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Pelvic Girdle Pain (Pregnancy-Associated)

Pelvic Girdle Pain (Pregnancy-Associated) is a topic covered in the 5-Minute Clinical Consult.

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Basics

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)

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Citation

Stephens, Mark B., et al., editors. "Pelvic Girdle Pain (Pregnancy-Associated)." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816092/all/Pelvic_Girdle_Pain__Pregnancy_Associated_.
Pelvic Girdle Pain (Pregnancy-Associated). In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816092/all/Pelvic_Girdle_Pain__Pregnancy_Associated_. Accessed May 22, 2019.
Pelvic Girdle Pain (Pregnancy-Associated). (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816092/all/Pelvic_Girdle_Pain__Pregnancy_Associated_
Pelvic Girdle Pain (Pregnancy-Associated) [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 May 22]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816092/all/Pelvic_Girdle_Pain__Pregnancy_Associated_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Pelvic Girdle Pain (Pregnancy-Associated) ID - 816092 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816092/all/Pelvic_Girdle_Pain__Pregnancy_Associated_ PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -