Reflex sympathetic dystrophy in pregnancy: nine cases and a review of the literature

Objective: To better understand the diagnosis of reflex sympathetic dystrop hy of the lower extremities in pregnant women. Subject: Disease analysis us ing a retrospective series of nine cases and a review of the literature (57 patients and 159 sites of reflex sympathetic dystrophy). Results: This dis order should be considered in any painful pelvic girdle syndrome or lower e xtremity pain. The hip is involved in 88% of cases. Symptoms develop in the third trimester of pregnancy, between the 26th and the 34th weeks. Magneti c resonance imaging (MRI) provides an early, accurate, and very specific di agnosis, although standard radiography continues to be the first-line diagn ostic tool. Fracture occurs in 19% of patients. The etiology and pathophysi ology remain unclear, although pregnancy itself appears to play a significa nt role in this disease. Although locoregional mechanical factors partly ex plain reflex sympathetic dystrophy. Hypertriglyceridemia appears to be a ri sk factor. This disorder develops independently, but the conclusion of preg nancy appears to be necessary for cure. Reflex sympathetic dystrophy does n ot appear to affect the course of the pregnancy. Indications for cesarean d elivery remain obstetrical and should be discussed when a fracture is invol ved. Simple therapeutic management using gentle physical therapy provides r apid and complete recovery in 2-3 months. Conclusion: Reflex sympathetic dy strophy during pregnancy remains poorly understood and underestimated. Only joints of the inferior limbs are involved. MRI appears to be the best diag nostic tool. Pathogenesis remains unclear. Fractures are not rare. Treatmen t should be non-aggressive. (C) 1999 Elsevier Science Ireland Ltd. All righ ts reserved.