Does Hypermobility Affect Pregnancy?

Yes, Hypermobility affects pregnancy. Miscarriage, ectopic pregnancies (pregnancy outside the uterus), and preterm birth have all been documented as pregnancy-related problems in hypermobility individuals. Hypermobile individuals are more likely to have a preterm delivery or a late abortion. Breast alterations are frequent as a result of pregnancy-related hormonal changes. As a result, women with hypermobility may need additional breast support to control breast changes and avoid damage from stretched skin.(1)

The following are some of the most often documented post-partum problems in hypermobility patients:

• A rupture of the intestinal wall or a blood vessel
• Delayed wound healing
• There is a decrease in muscular tone in the uterus (uterine atony).
• Pelvic organ prolapse as a result of weakened muscles
• A lot of bruising
• A tailbone misalignment
• Vein thrombosis in the deep veins
• Musculoskeletal system problems

Hypermobility Affect the Pregnancy By Muskuloskeletal  Issues:

During pregnancy, joint laxity increases, making existing issues worse and causing new joint aches and instability. Some women, on the other hand, claim to feel considerably better when pregnant. Low back and pelvic discomfort are typical pregnancy symptoms. Hypermobility is one of many variables linked to the development of lower back pain. Pelvic discomfort in pregnancy may be caused by increased sacroiliac joint instability.

Hypermobilities are also susceptible to pubic symphysis dysfunction. Pain in the midline of the groin that radiates to the lower abdomen and hips is a common symptom. Walking and weight-bearing may be very uncomfortable if the pelvis feels unstable. Those with pelvic girdle discomfort can benefit from delivery positions that do not require laying on their backs, so make sure their hips and legs are supported.(2)

Hypermobility Affect On Muscles during Pregnancy:

For certain hypermobile people, the daily lifting and handling of a baby may cause difficulties. Women often claim that whatever discomfort they had during pregnancy has vanished after birth. Nonetheless, if a mother is still suffering from discomfort, muscular weakness, or subluxations/dislocations, especially in her arms, breastfeeding and caring for her newborn infant may be more challenging.(3)

However, there are a few things to keep in mind when pregnant.

• The amount of discomfort experienced during pregnancy may increase, particularly in the case of spinal and joint pain.
• There’s a chance you’ll have faster labor.
• There is no definitive indication for Caesarean section; the benefits and risks must be clinically assessed, taking wound healing and bleeding concerns into account.
• If you have an episiotomy or a tear, epidural anesthesia or other local analgesics may be ineffective due to potential resistance to the effects of local anesthetics.
• Any rip or episiotomy wound may take a long time or never heal at all.
• Any necessary surgery must consider the potential impact on recovery.
• You may find feeding and care for the infant more difficult and exhausting than others.
• It’s critical to ensure that all postnatal exercises are done with more caution, taking into account any specific needs, but pelvic floor exercises are especially essential for preventing issues like uterine prolapse later in life.
• Hypermobility is a genetic disorder. This does not guarantee that the kid will develop symptoms throughout childhood or later in life.

Hypermobility Affect on Chronic Back Pain:

Patients who suffer from chronic pain often claim that their problems began during pregnancy. During pregnancy, patients’ joints should also be considered vulnerable. While it is normal to gain weight during pregnancy, patients should avoid gaining too much weight so that their joints are not overworked.

When you think of pregnancy, as your baby becomes larger and bigger, your belly button gets bigger and bigger, and your lower back curve begins to expand. So, if you consider someone who has hypermobile joints, the strain on those joints will increase as the curve widens, as your baby develops, and your bump expands. When this occurs, the muscles surrounding your back and pelvis often spasm in an attempt to protect your back, and this may result in back pain.(4)

Hypermobility Resist to Local Anesthesia that links to analgesia for labor during pregnancy:

Many individuals with Joint Hypermobility seem to be resistant to local anesthetics, whether in the form of topical creams or injections. When compared to individuals without hypermobility, hypermobility patients were three times more likely to report inadequate local anesthetic efficacy in a large study. This may imply that epidural analgesia for labor is used in an obstetric context.

Hypermobility Affect Cesarean delivery due to anesthesia resistance:

If utilized for operative delivery, it is inadequate or ineffective (instrumental or cesarean delivery), it may be insufficient. A formalized paraphrase. The use of a spinal anesthetic may be more reliable, although this will depend on the situation. Depending on the individual. Using an epidural to prepare a woman for labor. They will need a significant deal of care to avoid unintended consequences. Joint subluxation is a condition in which one or more joints are out of alignment. The administration of anesthesia in the context of surgical intervention is common practice.

Analgesia may be difficult to achieve, particularly if nerve blocks are used. For post-operative discomfort, catheters or epidural analgesia are suggested relief. The patient should be fully informed about this; else, the post will be deleted.-operative experience may be dissatisfying. If there is a consciousness, Alternatives to local anesthetics should be considered because of the possibility of local anesthetic resistance. Patient-controlled analgesia (PCA), for example, is one kind of analgesia.be started early or as a follow-up treatment. There is a known link between dysautonomia and these individuals. When these women are pregnant, extreme caution should be used in an obstetric environment. In certain cases, the Valsalva reaction may be significantly exaggerated. This may also result in an excessive drop in blood pressure. while you’re under regional or global anesthetic. Choosing whether to allow for joint hypermobility syndrome or not to allow for joint hypermobility syndrome difference between vaginal birth and a cesarean procedure may be significant.

Hypermobility Cause the Genital Perineal Trauma:

Genital Perineal trauma may occur during delivery due to a variety of factors. Whether it’s a spontaneous or instrumental delivery, the choice is yours. Tissue tears and large tears. Fistulas and sphincter dysfunction have been reported as a result of the disturbance described. (5)

Hypermobility raises the chances of impaired wound repair during pregnancy and after a Cesarean section:

There is a substantial rise in the likelihood of post-traumatic stress disorder (PTSD). Partum hemorrhage, and any other circumstances that may result in a major obstetrical emergency. Placental abruption or placenta praevia may aggravate bleeding as a result of connective tissue laxity. An understanding of the specific difficulties that individuals with joint disease face. As well as the broader population of individuals that suffer from it, connective tissue problems, health practitioners will be able to work more efficiently. It is difficult to have a fair conversation with a patient in an obstetric or peri-operative

Hypermobile women were less likely to need a cesarean after full labor (e.g., after dilation of the cervix to 10cm). They were also less likely to have a vaginal delivery during surgery (forceps or vacuum birth).(6)

Hypermobility is linked with hormones and affect during Pregnancy:

Hormones linked to hypermobility play a unique role during pregnancy. Relaxin relaxes the ligaments shortly before delivery, allowing the pelvis to expand wide enough for the fetal head to pass through safely. Although it has been noted that joint laxity increases during pregnancy, research has yet to show a clear link between relaxin levels and the degree of laxity. Other variables must be taken into account. Oestrogens and progestogens increase in concentration during pregnancy, which may explain the loosening of the joints. This usually goes away shortly after delivery, although it may last longer if the mother is nursing. Relaxin is a hormone generated during pregnancy and allows your body to adjust to keep the pregnancy going. When you add relaxin to an already ‘over mobile’ joint, the consequence may be discomfort, most often in the pelvis, since here is where your body takes all of the extra strain.(7)

Hypermobility Affect on gynecological issues:

Due to injury to the connective tissue that supports the reproductive organs, women with hypermobility have a greater incidence of gynecological issues. Depending on the kind of hypermobility, the severity of the consequences may vary. Menorrhagia (heavy menstrual bleeding) and bleeding between menstruations are two of the most often reported gynecological problems.(3)

• Dysmenorrhea (menstrual cramps) (severe dysmenorrhea)
• Dyspareunia despair (painful sex)
• Agonizing pelvic pain

Females whose hypermobility deteriorates during menstruation frequently notice that if their periods become irregular for whatever reason, their joints not only deteriorate but deteriorate for longer. This may be because progesterone is present in large quantities in these individuals at periods when it would not usually be present. Period irregularities may indicate gynecological issues such as an ovarian cyst or endometriosis.

Hypermobility causes the uterine rupture during Pregnancy:

Bleeding issues are prevalent in the vascular form of hypermobility and are caused by blood vessel and organ tearing (rupture). These issues may result in easy bruising, internal bleeding, a hole in the gut wall (intestinal perforation), or a stroke. Women with vascular hypermobility may suffer a uterine rupture during pregnancy.

References:

1. Sundelin HE, Stephansson O, Johansson K, Ludvigsson JF. Pregnancy outcome in joint hypermobility syndrome and Ehlers-Danlos syndrome. Acta Obstet Gynecol Scand. 2017;96(1):114-9.
2. Wolf JM, Cameron KL, Owens BD. Impact of joint laxity and hypermobility on the musculoskeletal system. J Am Acad Orthop Surg. 2011;19(8):463-71.
3. Knoepp LR, McDermott KC, Muñoz A, Blomquist JL, Handa VL. Joint hypermobility, obstetrical outcomes, and pelvic floor disorders. Int Urogynecol J. 2013;24(5):735-40.
4. Kumar B, Lenert P. Joint Hypermobility Syndrome: Recognizing a Commonly Overlooked Cause of Chronic Pain. Am J Med. 2017;130(6):640-7.
5. Dietz HP, Alcoba ME, Friedman T, Subramaniam N. Is perineal hypermobility an independent predictor of obstructive defecation? Int Urogynecol J. 2021;32(9):2377-81.
6. Ahlqvist K, Bjelland EK, Pingel R, Schlager A, Nilsson-Wikmar L, Kristiansson P. The Association of Self-Reported Generalized Joint Hypermobility with pelvic girdle pain during pregnancy: a retrospective cohort study. BMC Musculoskelet Disord. 2020;21(1):474.
7. Cherni Y, Desseauve D, Decatoire A, Veit-Rubinc N, Begon M, Pierre F, et al. Evaluation of ligament laxity during pregnancy. J Gynecol Obstet Hum Reprod. 2019;48(5):351-7.