Analysis On The Incidence And The Risk Factors Of Chronic Low Back Pain In Women After Childbirth

European guidelines for the management of chronic nonspecific low back pain in 2006 defined low back pain (LBP) as pain and discomfort, localized below the costal margin and above the inferior gluteal folds, with or without referred leg pain, which lasted at least 12 weeks. LBP is a very common symptoms in woman after childbirth. and may be related to its physiological characteristics, mode of delivery and Spinal anesthesia. Many foreign experts have ever deeply explored the incidence of LBP, risk factors and pathogenesis. But the definitions, research methods, observation time and the sample size of those studies were different, leading to different results of LBP incidence and risk factors. There are few LBP reports and studies in our country, and also lack of large sample study in LBP. This is a prespective study. the study make a epidemiological survey on some factors that might affect LBP postpartum. The result can provide evidence for prevention and treatment of chronic LBP. The study collects a total of 1271 pregnant women, s data from October 2013 to May 2014 in three hospital in zhongshan, Guangdong Province. The women were interviewed once every month by telephone, and LBP occurred within 1 month and last three months Postpartum were recorded. in which 390 women’s data lost because of change of their telephone number or their addresses.. A total of 881 women, s datas were completely obtained in four months. The success rate of call interview is 69.5%. This paper is divided into two parts, the first part analyzes the incidence of chronic LBP and risk factors of 881 postpartum women; the second part is about the risk factors of chronic LBP after cesarean delivery.Part one Analysis on the incidence and the risk factors of chronic low back pain in women after childbirthObjectiveThe aim of the study is to observe the incidence and risk factors of chronic LBP in 881 women after childbirth.Methods1271 patients (American Society of Anesthesiologists, ASA physical status Ⅰ～Ⅱ, aged 17～42 years) were enrolled in three hospitals in the study, in which there are 673 cases of cesarean delivery and 598 cases of vaginal delivery. Patients with Multiple pregnancy, Lumbar operation, Spinal tumor, Nervous system disease, mental disease, and inflammation of the lumbar spine and pelvic region are excluded in the study. Vaginal delivery women were sent into the delivery room when cervical mouth opened to 3 cm. Standard monitoring was used to the women, including ECQ heart rate(lead II) and pulse oximetry. Nurses checked cervix every 30 minutes. When the cervical mouth opened to 10 cm, the pregnant woman was placed lithotomy position for delivery, The operation was not over until the maternal placental delivery and perineal wound was closed. Cesarean section women were standard monitored, including ECG, heart rate(lead II), pulse oximetry and inhalation of oxygen when they were sent into the operating room. Pregnant women were used Combined Spinal Epidural Anesthesia. The pregnant women were placed side lying position,and skin disinfection and operation towels. The L3-4, L2-3 or L4-5 were chose as puncture space and local anesthesia with 1% lidocaine. Puncture needle bevel parallelled with sagittal plane and blunt separation of supraspinal ligament, midspinal ligament and ligamentum flavum ligament. A bubble experiment was used to observe whether epidural puncture needle in spinal epidural cavity or not. After the lumbar epidural needle puncture,0.5% bupivacaine 1.8-2.4ml were injected in the subarachnoid space. The operation bed was inclined to left 15℃ after the patient was supine. The level of anesthesia was controled in T6～T4. An additional 1% lidocaine 5～10ml was used in spinal epidural cavity when the level of anesthesia was insufficient, and also Blood pressure decreased>30% the ephedrine 5～10mg was given. Patient controlled epdural analgesia (PCEA) or patient controlled intravenous analgesia (PCIA) was given for two days and lay for 6 hours without a pillow but a thin pillow their back in the ward.The age, height and weight of pregnant women, body mass index(BMI, kg/m2) lower than normal weight<20kg/m, normal weight=20-25kg/m, mild obesity >25kg/m2, severe obesity> 30kg/m2), the weight of newborn babies(Lower weight <2.5kg, normal birth weight 2.5-4kg, huge fetus>4kg), the history of LBP during pregnancy, whether breastfeeding or not, the parity, and the mode of delivery were recorded.1271 postpartum women had been followed-up for four months by phone call. We recorded that chronic LBP occurred within one month and lasted three months, the site of pain location (waist, pelvis, waist and pelvis) and whether to hospital diagnosis and treatment due to severe pain or not were recordedResults:1.1271 pregnant women as the object of study, in which 390 women’s data lost because of change of their telephone number or their addresses.. A total of 881 women’s datas were completely obtained in four months. The success rate of call interview is 69.5%. of which 459 women with cesarean section,422 parturients with natural delivery.2.259 of 881 (29.4%) women experienced chronic LBP.133 of 881(15.1%) experienced lumbar pain,72 of 881 (8.2%) experienced pelvic girdle pain(PGP) and 54 of 881 (6.1%) experienced Combined PGP and lumbar pain.39 of 881 (4.4%) women were back to hospital for treatment because of severe pain.150 of 658 (22.8%) women were reported new onset chronic LBP postpartum.3. The incidence on LBP in Pregnancy period and 2,3,4 months postpartum were 25.3%,31.8%,28.6%,29.4%, it was not significant difference compared with each period (P>0.05).4. The incidence of LBP on women with vaginal delivery in pregnancy period was 27%(114/422), and on women with cesarean section in pregnancy period was 23.7% (109/459). it was not significant difference compared with two groups (P>0.05). The incidence of LBP by vaginal delivery after childbirth 2,3,4 months was 25.6%、 22.7%、24.2%. The incidence of LBP by Cesarean delivery after childbirth 2,3,4 months was 37.5%、34%、34.2%. It had statistically significant compared with two groups (P<0.01)5. Logistic regression analysis shows that Cesarean delivery (OR=1.82,95%CI 1.34-2.47), greater than or equal to 3 times of fertility (OR=1.31,95%CI 1.02-1.68), a history of LBP during pregnancy (OR=3.23,95%CI 2.33-4.48) are the risk factors of chronic LBP for post-partum womenConclusions:1. Chronic LBP is a common complication. The majority of symptoms is mild and recurrent.2. compared with the period of pregnancy, LBP in early postpartum had no significant decline.3. compared with vaginal delivery, the incidence of LBP in cesarean section was significantly higher.4..Cesarean delivery, greater than or equal to 3 times of fertility, a history of LBP during pregnancy are the risk factors of chronic LBP for post-partum women.Part two Analysis on the incidence and the risk factors of chronic low back pain in women after Cesarean deliveryObjectiveTo observe the risk factors of chronic LBP in women after Cesarean delivery.Methods459 patients (American Society of Anesthesiologists, ASA physical status I～II, aged 17-42 years) by Cesarean delivery were enrolled in three hospitals in this study. patients with Multiple pregnancy, Lumbar operation, Spinal tumor, Nervous system disease, mental disease, and inflammation of the lumbar spine and pelvic region were excluded in the study.Cesarean delivery women were standard monitored, including ECG, heart rate(lead II) pulse oximetry, and inhalation of oxygen when they were sent into the operating room. Combined Spinal Epidural Anesthesia were used on all the Pregnant women. The pregnant women was placed side lying position and skin disinfection and operation towels. The L3.4, L2-3, or L4.5 were chose as puncture space and local anesthesia with 1% lidocaine. Epidural puncture needle bevel parallelled with sagittal plane and blunt separation of Supraspinal Ligament, midspinal Ligament and ligamentum flavum ligament. A bubble experiment was used to observe whether epidural puncture needl ewas in spinal epidural cavity or not. After the waist epidural needle puncture,0.5% bupivacaine 1.8-2.4 ml were injected in the subarachnoid space. The operation bed was left inclined 15℃ after the patient was supine. The level of anesthesia was controled in T6～T4. An additional 1% lidocaine 5～10ml was used in spinal epidural cavity when the level of anesthesia was insufficient. Ephedrine 5～10mg was given to Pregnant women when Blood pressure decreased>30% Patient controlled epdural analgesia (PCEA) or patient controlled intravenous analgesia (PCIA) was given for two days. PCEA liquor including 0.1mg/kg morphine and 0.198-0.224% Mesylate Ropivacaine. The speed was 2ml/h and lock time was 15 minutes, and the PCA dose was 0.5 ml. PCIA liquor was 3ug/kg fentanyl and 0.9%NS 80 ml,2 ml/h, The speed was 2ml/h and lock time was 15 min, and the Patient controlled analgesia (PCA) dose was 0.5 ml.The patient lay for 6 hours without pillow and pad a thin pillow under the waist after back to the ward.The age, height and weight of the pregnant women, BMI, birth weight of the newborn babies, the history of LBP during pregnancy. Delivery times, cesarean delivery time, epidural puncture times, epidural puncture placement, postoperative analgesia method, emergency or not and the title of puncture physician were recorded.The maternal whose chronic LBP occurred within one month after delivery and lasted for three mouths, and the intension of pain and the site of pain and wether severe pain to hospital or not also were recorded. There were 214 women loss of contact and we obtained 459 women’s complete data within four months, the success rate of call interview is 68.2%.Results1.673 pregnant women as the object of study, in which 214 women’s data lost because of change of their telephone number or their addresses.. A total of 459 women’s datas were completely obtained in four months. The success rate of call interview is 68.2%.2.157 of 459 (34.2%) women experienced chronic LBP.3. Compared with the women without chronic LBP, the age, BMI, cesarean delivery time, epidural puncture times, epidural puncture placement, postoperative analgesia method, emergency or not and the title of puncture physician were not significant difference (P>0.05), birth weight of the newborn babies, greater than or equal to 3 times of fertility, the history of LBP during pregnancy were Suspicious risk factors(P<0.05).4. Logistic regression analysis showed that the birth weight of newborn babies (OR=1.68,95%CI 1.12-2.53), greater than or equal to 3 times of fertility (OR=1.81, 95%CI 1.30-2.54), a history of LBP during pregnancy (OR=3.16,95%CI 2.00-4.99) were the risk factors of chronic LBP for post-partum women.Conclusions1. Chronic LBP is a common complication. The incidence of chronic LBP in cesarean section women is 34.2%. The birth weight of newborn babies, greater than or equal to 3 times of fertility, a history of LBP during pregnancy are the risk factors of chronic LBP for cesarean section women.2. Combined spinal epidural anesthesia’s puncture placement, puncture times, mode of postoperative analgesia, anesthesia times were not the risk factors of chronic LBP after cesarean section...