Thesis, Université de Picardie.
Coccygodynia in general, and more particularly postpartum, is a clinical pathology overlooked by clinicians and the population, yet its clinical management is well documented. Treated mother could consider the care of the newborn more easily. There is a lack of data in the literature, so we decided to investigate coccygodynia in 56 cases.
Materials and Methods
56 women affected by coccygodynia immediately following childbirth were included in this study. The inclusion and follow-up period were from January 2006 and May 2011. The type of lesions (in particular dislocation), as well as potential risk factors have been analyzed and compared with a series of 51 non-obstetrical coccygodynies-suffering patients. We measured and documented the treatment efficacy.
51 patients had complete information concerning their mode of delivery and the resulting lesions. 50% of child-delivery were associated with dislocation 95% CI [0,37 ; 0,63] compared to 25% in the control group 95% CI [0,13 ; 0,37]. We observed hyper mobility in 20% of cases compared to 14% in the control group, rigid coccyx in 16% against 16.5% and normal flexions in 13% against 41%. No risk factors were statistically identified; however there was a trend towards parity, IMC and instrumented fetal extraction. The delivery with forceps represents 51% of the cases, highly superior to the national frequency. The pain evolution is similar to the coccygodynia of the control group.
This study indicates that there is a traumatic pathology of the coccyx following child delivery represented by the coccyx dislocation. The absence of data in the literature has unable us to compare our results. The study lacks power of magnitude to clearly state the delivery with forceps as a statistically significant risk factor. The traumatic aspect is however established. The type of fetal presentation was unknown. This information appears crucial for the prognostic. Following the current movement concerning the free choice of position during delivery could decrease the use of forceps by facilitating the intra-uterine movement. The standardization of obstetrical practice and the adequate formation of medical staff could prevent these obstetrical traumas.