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Obstetrics & Gynecology 2008;111:839-846
© 2008 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

The Pfannenstiel Incision as a Source of Chronic Pain

Maarten J. Loos, MD1, Marc R. Scheltinga, MD, PhD1, Leon G. Mulders, MD, PhD2 and Rudi M. Roumen, MD, PhD1

From the Departments of 1General Surgery and 2Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands.

OBJECTIVE: To estimate prevalence, risk factors, and etiology of post-Pfannenstiel pain syndromes.

METHODS: All women (n=866) with a Pfannenstiel incision for cesarean delivery or abdominal hysterectomy performed between January 2003 and December 2004 received a questionnaire evaluating pain located in the Pfannenstiel region. A multivariate logistic regression analysis was done to determine predictors for chronic pain development. Patients with moderate or severe pain were interviewed and underwent a physical examination.

RESULTS: The response rate was 80% (690 of 866 patients). Subsequent to a follow-up after 2 years, one third (223 of 690) experienced chronic pain at the incision site. Moderate or severe pain was reported by 7%, and in 8.9% of respondents, pain impaired daily activities. Numbness, recurrent Pfannenstiel surgery, and emergency caesarean delivery were significant predictors of chronic pain. Nerve entrapment was present in over half the examined patients with moderate-to-severe pain (17 of 32).

CONCLUSION: Chronic pain occurs commonly after a Pfannenstiel incision. Nerve entrapment was found to be a frequent cause of moderate-to-severe pain.

LEVEL OF EVIDENCE: II




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