Maternal Care Center Research Articles

Disseminated Bacillus Calmette-Guérin and Susceptibility to Mycobacterial Infections—Implications on Bacillus Calmette-Guérin Vaccinations

Bacillus Calmette-Guérin (BCG) is a live vaccine and has the potential to cause local disease and systemic dissemination in immunocompromised hosts, including infants who are infected with human immunodeficiency virus (HIV) through vertical transmission, and patients with primary immunodeficiencies (PID) such as severe combined immunodeficiency (SCID), chronic granulomatous disease (CGD), hyper-IgM syndrome, and defects of the IL12- IFNγ axis (Mendelian susceptibility to mycobacterial diseases, MSMD). Disseminated BCG is extremely difficult to treat. The chance of complete eradication is low unless functional immune response is restored by haematopoietic stem cell transplant. Prolonged use of anti-mycobacterial drugs often causes organ toxicities and drug resistance. Inflammatory complications which develop upon immunoreconstitution post-transplant may necessitate immunosuppressive treatment, which adversely affect immune recovery and increases risks of opportunistic infections. Multiple BCG reactivations can occur in patients with CGD and MSMD, and BCG can remain latent until reactivations take place in adulthood and manifest as disease. It is important for neonatologists, general practitioners, primary care clinicians and nurses working in maternal and child care centres to be aware of BCG-related complications, which may be the first sign of an underlying immunodeficiency. As neonatal BCG is included in standard vaccination schedule in many countries, it is a challenge to identify and avoid administration of BCG to infants who potentially have PIDs. Deferring BCG vaccination is recently advocated to protect highly vulnerable populations, but the appropriate strategy is yet to be determined. Newborn screening for SCID offers a potential to avoid this complication, if an integrated system of screening and vaccination can be organised.

Sociodemographic and obstetrical factors associated with low birth weight: Community based retrospective study in an urban slum of Western India

Aim: This study aimed to find out association between low birth weight (LBW) and sociodemographic factors, obstetrical factors and ante natal care. The study also helped to recognize whether the known risk factors of LBW still exists or their relation is modified in current era in urban slum area of Surat city in Western India. Methodology: This study is a part of large scale survey conducted to assess reproductive and child health services in Surat city in Western India. In this large scale study, out of 1004 community-based “Maternal and Child Day Care Centres,” 30 center were selected by using cluster sampling design. In the selected areas, a household survey was conducted to assess maternal and child healthcare status. Birth weight <2500 g was considered as LBW and association of study variables with LBW was find out using Chi-square and odds ratio. Results: Among the 322 mothers interviewed, 51.6% were of 20-24 years of age; 97.2% were having antenatal registration; 35.7% had high risk pregnancy; 9.6% were working; 23.3% had birth interval ≤2 years. LBW rate was 20.5%. High risk pregnancy, preterm birth and birth interval ≤2 years shows statistically significant (P < 0.05) association with LBW. Conclusion: High risk pregnancy and ≤2 years of birth interval are good predictor of LBW

Infant Feeding Practices among HIV-Positive Women in Enugu, Nigeria

Background: Preventing transmission of HIV from mother to child after birth is one of the greatest challenges in HIV prevention. Aim: To evaluate the infant feeding practices among HIV-positive mothers and the factors that influenced their decisions at the University of Nigeria Teaching Hospital, Enugu, Nigeria. Methods: This was a questionnaire based cross-sectional study carried out at the paediatric HIV follow-up clinic between 1 st January and 31 st March 2014. Analysis was carried out using SSPS version 10.0 (Chicago IL, USA). P values less than 0.05 were considered significant. Results: Fifty four HIV-Positive mothers were evaluated. The mean (standard deviation) for age of the respondents was 29.7 (4.2) years. Thirty two respondents (59.3%) practiced replacement feeding, 14(29.9%) practiced mixed feeding while 8(14.8%) practiced exclusive breast feeding. Of the mothers that practiced mixed feeding, 10(71.4%) did not receive counseling on infant feeding practices. Replacement feeding was adopted by 27 (84.4%) of respondents for fear of transmission of HIV to their children. Disclosure of status and counseling were independently significantly Original Research Article Ikeako et al.; BJMMR, 8(1): 61-68, 2015; Article no.BJMMR.2015.427 62 associated with the adoption of recommended infant feeding methods (EBF and RF) P<0.05. Conclusion: Exposure to counseling on infant feeding methods was low. Current guidelines on infant feeding methods should be disseminated through structured counseling sessions at Maternity care centres for HIV-positive mothers.

Weight gain in pregnancy, maternal age and gestational age in relation to fetal macrosomia.

To investigate the possible risk factors related to macrosomia. Pregnant women and their newborns (n = 1041) were recruited from a cohort study in Maternal and Child Care Center of Hefei from January 2011 to July 2012. Questionnaires were applied to collect the demographic data besides the medical records. Detailed health records of the entire pregnancy were obtained using retrospective study. Meanwhile the data of neonatal outcomes was prospectively tracked. Associations between exposure risk factors and macrosomia were analyzed using Pearson's chi squared test. Logistic regression models were used to assess the independent association between these potential predictors and macrosomia. The incidence of macrosomia of this cohort was 11.24% of which male: female = 2.55:1. Male incidence (8.07%) of macrosomia was higher than female (3.17%), p < 0.001. Body mass index (BMI) before pregnancy (pre-BMI), maternal height, parity were not independently associated with macrosomia; multiple logistic regression analysis indicated that macrosomia was mainly independently associated with weight gain in pregnancy (OR=1.14, 95% CI [1.10-1.19]), maternal age (OR = 1.09, 95% CI [1.03-1.15]) and gestational age (OR = 1.62, 95% CI [1.31-1.99]), respectively. Our findings indicate that weight gain in pregnancy, maternal age and gestational age should be considered as independent risk factors for macrosomia.

High-Risk Maternal and Newborn Integrated Care Centers: Status and Issues on Aspect of Pediatric Surgery

High-Risk Maternal and Newborn Integrated Care Centers: Status and Issues on Aspect of Pediatric Surgery

Targeted Routine Antenatal Anti-D Prophylaxis in the Prevention of RhD Immunisation - Outcome of a New Antenatal Screening and Prevention Program

ObjectiveTo estimate the incidence of RhD immunisation after implementation of first trimester non-invasive fetal RHD screening to select only RhD negative women carrying RHD positive fetuses for routine antenatal anti-D prophylaxis (RAADP).Materials and MethodsWe present a population-based prospective observational cohort study with historic controls including all maternity care centres and delivery hospitals in the Stockholm region, Sweden. All RhD negative pregnant women were screened for fetal RHD genotype in the first trimester of pregnancy. Anti-D immunoglobulin (250–300 µg) was administered intramuscularly in gestational week 28–30 to participants with RHD positive fetuses. Main outcome measure was the incidence of RhD immunisation developing during or after pregnancy.ResultsDuring the study period 9380 RhD negative women gave birth in Stockholm. Non-invasive fetal RHD genotyping using cell-free fetal DNA in maternal plasma was performed in 8374 pregnancies of which 5104 (61%) were RHD positive and 3270 (39%) RHD negative. In 4590 pregnancies with an RHD positive test the women received antenatal anti-D prophylaxis. The incidence of RhD immunisation in the study cohort was 0.26 percent (24/9380) (95% CI 0.15–0.36%) compared to 0.46 percent (86/18546) (95% CI 0.37 to 0.56%) in the reference cohort. The risk ratio (RR) for sensitisation was 0.55 (95% CI 0.35 to 0.87) and the risk reduction was statistically significant (p = 0.009). The absolute risk difference was 0.20 percent, corresponding to a number needed to treat (NNT) of 500.ConclusionsUsing first trimester non-invasive antenatal screening for fetal RHD to target routine antenatal anti-D prophylaxis selectively to RhD negative women with RHD positive fetuses significantly reduces the incidence of new RhD immunisation. The risk reduction is comparable to that reported in studies evaluating the outcome of non selective RAADP to all RhD negative women. The cost-effectiveness of this targeted approach remains to be studied.

Hypnosis Antenatal Training for Childbirth: a randomised controlled trial

To determine the use of pharmacologic analgesia during childbirth when antenatal hypnosis is added to standard care. Randomised controlled clinical trial, conducted from December 2005 to December 2010. The largest tertiary referral centre for maternity care in South Australia. A cohort of 448 women at >34weeks of gestation, with a singleton pregnancy and cephalic presentation, planning a vaginal birth. Exclusions were: the need for an interpreter; pre-existing pain; psychiatric illness; younger than 18years; and previous experience of hypnosis for childbirth. All participants received usual care. The group of women termed Hypnosis+CD (hypnotherapist guided) were offered three antenatal live hypnosis sessions plus each session's corresponding audio CD for further practise, as well as a final fourth CD to listen to during labour. The group of women termed CD only (nurse administered) were played the same antenatal hypnosis CDs as group 1, but did not receive live hypnosis training. The control group participants were given no additional intervention or CDs. Use of pharmacological analgesia during labour and childbirth. No difference in the use of pharmacological analgesia during labour and childbirth was found comparing hypnosis+CD with control (81.2 versus 76.2%; relative risk, RR 1.07; 95%confidence interval, 95%CI 0.95-1.20), or comparing CD only with control (76.9 versus 76.2%, RR 1.01, 95%CI 0.89-1.15). Antenatal group hypnosis using the Hypnosis Antenatal Training for Childbirth (HATCh) intervention in late pregnancy does not reduce the use of pharmacological analgesia during labour and childbirth.

Effects of craniosacral therapy as adjunct to standard treatment for pelvic girdle pain in pregnant women: a multicenter, single blind, randomized controlled trial

Pelvic girdle pain (PGP) is a disabling condition affecting 30% of pregnant women. The aim of this study was to investigate the efficacy of craniosacral therapy as an adjunct to standard treatment compared with standard treatment alone for PGP during pregnancy. Randomized, multicenter, single blind, controlled trial. University hospital, a private clinic and 26 maternity care centers in Gothenburg, Sweden. A total of 123 pregnant women with PGP. Participants were randomly assigned to standard treatment (control group, n = 60) or standard treatment plus craniosacral therapy (intervention group, n = 63). pain intensity (visual analog scale 0-100 mm) and sick leave. function (Oswestry Disability Index), health-related quality of life (European Quality of Life measure), unpleasantness of pain (visual analog scale), and assessment of the severity of PGP by an independent examiner. Between-group differences for morning pain, symptom-free women and function in the last treatment week were in favor of the intervention group. Visual analog scale median was 27 mm (95% confidence interval 24.6-35.9) vs. 35 mm (95% confidence interval 33.5-45.7) (p = 0.017) and the function disability index was 40 (range 34-46) vs. 48 (range 40-56) (p = 0.016). Lower morning pain intensity and less deteriorated function was seen after craniosacral therapy in conjunction with standard treatment compared with standard treatment alone, but no effects regarding evening pain and sick-leave. Treatment effects were small and clinically questionable and conclusions should be drawn carefully. Further studies are warranted before recommending craniosacral therapy for PGP.

KAP assessment of oral health and adverse pregnancy outcomes among pregnant women in Hyderabad, India.

To conduct a questionnaire-based survey of pregnant women with particular reference to their knowledge, attitudes and practices in relation to oral care and adverse pregnancy outcomes and also to identify the various risk indicators for gingival bleeding during pregnancy. This was a cross-sectional questionnaire-based survey using interviewer-administered, structured questionnaires at three maternity care centres. The study group comprised 359 pregnant women who were assessed for their knowledge, attitudes and practices regarding oral health care during pregnancy and adverse pregnancy outcomes. There were deficits in various areas of the knowledge, attitudes and practices of the pregnant women. The majority (87.2%) were not aware of the importance of oral hygiene and its probable association with adverse pregnancy outcomes. None of the respondents ever used dental floss and only a few (1.4%) had heard about it. Risk indicators that were identified in our study for gingival bleeding during pregnancy were: poor knowledge regarding various parameters, brushing only once daily and infrequent visits to the dentist. Most pregnant women need more information about oral health and disease prevention. It would be prudent to compile and consider their knowledge, attitudes and practices along with sociocultural characteristics, so that health education programmes are customised to different sectors of the population.

Prevalence of Anemia and Associated Risk Factors among Pregnant Women Attending Antenatal Care in Azezo Health Center Gondar Town, Northwest Ethiopia

ABSTRACT Background: Anemia is a global public health problem affecting both developing and developed countries; approximately 1.3 billion individuals suffer from it. Pregnant women are the most vulnerable groups to anemia. The aim of this study was to assess the prevalence and risk factors for anemia in pregnant women attending antenatal care in Azezo Health Center, Gondar town, Northwest Ethiopia. Method: A cross-sectional study was conducted at Azezo Health Center from February to May 2011. Red blood cell morphology, Hgb level determination and intestinal parasites were assessed following the standard procedures. Socio-demographic data was collected by using a structured questionnaire. The data entered and analyzed by using the SPSS version 16.0 statistical software. P34, rural residence, history of malaria attack, hookworm infection and absence of iron supplements are significantly associated with increased risk of anemia. The most prevalent intestinal parasite among pregnant women was hookworm 18 (4.7%). Conclusion: In the present study, the prevalence of anemia was low when compared with the previous studies carried out in different countries including Ethiopia. More should be done in respect to the importance of regular visit to maternal care centres and health education promotion programs to succeed more.

Assessment of infection control practices in maternity units in Southern Nigeria

Puerperal sepsis accounts for 12% of maternal deaths in Nigeria. To date, little is known about the background hospital factors that predispose pregnant women to puerperal infection that leads to mortality. The objective of this study was to investigate the nature and pattern of existing policies and practices relating to infection control in maternity care centres in Edo state, South-South Nigeria. Cross-sectional study consisting of in-depth interviews with service providers, observation of clinical practices and examination of medical records. Public and private health-care facilities in eight local government areas (LGAs) selected from the three senatorial districts of Edo State, Nigeria. Health providers from 63 primary, secondary and tertiary maternity care centres. Sixty-three health-care facilities were sampled from eight LGAs from the three senatorial districts in Edo State. Three pre-tested tools were adapted to the local setting and used to interview key informants in the health facilities and to observe for practices and records relating to infection control. Of the 63 health facilities, 68% (43) reported that they had infection control procedures in place, while only 25% (16) reported that they documented these as manuals or charts. Only 13% (8) of facilities had infection control committees; 11% (7) routinely carried out audits of maternal deaths, while 33% (21) reported that they had an ongoing programme for staff training on infection control. A high proportion of the health facilities reported that staff routinely wash their hands before and after sterile procedures, but only half of the facilities were observed to have 24-h running water and only two-thirds had soap and antiseptic solutions in delivery and operating theatre areas. Although more than 90% (57) of the health facilities reported that they use sterile gloves routinely, unused sterile gloves were found in only 60% (38) of these facilities, and recycled gloves in 11.1% (7). The results of this study suggest the need for improved record-keeping procedures, the development of appropriate policies and protocols for infection control and staff training on infection control in maternity care facilities in Edo State. A public health education and advocacy programme to create awareness on clean delivery places as an approach for reducing maternal morbidity and mortality and to build political will for implementing related activities is also urgently needed.

Infant and Maternal Factors Influencing Breastmilk Sodium Among Primiparous Mothers

This study identified birth events and infant/maternal factors related to breastmilk sodium (Na+) among primiparous mothers. Data were collected in a larger study on perceived insufficient milk among 252 breastfeeding mothers at a Canadian, French-speaking university maternal care center. Birth events and infant and maternal factors were collected at 48 hours, 2 weeks, and 6 weeks after birth and were analyzed with bivariate and regression analysis. Presence of gestational diabetes increases the risk of an elevated breastmilk Na+ level at 48 hours, and increased number of breastfeeds (mean=8.91, SD=3.77) lowers it, indicating lactogenesis II was initiated. Breastfeeding frequency impacts initiation of lactogenesis II, which in turn influences duration of breastfeeding exclusivity. Therefore feedings should be promoted as soon as possible after birth and as frequently as eight to 12 times a day.

Impacts of virulence factors of Streptococcus mutans isolates on the pathogenesis of acute vaginitis

Streptococcus mutans, known to be an etiologic agent of dental caries, also causes infective endocarditis. Adherence of these bacteria results from the interaction of adhesions that form part of their structure with salivary components (or other body’s fluids), specifically those that compose the acquired pellicle. In the present study, acute vaginitis samples (vaginal swabs) were investigated from pregnant women patients who were admitted to many hospitals and maternal care centres in Baghdad city of Iraq. Ages of the women ranged from 20 to 30 years (only married women), while all samples were collected during March to July 2009. One hundred and fifty vaginal swabs were collected and cultured on blood agar plate, nutrient agar plates, chocolate agar plates and MacConkey agar plates, then incubated aerobically and anaerobically for 24 h at 37°C. Bacterial diagnosis were done according to macroscopic, microscopic and biochemical tests. The results of recent study showed that the prevalence of bacterial acute vaginitis of pregnant women indicated 18 (12%) as positive cases, while no growth was seen in the rest vaginal swabs (132, 88%). Results of bacterial isolation and identification showed that out of 18 isolates, only 8 (44.4%) isolates were diagnosed as S. mutans while other isolates were distributed to Staphylococcus epidermidis (8, 44.4%) isolates, Staphylococcus aureus (6, 33.3%) isolates, and 5 (27.7%) isolates each for Streptococcus agalactiae, Streptococcus salivaris and Proteus spp. Results of blood hemolysis of S. mutans isolates as virulence factors showed that only two isolates (25%) have the ability to produce hemolycin enzyme, and noticed that four isolates (50%) of S.. mutans were had the ability to produce extracellular protease enzyme on Mg media. Results of antibiotics profile resistance of S. mutans isolates showed that all isolates (100%) were resistant to ampicillin and amoxcillin, whereas seven isolates had also shown resistance in a lesser degree (87.5%) to tetracycline and gentamycin and to cefotaxime (75%) and ciprofloxacin and to erythromycin (62.5%) while all isolates showed high sensitivity (100%) to amoxiclave, doxicyclin and ampiclox antibiotics. S. mutans isolates showed moderate prevalence in the distribution of pathogenic microorganism of acute vaginitis. These isolates had 25% ability of blood hemolysis, and 50% ability to produce protease enzyme. S. mutans vaginal isolates appeared highly (100%) sensitive to amoxiclave, doxicyclin and ampiclox antibiotics, but it had 100% resistance to synthetic penicillin (ampicillin and amoxcillin) and there were different susceptibility to the rest antibiotics used in the study. Key words: Streptococcus mutans, virulence factors, antibiotics susceptibility.

Pain relief for childbirth: The preferences of pregnant women, midwives and obstetricians

To compare the personal preferences of pregnant women, midwives and obstetricians regarding a range of physical, psychosocial and pharmacological methods of pain relief for childbirth. Self-completed questionnaires were posted to a consecutive sample of 400 pregnant women booked-in to a large tertiary referral centre for maternity care in South Australia. A similar questionnaire was distributed to a national sample of 500 obstetricians as well as 425 midwives at: (1) the same hospital as the pregnant women, (2) an outer-metropolitan teaching hospital and (3) a district hospital. Eligible response rates were: pregnant women 31% (n=123), obstetricians 50% (n=242) and midwives 49% (n=210). Overall, midwives had a greater personal preference for most of the physical pain relief methods and obstetricians a greater personal preference for pharmacological methods than the other groups. Pregnant women's preferences were generally located between the two care provider groups, though somewhat closer to the midwives. All groups had the greatest preference for having a support person for labour with more than 90% of all participants wanting such support. The least preferred method for pregnant women was pethidine/morphine (14%). There are differences in the personal preferences of pregnant women, midwives and obstetricians regarding pain relief for childbirth. It is important that the pain relief methods available in maternity care settings reflect the informed preferences of pregnant women.

Eclampsia and Pregnancy Outcome at Lautech Teaching Hospital, Osogbo, South West, Nigeria

Eclampsia is one of the leading causes of maternal and perinatal morbidity and mortality in sub-Saharan Africa. This problem has continued unabated due to lack of policies supporting financial protection in times of ill health, non-implementation of proven interventions as well as gaps in capacity building by stakeholders in health care delivery in this region. The aim of this retrospective study is to assess the impact of eclampsia on maternal and perinatal survival and suggest ways of reducing maternal death. A 6-year retrospective study was conducted with eighty-three cases of eclampsia. The cases were mainly antepartum patients with poor blood pressure control and resultant eclampsia. The case fatality rate was 8.3% and perinatal death was 24.1%. Magnesiun sulphate may have contributed to improvements in pregnancy outcome as mortality was higher among women with no access to magnesium sulphate. Most of the eclamptic patients were referred late from private health facilities hence the need for public-private collaboration in strengthening the referral system and making magnesium sulphate widely available in maternal care centers.

Denial of pain relief during labor to parturients in southeast Nigeria

Objective To evaluate the experiences of parturients with regard to pain relief during labor in Enugu, Nigeria. Methods Women attending the prenatal clinics of 3 maternity care centers were interviewed via pre-tested interviewer-administered questionnaires between August 2010 and January 2011. Both open and closed questions were asked to evaluate the opinions and experiences of the respondents with regard to labor analgesia in previous pregnancies. Results Overall, 34.1% of respondents were aware of their right to labor pain relief. Only 33.5% of maternal requests for labor pain relief were granted. Women who did not request labor analgesia indicated ignorance and fear of labor caregivers as their major reasons. Conclusion Most women in southeast Nigeria are unaware of their right to pain relief in labor. Ignorance and fear of unfavorable reactions from labor caregivers are hindering women from requesting labor analgesia. There is a need to address the issue of refusal of maternal requests for labor pain relief because it constitutes a violation of the fundamental right of the parturient and an unnecessary breach of medical ethics.

Residential proximity to heavy traffic and birth weight in Shizuoka, Japan

An association between exposure to traffic-related air pollution and reduced birth weight has been suggested. However, previous studies have failed to adjust for maternal size, which is an indicator of individual genetic growth potential. Therefore, we evaluated the association of air pollution with birth weight, term low birth weight (term-LBW), and small for gestational age (SGA), with adjustment for maternal size. Individual data were extracted from a database that is maintained by a maternal and perinatal care center in Shizuoka, Japan. We identified liveborn singleton births ( n=14,204). Using geocoded residential information, each birth was assigned a number of traffic-based exposure indicators: distance to a major road; distance-weighted traffic density; and estimated concentration of nitrogen dioxide by land use regression. The multivariate adjusted odds ratios and their 95% confidence intervals (CIs) for the associations between exposure indicators and outcomes were then estimated using logistic regression models. Overall, exposure indicators of air pollution showed no clear pattern of association. Although there are many limitations, we did not find clear associations between birth-weight-related outcomes and the three markers of traffic-related air pollution.

Pertussis immunization in paediatric healthcare workers: Knowledge, attitudes, beliefs, and behaviour

Healthcare workers’ (HCWs) knowledge, attitudes, and beliefs regarding pertussis immunization were assessed and compared to the rate of vaccine uptake. A questionnaire was distributed to employees at a paediatric and maternity tertiary care centre. Respondents were then offered a dose of the tetanus, diphtheria, and acellular pertussis vaccine (Tdap) at a free vaccine clinic. In total, 529 out of 3051 (17%) employees completed the survey and 61 received the Tdap vaccine. Although 76% of participants were willing to be immunized, only 15% presented to the clinic. There is a widespread acceptance of pertussis immunization among paediatric HCWs. Stated intentions may be poorly predictive of behaviour. Education and institutional or public funding may improve vaccine uptake.

Is Questionnaire-Based Alcohol Counseling More Effective for Pregnant Women Than Standard Maternity Care?

To compare current standard maternity care in Sweden concerning provision of alcohol advice with a more comprehensive questionnaire-based counseling model. The study population included pregnant women in Linköping who were registered at a maternity care center during a 2-year period and whose pregnancies resulted in liveborn infants without birth defects, representing 93% of all pregnant women. Anonymous questionnaires were mailed to the women. The first cohort (registered April 2005 1, to March 31, 2006) received standard care according to a procedure that is common practice in Sweden. The second cohort (April 1, 2006 to March 31, 2007) received alcohol advice based on a comprehensive counseling model, incorporating the use of the three-item Alcohol Use Disorders Identification Test (AUDIT-C) questionnaire and tailored counseling based on the AUDIT-C score. The response rate was 61% in the first cohort (standard care) and 70% in the second cohort (questionnaire-based counseling). The cohorts were similar in sociodemographic variables and prepregnancy drinking characteristics. The proportion of women who continued drinking alcohol during the pregnancy was 6.0% in cohort 1 and 5.8% in cohort 2. Women in cohort 2 were more favorable to the advice and, to a larger extent, perceived the main message to be abstinence from drinking during pregnancy. The questionnaire-based counseling model was more favorably perceived than the standard care model, but the new model was not more effective in terms of its impact on the proportion of women who abstained from drinking during pregnancy.

Regression of pelvic girdle pain after delivery: follow‐up of a randomised single blind controlled trial with different treatment modalities

An earlier publication showed that acupuncture and stabilising exercises as an adjunct to standard treatment was effective for pelvic girdle pain during pregnancy, but the post-pregnancy effects of these treatment modalities are unknown. The aim of this follow-up study was to describe regression of pelvic girdle pain after delivery in these women. A randomised, single blind, controlled trial. East Hospital and 27 maternity care centres in Göteborg, Sweden. Some 386 pregnant women with pelvic girdle pain. Participants were randomly assigned to standard treatment plus acupuncture (n=125), standard treatment plus specific stabilising exercises (n=131) or to standard treatment alone (n=130). pain intensity (Visual Analogue Scale). assessment of the severity of pelvic girdle pain by an independent examiner 12 weeks after delivery. Approximately three-quarters of all the women were free of pain 3 weeks after delivery. There were no differences in recovery between the 3 treatment groups. According to the detailed physical examination, pelvic girdle pain had resolved in 99% of the women 12 weeks after delivery. This study shows that irrespective of treatment modality, regression of pelvic girdle pain occurs in the great majority of women within 12 weeks after delivery.