Childbearing with Hypermobile Ehlers–Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications
Abstract
:1. Introduction
2. Materials and Methods
3. Results
Pregnancy and Birth Outcomes and Complications
Complications/Outcomes | Pregnancies in Third Trimester (N = 1209) 1 | Percentage of Pregnancies (95% Confidence Intervals) | Published Population Incidence |
---|---|---|---|
Hyperemesis Gravidarum | 308 | 25.48% (23.04–28.03) | 3% [46] |
Antepartum Haemorrhage | 104 | 8.60% (7.08–10.33) | 3–5% [47] |
Pre-term Rupture of Membranes | 85 | 7.03% (5.65–8.62) | <3% [48] |
Pre-eclampsia | 115 | 9.51% (7.92–11.31) | 2.4% [49] |
Eclampsia | 17 | 1.41% (0.82–2.24) | 0.027% [50] |
Preterm birth < 37 weeks (singleton) | 155/1185 | 13.08% (11.21–15.13) | 6.2% [51] |
Preterm birth < 37 weeks (twin) | 35/46 | 76.09% (61.23–87.41) | 50% [51] |
Preterm birth < 37 weeks (all) | 190/1230 | 15.45% (13.47–17.59) | 7.8% [51] |
Stillbirth ≥ 24 weeks (singleton) | 6/1185 | 0.51% (0.19–1.10) | 0.4% [51] |
Stillbirth ≥ 24 weeks (twin) | 1/46 | 2.1% (0.05–11.5) | 2.3% [51] |
Stillbirth ≥ 24 weeks (all) | 7/1230 | 0.57% (0.23–1.17) | 0.48% [51] |
Abnormal foetal presentation | 338 | 27.96% (25.44–30.58) | N/A |
Precipitate labour (<3 h) | 357/1041 | 34.29% (31.41–37.27) | 0.07–14% [39,40] |
Born before arrival at intended place of birth | 23 | 1.90% (1.21–2.84) | 0.4% [52] |
Caesarean section | 363 | 30.02% (27.45–32.70) | 27.6% [53] |
Shoulder dystocia | 52/847 | 6.14% (4.62–7.97) | 0.18% [54] |
1st degree perineal tear | 170/847 | 20.07% (17.42–22.93) | N/A |
2nd degree perineal tear | 303/847 | 35.77% (32.54–39.11) | N/A |
3rd degree perineal tear | 72/847 | 8.50% (6.71–10.59) | N/A |
4th degree perineal tear | 17/847 | 2.01% (1.17–3.19) | N/A |
Intrapartum haemorrhage | 173 | 14.31% (12.38–16.41) | N/A |
Postpartum haemorrhage | 249 | 20.60% (18.35–22.99) | 6.38% [55] |
Ineffective pain relief | 517 | 42.76% (39.95–45.61) | N/A |
Ineffective epidural | 284 | 23.49% (21.13–25.98) | 8–23% [56] |
Ineffective local injection | 192 | 15.88% (13.86–18.07) | N/A |
Caesarean wound infection | 87/363 | 23.97% (19.67–28.70) | 3–15% [57] |
Vaginal wound infection | 61/847 | 7.20% (5.55–9.16) | N/A |
Wound dehiscence | 132 | 10.92% (9.22–12.81) | N/A |
Slow healing | 487 | 40.28% (37.50–43.11) | N/A |
Pelvic organ prolapse | 149 | 12.32% (10.52–14.31) | N/A |
Postpartum psychosis | 57 | 4.71% (3.59–6.07) | 0.089–0.26% [58] |
Post Traumatic Stress Disorder | 227 | 18.78% (16.61–21.09) | 4% [59] |
Other | 87 | 7.20% (5.80–8.80) | N/A |
None | 71 | 5.87% (4.61–7.35) | N/A |
- (1)
- Joints moving out of place and pain: “hip dislocation in labour”, “sporadic pelvic displacement, wheelchair from 5 months until 2 weeks after”, “widespread post-partum joint pain and weakness”, “hip subluxation from stirrups (wasn’t aware of hypermobility)”, “severe looseness of shoulders and hips”, “pain, pain, pain”, “pelvic separation leading to bad post-partum pain”, “abdominal divarication, torn ligaments, stretched ligaments, pubis symphysis”; “Pubic Bone Separated at 20 weeks gestation”, “subluxed hips”, “costochondritis as baby moved from under ribs—misdiagnosed as indigestion at the time (EDS not diagnosed at that time)”, “pelvic displacement”, “SI [sacroiliac] joint issues, headaches” and “induced labour caused hip dislocations”.
- (2)
- Issues from epidural anaesthesia: “CSF [cerebral spinal fluid] leak”, “post-dural puncture headache from a ‘technically difficult’ epidural (x3) requiring a blood patch [sic]”, “CSF leak from epidural and have continued pain there since”, “extreme hypotension from epidural”; “hypotension with epidural. Prolonged effects of epidural”, and three people said “broken” or “dislocated coccyx”.
- (3)
- Bruising, tearing and poor wound healing: “very significant bruising”, “bruising on the baby from fast birth”, “site of vaginal tear never fully healed”, “previous Caesarean scar ruptured during this labour”; “polyps in birth canal from tearing”, “torn hip labrum from long labour” and “bilateral femoral nerve damage and bilateral hip labral tears”.
- (4)
- Blood pressure and syncope issues: “blood pressure dropped severely (PoTS) [Postural (orthostatic) Tachycardia Syndrome]”, “tachycardia”, “syncope several hours following birth”, “low blood pressure” and “high blood pressure after delivery”.
- (5)
- Infections and unexplained allergic reactions: “unexplained anaphylaxis 7 days and 8 days postpartum respectively [sic]”, “chorioamnionitis”, “systemic infection”, “baby born with group B strep”, “infection due to time between waters breaking and giving birth”, “bladder infection”, and four people said “uterine infection”.
4. Discussion
Strengths, Limitations and Implications
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Pearce, G.; Bell, L.; Pezaro, S.; Reinhold, E. Childbearing with Hypermobile Ehlers–Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications. Int. J. Environ. Res. Public Health 2023, 20, 6957. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20206957
Pearce G, Bell L, Pezaro S, Reinhold E. Childbearing with Hypermobile Ehlers–Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications. International Journal of Environmental Research and Public Health. 2023; 20(20):6957. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20206957
Chicago/Turabian StylePearce, Gemma, Lauren Bell, Sally Pezaro, and Emma Reinhold. 2023. "Childbearing with Hypermobile Ehlers–Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications" International Journal of Environmental Research and Public Health 20, no. 20: 6957. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20206957