Background: Low back pain (LBP) is commonly experienced during pregnancy and is often poorly managed. There is much ambiguity in diagnostic work-up, appropriate management and decision-making regarding the use of neuraxial analgesia and anaesthesia during labour and delivery in these patients. This systematic review summarises the evidence regarding investigations, management strategies and considerations around performing neuraxial blocks for pregnant women with LBP. Methods: We searched 3 databases and reviewed literature concerning LBP in pregnancy with regards to diagnostic modalities, management strategies and use of neuraxial techniques for facilitating labour and delivery. Results: In all, we included 78 studies in this review, with 32 studies concerning diagnostic investigations, 56 studies involving management strategies, and 4 studies regarding the use of neuraxial techniques for labour and delivery. Summary: MRI is the safest investigative modality for LBP in pregnancy. Antenatal educational programmes, exercise and steroid injections into the epidural space or sacroiliac joints may help with pain management. Worsening neurological deficits, vertebral fractures and tumours may need surgical management. There is limited evidence on challenges of performing neuraxial blocks in the peripartum period for analgesia and anaesthesia, but there is a potential for increased risk of neurological complications in parturients with pre-existing neurological deficits.

Journal Section:
Editor's choice
Keywords:
Low back pain, Pregnancy, Sciatica, Neuraxial, Analgesia, Anaesthesia
1.
Fast A, Shapiro D, Ducommun EJ, Friedmann LW, Bouklas T, Floman Y: Low-back pain in pregnancy. Spine (Phila Pa 1976) 1987;12:368-371.
2.
Ostgaard HC, Andersson GB, Karlsson K: Prevalence of back pain in pregnancy. Spine (Phila Pa 1976) 1991;16:549-552.
3.
Wu WH, Meijer OG, Uegaki K, Mens JM, van Dieen JH, Wuisman PI, et al: Pregnancy-related pelvic girdle pain (PPP), I: terminology, clinical presentation, and prevalence. Eur Spine J 2004;13:575-589.
4.
Ostgaard HC, Andersson GB: Previous back pain and risk of developing back pain in a future pregnancy. Spine (Phila Pa 1976) 1991;16:432-436.
5.
Albert H, Godskesen M, Westergaard J: Prognosis in four syndromes of pregnancy-related pelvic pain. Acta Obstet Gynecol Scand 2001;80:505-510.
6.
Rost CC, Jacqueline J, Kaiser A, Verhagen AP, Koes BW: Prognosis of women with pelvic pain during pregnancy: a long-term follow-up study. Acta Obstet Gynecol Scand 2006;85:771-777.
7.
Ostgaard HC, Andersson GB, Wennergren M: The impact of low back and pelvic pain in pregnancy on the pregnancy outcome. Acta Obstet Gynecol Scand 1991;70:21-24.
8.
Aune D, Saugstad OD, Henriksen T, Tonstad S: Physical activity and the risk of preeclampsia: a systematic review and meta-analysis. Epidemiology 2014;25:331-343.
9.
Domenjoz I, Kayser B, Boulvain M: Effect of physical activity during pregnancy on mode of delivery. Am J Obstet Gynecol 2014;211:401.e1-e11.
10.
Price BB, Amini SB, Kappeler K: Exercise in pregnancy: effect on fitness and obstetric outcomes - a randomized trial. Med Sci Sports Exerc 2012;44:2263-2269.
11.
Vermani E, Mittal R, Weeks A: Pelvic girdle pain and low back pain in pregnancy: a review. Pain Pract 2010;10:60-71.
12.
Casagrande D, Gugala Z, Clark SM, Lindsey RW: Low back pain and pelvic girdle pain in pregnancy. J Am Acad Orthop Surg 2015;23:539-549.
13.
Black RA, Hill DA: Over-the-counter medications in pregnancy. Am Fam Physician 2003;67:2517-2524.
14.
Rathmell JP, Viscomi CM, Ashburn MA: Management of nonobstetric pain during pregnancy and lactation. Anesth Analg 1997;85:1074-1087.
15.
American Academy of Pediatrics Committee on Drugs: Transfer of drugs and other chemicals into human milk. Pediatrics 2001;108:776-789.
16.
Vercauteren M, Waets P, Pitkanen M, Forster J: Neuraxial techniques in patients with pre-existing back impairment or prior spine interventions: a topical review with special reference to obstetrics. Acta Anaesthesiol Scand 2011;55:910-917.
17.
Hebl JR, Horlocker TT, Kopp SL, Schroeder DR: Neuraxial blockade in patients with preexisting spinal stenosis, lumbar disk disease, or prior spine surgery: efficacy and neurologic complications. Anesth Analg 2010;111:1511-1519.
18.
Lee JM, Han IH, Moon SH, Choi BK: Surgery for recurrent lumbar disc herniation during pregnancy: a case report. Korean J Spine 2011;8:304-306.
19.
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264-269.
20.
Vleeming A, Albert HB, Östgaard HC, Sturesson B, Stuge B: European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 2008;17:794-819.
21.
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al: The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
22.
Guerreiro da Silva JB, Nakamura MU, Cordeiro JA, Kulay L Jr: Acupuncture for low back pain in pregnancy - a prospective, quasi-randomised, controlled study. Acupunct Med 2004;22:60-67.
23.
Nilsson-Wikmar L, Holm K, Oijerstedt R, Harms-Ringdahl K: Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain: a randomized clinical trial with 3, 6, and 12 months follow-up postpartum. Spine (Phila Pa 1976) 2005;30:850-856.
24.
Ostgaard HC, Zetherstrom G, Roos-Hansson E, Svanberg B: Reduction of back and posterior pelvic pain in pregnancy. Spine (Phila Pa 1976) 1994;19:894-900.
25.
Ostgaard HC, Zetherstrom G, Roos-Hansson E: Back pain in relation to pregnancy: a 6-year follow-up. Spine (Phila Pa 1976) 1997;22:2945-2950.
26.
Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST: Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. Am J Obstet Gynecol 2010;202:43.e1-e8.
27.
Eggen MH, Stuge B, Mowinckel P, Jensen KS, Hagen KB: Can supervised group exercises including ergonomic advice reduce the prevalence and severity of low back pain and pelvic girdle pain in pregnancy? A randomized controlled trial. Phys Ther 2012;92:781-790.
28.
Mens JM, Snijders CJ, Stam HJ: Diagonal trunk muscle exercises in peripartum pelvic pain: a randomized clinical trial. Phys Ther 2000;80:1164-1173.
29.
Stuge B, Laerum E, Kirkesola G, Vøllestad N: The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial. Spine (Phila Pa 1976) 2004;29:351-359.
30.
Akmese ZB, Oran NT: Effects of progressive muscle relaxation exercises accompanied by music on low back pain and quality of life during pregnancy. J Midwifery Womens Health 2014;59:503-509.
31.
Bastiaenen CH, Bastiaanssen JM, de Bie RA: Re: Gutke A, Ostgaard HC, Oberg B: Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning. Spine 2006;31:E149-55. Spine (Phila Pa 1976) 2006;31:2406; author reply 2406-2407.
32.
Elden H: Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial. BMJ 2005;330:761.
33.
Elden H, Fagevik-Olsen M, Ostgaard HC, Stener-Victorin E, Hagberg H: Acupuncture as an adjunct to standard treatment for pelvic girdle pain in pregnant women: randomised double-blinded controlled trial comparing acupuncture with non-penetrating sham acupuncture. BJOG 2008;115:1655-1668.
34.
Gutke A, Sjodahl J, Oberg B: Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial. J Rehabil Med 2010;42:929-935.
35.
Kihlstrand M, Stenman B, Nilsson S, Axelsson O: Water-gymnastics reduced the intensity of back/low back pain in pregnant women. Acta Obstet Gynecol Scand 1999;78:180-185.
36.
Kvorning N, Holmberg C, Grennert L, Aberg A, Akeson J: Acupuncture relieves pelvic and low-back pain in late pregnancy. Acta Obstet Gynecol Scand 2004 ;83:246-250.
37.
Haugland KS, Rasmussen S, Daltveit AK: Group intervention for women with pelvic girdle pain in pregnancy. A randomized controlled trial. Acta Obstet Gynecol Scand 2006;85:1320-1326.
38.
Abou-Shameh MA, Dosani D, Gopal S, McLaren AG: Lumbar discectomy in pregnancy. Int J Gynaecol Obstet 2006;92:167-169.
39.
Al-areibi A, Coveney L, Singh S, Katsiris S: Case report: anesthetic management for sequential Cesarean delivery and laminectomy. Can J Anaesth 2007;54:471-474.
40.
Brown MD, Levi AD: Surgery for lumbar disc herniation during pregnancy. Spine (Phila Pa 1976) 2001;26:440-443.
41.
Brown MD, Brookfield KF: Lumbar disc excision and cesarean delivery during the same anesthesia. A case report. J Bone Joint Surg Am 2004;86:2030-2032.
42.
Darwich AA, Diwan SA: Management of back pain in pregnancy. Tech Reg Anesth Pain Manag 2009;13:251-254.
43.
Garmel SH, Guzelian GA, D'Alton JG, D'Alton ME: Lumbar disk disease in pregnancy. Obstet Gynecol 1997;89(5 pt 2):821-822.
44.
Han IH, Kuh SU, Kim JH, Chin DK, Kim KS, Yoon YS, et al: Clinical approach and surgical strategy for spinal diseases in pregnant women: a report of ten cases. Spine (Phila Pa 1976) 2008;33:E614-E619.
45.
Kim HS, Kim SW, Lee SM, Shin H: Endoscopic discectomy for the cauda equina syndrome during third trimester of pregnancy. J Korean Neurosurg Soc 2007;42:419-420.
46.
LaBan MM, Rapp NS, von Oeyen P, Meerschaert JR: The lumbar herniated disk of pregnancy: a report of six cases identified by magnetic resonance imaging. Arch Phys Med Rehabil 1995;76:476-479.
47.
Bayram S, Ozturk C, Sivrioglu K, Aydinli U, Kucukoglu S: Kyphoplasty for pregnancy-associated osteoporotic vertebral fractures. Joint Bone Spine 2006;73:564-566.
48.
Kim HW, Song JW, Kwon A, Kim IH: Percutaneous vertebroplasty for pregnancy-associated osteoporotic vertebral compression fractures. J Korean Neurosurg Soc 2010;47:399-402.
49.
Ozdemir D, Tam AA, Dirikoc A, Ersoy R, Cakir B: Postpartum osteoporosis and vertebral fractures in two patients treated with enoxaparin during pregnancy. Osteoporos Int 2015;26:415-418.
50.
Hsieh HP, Po HL, Hseuh IH: Low back pain in a pregnant woman. Acta Neurol Taiwan 2004;13:84-86.
51.
Moles A, Hamel O, Perret C, Bord E, Robert R, Buffenoir K: Symptomatic vertebral hemangiomas during pregnancy. J Neurosurg Spine 2014;20:585-591.
52.
Egerman RS, Mabie WC, Eifrid M, Whitnack E, Sibai BM: Sacroiliitis associated with pyelonephritis in pregnancy. Obstet Gynecol 1995;85:834-835.
53.
Mulvey JM: Postpartum septic sacroiliitis coincident with labour epidural analgesia. Anaesth Intensive Care 2008;36:875-878.
54.
Park YS, Owen AM, Adno AM, Marry J: Pyogenic sacroiliitis due to group A streptococcus following uncomplicated pregnancy and vaginal delivery. Case Rep Obstet Gynecol 2013;2013:981474.
55.
Giannoulis DK, Koulouvaris P, Zilakou E, Papadopoulos DB, Lykissas MG, Mavrodontidis AN: Atraumatic sacral fracture in late pregnancy: a case report. Global Spine J 2015;5:248-251.
56.
Goeb V, Strotz V, Verdet M, Le Loet X, Vittecoq O: Post-partum sacral fracture associated with heparin treatment. Clin Rheumatol 2008;27(suppl 2):S51-S53.
57.
Karatas M, Basaran C, Ozgul E, Tarhan C, Agildere AM: Postpartum sacral stress fracture: an unusual case of low-back and buttock pain. Am J Phys Med Rehabil 2008;87:418-422.
58.
Onur O, Atalar H, Cakirbay H, Gok K: Postpartum sacral stress fracture: case report. Turkiye Klin Jinekoloji Obstet 2011;21:42-46.
59.
Ozturk G, Kulcu DG, Aydog E: Intrapartum sacral stress fracture due to pregnancy-related osteoporosis: a case report. Arch Osteoporos 2013;8:139.
60.
Park J, Ok E, Park HJ, Hong SH, Lee JI: Postpartum sacral stress fracture mimicking lumbar radiculopathy in a patient with pregnancy-associated osteoporosis. Ann Rehabil Med 2013;37:582-585.
61.
Pishnamaz M, Sellei R, Pfeifer R, Lichte P, Pape HC, Kobbe P: Low back pain during pregnancy caused by a sacral stress fracture: a case report. J Med Case Rep 2012;6:98.
62.
Rousiere M, Kahan A, Job-Deslandre C: Postpartal sacral fracture without osteoporosis. Joint Bone Spine 2001;68:71-73.
63.
Sansone V, McCleery J, Bonora C: Post-partum low-back pain of an uncommon origin: a case report. J Back Musculoskelet Rehabil 2013;26:475-477.
64.
Thein R, Burstein G, Shabshin N: Labor-related sacral stress fracture presenting as lower limb radicular pain. Orthopedics 2009;32:447.
65.
Hasegawa Y, Iwata H: Chronic pelvic girdle relaxation. Jpn J Rheumatol 1999;9:391-395.
66.
Damen L, Buyruk HM, Guler-Uysal F, Lotgering FK, Snijders CJ, Stam HJ: Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints. Acta Obstet Gynecol Scand 2001;80:1019-1024.
67.
Arab AM, Behbahani RB, Lorestani L, Azari A: Assessment of pelvic floor muscle function in women with and without low back pain using transabdominal ultrasound. Man Ther 2010;15:235-239.
68.
Bastiaenen CH, de Bie RA, Wolters PM, Vlaeyen JW, Leffers P, Stelma F, et al: Effectiveness of a tailor-made intervention for pregnancy-related pelvic girdle and/or low back pain after delivery: short-term results of a randomized clinical trial [ISRCTN08477490]. BMC Musculoskelet Disord 2006;7:19.
69.
Mantle MJ, Holmes J, Currey HL: Backache in pregnancy II: prophylactic influence of back care classes. Rheumatol Rehabil 1981;20:227-232.
70.
George JW, Skaggs CD, Thompson PA, Nelson DM, Gavard JA, Gross GA: A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy. Am J Obstet Gynecol 2013;208:295.e1-e7.
71.
Miquelutti MA, Cecatti JG, Makuch MY: Evaluation of a birth preparation program on lumbopelvic pain, urinary incontinence, anxiety and exercise: a randomized controlled trial. BMC Pregnancy Childbirth 2013;13:154.
72.
Garshasbi A, Faghih Zadeh S: The effect of exercise on the intensity of low back pain in pregnant women. Int J Gynecol Obstet 2005;88:271-275.
73.
Andrews CM, O'Neill LM: Use of pelvic tilt exercise for ligament pain relief. J Nurse Midwifery 1994;39:370-374.
74.
Kluge J, Hall D, Louw Q, Theron G, Grové D: Specific exercises to treat pregnancy-related low back pain in a South African population. Int J Gynaecol Obstet 2011;113:187-191.
75.
Dumas GA, Reid JG, Wolfe LA, Griffin MP, McGrath MJ: Exercise, posture, and back pain during pregnancy. Part 2. Exercise and back pain. Clin Biomech 1995;10:104-109.
76.
Kashanian M, Akbari Z, Alizadeh MH: The effect of exercise on back pain and lordosis in pregnant women. Int J Gynaecol Obstet 2009;107:160-161.
77.
Haakstad LA, Bø K: Effect of a regular exercise programme on pelvic girdle and low back pain in previously inactive pregnant women: a randomized controlled trial. J Rehabil Med 2015;47:229-234.
78.
Stafne SN, Salvesen KÅ, Romundstad PR, Stuge B, Mørkved S: Does regular exercise during pregnancy influence lumbopelvic pain? A randomized controlled trial. Acta Obstet Gynecol Scand 2012;91:552-559.
79.
Mens JM, Damen L, Snijders CJ, Stam HJ: The mechanical effect of a pelvic belt in patients with pregnancy-related pelvic pain. Clin Biomech (Bristol, Avon) 2006;21:122-127.
80.
Kalus S, Kornman LH, Quinlivan JA: Managing back pain in pregnancy using a support garment: a randomised trial. BJOG 2007;115:68-75.
81.
Hiemstra LA, Kerslake S, Irving C: Anterior knee pain in the athlete. Clin Sports Med 2014;33:437-459.
82.
Schwerla F, Rother K, Rother D, Ruetz M, Resch KL: Osteopathic manipulative therapy in women with postpartum low back pain and disability: a pragmatic randomized controlled trial. J Am Osteopath Assoc 2015;115:416-425.
83.
Martins RF, Pinto e Silva JL: Treatment of pregnancy-related lumbar and pelvic girdle pain by the yoga method: a randomized controlled study. J Altern Complement Med 2014;20:24-31.
84.
Cummings M: Acupuncture for low back pain in pregnancy. Acupunct Med 2003;21:42-46.
85.
Forrester M: Low back pain in pregnancy. Acupunct Med 2003;21:36-41.
86.
Ekdahl L, Petersson K; Acupuncture treatment of pregnant women with low back and pelvic pain - an intervention study. Scand J Caring Sci 2010;24:175-182.
87.
Lund I, Lundeberg T, Lönnberg L, Svensson E: Decrease of pregnant women's pelvic pain after acupuncture: a randomized controlled single-blind study. Acta Obstet Gynecol Scand 2006;85:12-19.
88.
Keskin EA, Onur O, Keskin HL, Gumus II, Kafali H, Turhan N: Transcutaneous electrical nerve stimulation improves low back pain during pregnancy. Gynecol Obstet Invest 2012;74:76-83.
89.
Desmond FA, Harmon D: Ultrasound-guided symphysis pubis injection in pregnancy. Anesth Analg 2010;111:1329-1330.
90.
Hurdle M-FB, McHugh R, Schwendemann W, Psimos C, Smith J: Poster 128: ultrasound guided sacroiliac joint injection in pregnancy: a case series. Arch Phys Med Rehabil 2007;88:E45-E46.
91.
Moles A, Hamel O, Perret C, Bord E, Robert R, Buffenoir K: Symptomatic vertebral hemangiomas during pregnancy. J Neurosurg Spine 2014;20:585-591.
92.
Ko JY, Leffert LR: Clinical implications of neuraxial anesthesia in the parturient with scoliosis. Anesth Analg 2009;109:1930-1934.
93.
Villevieille T, Mercier FJ, Benhamou D: [Is obstetric epidural anaesthesia technically possible after spinal surgery and does it work?]. Ann Fr Anesth Reanim 2003;22:91-95.
94.
Young AC, Lubenow TR, Buvanendran A: The parturient with implanted spinal cord stimulator: management and review of the literature. Reg Anesth Pain Med 2015;40:276-283.
95.
Aldabe D, Ribeiro DC, Milosavljevic S, Dawn Bussey M: Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. Eur Spine J 2012;21:1769-1776.
96.
Ireland ML, Ott SM: The effects of pregnancy on the musculoskeletal system. Clin Orthop Relat Res 2000;169-179.
97.
Sneag DB, Bendo JA: Pregnancy-related low back pain. Orthopedics 2007;30:837-839.
98.
Mens JM, Pool-Goudzwaard A, Stam HJ; Mobility of the pelvic joints in pregnancy-related lumbopelvic pain: a systematic review. Obstet Gynecol Surv 2009;64:200-208.
99.
Moros ML, Rodrigo C, Villacampa A, Ruiz J, Lapresta C: Septic shock in pregnancy due to pyogenic sacroiliitis: a case report. J Med Case Rep 2009;3:6505.
100.
Han IH, Kuh SU, Kim JH, Chin DK, Kim KS, Yoon YS, et al: Clinical approach and surgical strategy for spinal diseases in pregnant women: a report of ten cases. Spine (Phila Pa 1976) 2008;33:E614-E619.
101.
Sabino J, Grauer JN: Pregnancy and low back pain. Curr Rev Musculoskelet Med 2008;1:137-141.
102.
Kanakaris NK, Roberts CS, Giannoudis PV: Pregnancy-related pelvic girdle pain: an update. BMC Med 2011;9:15.
103.
Choi JS, Ahn HK, Han JY, Han YJ, Kwak DO, Velazquez-Armenta EY, et al: A case series of 15 women inadvertently exposed to magnetic resonance imaging in the first trimester of pregnancy. J Obstet Gynaecol 2015;35:871-872.
104.
Bouyssi-Kobar M, du Plessis AJ, Robertson RL, Limperopoulos C: Fetal magnetic resonance imaging: exposure times and functional outcomes at preschool age. Pediatr Radiol 2015;45:1823-1830.
105.
Victoria T, Jaramillo D, Roberts TP, Zarnow D, Johnson AM, Delgado J, et al: Fetal magnetic resonance imaging: jumping from 1.5 to 3 tesla (preliminary experience). Pediatr Radiol 2014;44:376-386; quiz 373-375.
106.
Medical magnetic resonance (MR) procedures: protection of patients. Health Phys 2004;87:197-216.
107.
ACOG Committee Opinion. Number 299, September 2004 (replaces No. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 2004;104:647-651.
108.
Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley WG Jr, Froelich JW, et al: ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging 2013;37:501-530.
109.
Garcia-Bournissen F, Shrim A, Koren G: Safety of gadolinium during pregnancy. Can Fam Physician 2006;52:309-310.
110.
Tremblay E, Thérasse E, Thomassin-Naggara I, Trop I: Quality initiatives: guidelines for use of medical imaging during pregnancy and lactation. Radiographics 2012;32:897-911.
111.
Wang PI, Chong ST, Kielar AZ, Kelly AM, Knoepp UD, Mazza MB, et al: Imaging of pregnant and lactating patients: part 1, evidence-based review and recommendations. AJR Am J Roentgenol 2012;198:778-884.
112.
Masselli G, Derchi L, McHugo J, Rockall A, Vock P, Weston M, et al: Acute abdominal and pelvic pain in pregnancy: ESUR recommendations. Eur Radiol 2013;23:3485-3500.
113.
Groen RS, Bae JY, Lim KJ: Fear of the unknown: ionizing radiation exposure during pregnancy. Am J Obstet Gynecol 2012;206:456-462.
114.
Brent RL: Saving lives and changing family histories: appropriate counseling of pregnant women and men and women of reproductive age, concerning the risk of diagnostic radiation exposures during and before pregnancy. Am J Obstet Gynecol 2009;200:4-24.
115.
International Commission on Radiological Protection: Pregnancy and medical radiation. Ann ICRP 2000;30:1-43.
116.
Inamasu J, Nichols TA, Guiot BH: Vertebral hemangioma symptomatic during pregnancy treated by posterior decompression, intraoperative vertebroplasty, and segmental fixation. J Spinal Disord Tech 2006;19:451-454.
117.
O'Sullivan GJ, Carty FL, Cronin CG: Imaging of bone metastasis: an update. World J Radiol 2015;7:202-211.
118.
Torloni MR, Vedmedovska N, Merialdi M, Betrán AP, Allen T, González R, et al: Safety of ultrasonography in pregnancy: WHO systematic review of the literature and meta-analysis. Ultrasound Obstet Gynecol 2009;33:599-608.
119.
Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E: The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome. Arch Phys Med Rehabil 1998;79:288-292.
120.
Heidari P, Farahbakhsh F, Rostami M, Noormohammadpour P, Kordi R: The role of ultrasound in diagnosis of the causes of low back pain: a review of the literature. Asian J Sports Med 2015;6:e23803.
121.
Weishaupt D, Zanetti M, Hodler J, Boos N: MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology 1998;209:661-666.
122.
Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS: Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994;331:69-73.
123.
Barr K: Electrodiagnosis of lumbar radiculopathy. Phys Med Rehabil Clin N Am 2013;24:79-91.
124.
Cho SC, Ferrante MA, Levin KH, Harmon RL, So YT: Utility of electrodiagnostic testing in evaluating patients with lumbosacral radiculopathy: an evidence-based review. Muscle Nerve 2010;42:276-282.
125.
van Tulder MW, Assendelft WJ, Koes BW, Bouter LM: Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies. Spine (Phila Pa 1976) 1997;22:427-434.
126.
Videman T, Battie MC, Gibbons LE, Maravilla K, Manninen H, Kaprio J: Associations between back pain history and lumbar MRI findings. Spine (Phila Pa 1976) 2003;28:582-588.
127.
Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al: Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol 2015;36:811-816.
128.
Hooten WM, Cohen SP: Evaluation and treatment of low back pain: a clinically focused review for primary care specialists. Mayo Clin Proc 2015;90:1699-1718.
129.
National Institute for Health and Clinical Excellence: Antenatal care for uncomplicated pregnancies (CG62) [Internet]. 2008.https://www.nice.org.uk/guidance/cg62 (cited November 13, 2015).
130.
Bongers PM, de Winter CR, Kompier MA, Hildebrandt VH: Psychosocial factors at work and musculoskeletal disease. Scand J Work Environ Health 1993;19:297-312.
131.
Olsson CB, Grooten WJ, Nilsson-Wikmar L, Harms-Ringdahl K, Lundberg M: Catastrophizing during and after pregnancy: associations with lumbopelvic pain and postpartum physical ability. Phys Ther 2012;92:49-57.
132.
Ferreira CW, Alburquerque-Sendı NF: Effectiveness of physical therapy for pregnancy-related low back and/or pelvic pain after delivery: a systematic review. Physiother Theory Pract 2013;29:419-431.
133.
Pennick V, Liddle SD: Interventions for preventing and treating pelvic and back pain in pregnancy; in Pennick V (ed): Cochrane Database of Systematic Reviews. Chichester, John Wiley & Sons, Ltd., 2013, p CD001139.
134.
Zolotor AJ, Carlough MC: Update on prenatal care. Am Fam Physician 2014;89:199-208.
135.
Beaty CM, Bhaktaram VJ, Rayburn WF, Parker MJ, Christensen HD, Chandrasekaran K: Low backache during pregnancy. Acute hemodynamic effects of a lumbar support. J Reprod Med 1999;44:1007-1011.
136.
van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW: Lumbar supports for prevention and treatment of low back pain; in van Duijvenbode I (ed): Cochrane Database of Systematic Reviews. Chichester, John Wiley & Sons, Ltd., 2008, p CD001823.
137.
Cramer H, Lauche R, Haller H, Dobos G: A systematic review and meta-analysis of yoga for low back pain. Clin J Pain 2013;29:450-460.
138.
Combs MA, Thorn BE: Yoga attitudes in chronic low back pain: roles of catastrophizing and fear of movement. Complement Ther Clin Pract 2015;21:160-165.
139.
Hill C: Is yoga an effective treatment in the management of patients with chronic low back pain compared with other care modalities - a systematic review. J Complement Integr Med 2013;10:pii:/j/jcim.2013.10.issue-1/jcim-2012-0007/jcim-2012-0007.xml.
140.
Lam M, Galvin R, Curry P: Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis. Spine (Phila Pa 1976) 2013;38:2124-2138.
141.
Yuan QL, Guo TM, Liu L, Sun F, Zhang YG: Traditional Chinese medicine for neck pain and low back pain: a systematic review and meta-analysis. PLoS One 2015;10:e0117146.
142.
Zhao HJ, Tan JY, Wang T, Jin L: Auricular therapy for chronic pain management in adults: a synthesis of evidence. Complement Ther Clin Pract 2015;21:68-78.
143.
Abdi S, Datta S, Trescot AM, Schultz DM, Adlaka R, Atluri SL, et al: Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician 2007;10:185-212.
144.
Cohen SP, Bicket MC, Jamison D, Wilkinson I, Rathmell JP: Epidural steroids: a comprehensive, evidence-based review. Reg Anesth Pain Med;38:175-200.
145.
Nguyen GC, Seow CH, Maxwell C, Huang V, Leung Y, Jones J, et al: The Toronto consensus statements for the management of inflammatory Bowel disease in pregnancy. Gastroenterology 2016;150:734-757.e1.
146.
Kulkarni M, Shenoy L, Sagar MS: Anesthetic management of a pregnant patient undergoing open splenectomy for hypersplenism. Anesth Essays Res 2014;8(3):393-396.
147.
Cook TM, Counsell D, Wildsmith JA: Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth 2009;102:179-190.
148.
Abdallah MW, Elzayyat NS, Abdelhaq MM, Gado AA: A comparative study of general anesthesia versus combined spinal - epidural anesthesia on the fetus in cesarean section. Egypt J Anaesth 2014;30:155-160.
149.
Saygı Aİ, Özdamar Ö, Gün İ, Emirkadı H, Müngen E, Akpak YK: Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial. Sao Paulo Med J 2015;133:227-234.
150.
Chakraverty R, Pynsent P, Isaacs K: Which spinal levels are identified by palpation of the iliac crests and the posterior superior iliac spines? J Anat 2007;210:232-236.
151.
Perlas A, Chaparro LE, Chin KJ: Lumbar neuraxial ultrasound for spinal and epidural anesthesia: a systematic review and meta-analysis. Reg Anesth Pain Med 2016;41:251-260.
152.
Chin KJ, Perlas A, Chan V, Brown-Shreves D, Koshkin A, Vaishnav V: Ultrasound imaging facilitates spinal anesthesia in adults with difficult surface anatomic landmarks. Anesthesiology 2011;115:94-101.
153.
Loyola University: Ultrasound guided osterior sacroiliac ligament corticosteroid injection in pregnancy-related pelvic girdle pain; In ClinicalTrials.gov [Internet]. Bethesda, National Library of Medicine (US), 2000. https://clinicaltrials.gov/ct2/show/NCT02044991 (cited November 16, 2015).
154.
Hubbert CH: Epidural anesthesia in patients with spinal fusion. Anesth Analg 1985;64:843.
155.
Crosby ET, Halpern SH: Obstetric epidural anaesthesia in patients with Harrington instrumentation. Can J Anaesth 1989;36:693-696.
156.
Daley MD, Rolbin SH, Hew EM, Morningstar BA, Stewart JA: Epidural anesthesia for obstetrics after spinal surgery. Reg Anesth 1990;15:280-284.
157.
Kim SH, Jeon DH, Chang CH, Lee SJ, Shin YS: Spinal anesthesia with isobaric tetracaine in patients with previous lumbar spinal surgery. Yonsei Med J 2009;50:252-256.
158.
Okutomi T, Saito M, Koura M, Hoka S: Spinal anesthesia using a continuous spinal catheter for cesarean section in a parturient with prior surgical correction of scoliosis. J Anesth 2006;20:223-226.
159.
Wong CA, Scavone BM, Dugan S, Smith JC, Prather H, Ganchiff JN, et al: Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol 2003;101:279-288.
160.
Chan YL, Lam WW, Lau TK, Metreweli C, Chan DP: Back pain in pregnancy - magnetic resonance imaging correlation. Clin Radiol 2002;57:1109-1112.
161.
Elden H, Ostgaard HC, Fagevik-Olsen M, Ladfors L, Hagberg H: Treatments of pelvic girdle pain in pregnant women: adverse effects of standard treatment, acupuncture and stabilising exercises on the pregnancy, mother, delivery and the fetus/neonate. BMC Complement Altern Med 2008;8:34.
162.
Peterson CK, Mühlemann D, Humphreys B: Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1 year follow-up. Chiropr Man Therap 2014;22:15.
© 2017 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2017
You do not currently have access to this content.