-up
publisher	BMC
publishDate	2021
url	https://doaj.org/article/171d016f95204122b6984b219ba7b9bc
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Postpartum septic symphysitis, a rare condition with possible long-term consequences: a cohort study with long-term follow-up

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