Pelvic Girdle Pain (Pregnancy-Associated)

Description

• Persistent musculoskeletal pain localized from the level of the posterior iliac crest and gluteal fold over the anterior and posterior elements of the bony pelvis
• May radiate across hip joint and thigh bones
• Usually starts around the 18th week of pregnancy; can start in 1st trimester or present as late as 3 weeks postpartum
• Pelvic girdle pain (PGP) is a separate entity from pregnancy-related lower back pain.
• Synonyms: pelvic arthropathy; osteitis pubis; pelvic insufficiency; pelvic instability; pelvic relaxation pain; pelvic girdle relaxation; posterior pelvic pain; pregnancy-related PGP (PPGP); symphysis pubis dysfunction; lumbopelvic pain; peripartum pelvic pain; pelvic girdle syndrome

Epidemiology

Incidence
45% of all pregnant women; 25% of all postpartum women suffer from PGP, although likely underreported.

Prevalence
4–76%; wide range may be based on varying criteria and designs of studies.

Etiology and Pathophysiology

Generally agreed up pathophysiology hypothesis involves both hormonal and biomechanical factors.

• Increased amounts of relaxin produced by the corpus luteum and uterine decidua during pregnancy
• Relaxin acts on connective tissue, leading to greater ligament laxity especially in joints of the pelvis that normally serve to provide pelvic stability.
• Increased laxity causes widening and separation of the symphysis pubis as well as sacroiliac joints.
• Increased motion in pelvic joints decreases efficiency of load bearing and increases shearing forces across the joints.

Risk Factors

• Risk factors with consistent findings
  • History of low back pain
  • Previous PGP
  • Previous trauma to the pelvis
  • Progesterone intrauterine device (1)
• Probable risk factors with inconsistent findings
  • Increased workload
  • Physically demanding job
  • Pluripara
  • Parity
  • Increased BMI
  • Stress (1)
  • Operative delivery (2)
• Not a risk factor with consistent findings
  • Smoking
  • Oral contraceptive pills
  • Age
  • Interval between pregnancies (1)