Pelvic Girdle Pain, Pregnancy-Associated
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- 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
45% of all pregnant women; 25% of all postpartum women suffer from PGP, although likely underreported.
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 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
- Not a risk factor with consistent findings
- Oral contraceptive pills
- Interval between pregnancies (1)