Pregnancy Related Pelvic Pain

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Search Strategy

In my research I utilized the following databases : pubmed, pedro, medscape and the catalogus of the library of the Vrije Universiteit Brussels . I used different search terms like pelvic girdle pain, pregnancy related pelvic girdle pain, pelvic pain, lumbopelvic pain, pelvic girdle pain stabilization and pelvic pain pregnancy physiotherapy.

Definition/Description

According to the European guidelines of Vleeming et al [1], pelvic girdle pain can be defined as the following:
“Pelvic girdle pain generally arises in relation to pregnancy, trauma, arthritis and osteoarthritis. Pain is experienced between the posterior iliac crest and the gluteal fold, particularly in the vicinity of thesacroiliac joints(SIJ). The pain may radiate in the posterior thigh and can also occur in conjunction with/or separately in the symphysis.”
According to literature, the prevalence of women who suffer from pelvic girdle pain during their pregnancy is about 20 %. [ 1,3,5,13]

Clinically Relevant Anatomy

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Epidemiology /Etiology

The exact underlying mechanisms, leading to the development of pelvic girdle pain in pregnancy, are uncertain or speculative. [1,3,4,5] Literature actually proposed different, etiologic hypotheses like mechanical, traumatic, hormonal, metabolic and degenerative factors. [3,4]
The combination of hormonal and biomechanical factors seems to be the most trustworthy hypothesis that can explain the development of pregnancy–related pelvic girdle pain. The optimal stabilization of the pelvis is absolutely essential, because the pelvis serves as a platform that must transfer the load from the trunk to the legs. First of all the stabilization is from major concern because it determines if the load will be effectively transmitted. Secondly an optimal stabilization of the pelvis guarantees that the shear forces will be minimized across the joints. The stabilization, which is acquired by three specific anatomic characteristics, is mainly needed at the sacro-iliac joints. In the articular surfaces of the sacro-iliac joints there are ridges and grooves who form the first part of stabilization. Secondly the sacrum has a wedge shape, which allows it to fit tightly between the ilia. Finally there are additional compression forces which are generated by the muscles, fascia and ligaments, that attach to the pelvis and act across the sacro-iliac joints to give the joints their stability. Women produce increased quantities of a polypeptide hormone, namely Relaxin, during their pregnancy. Consequently there is greater ligamental laxity, especially in the joints of the pelvis by relaxing the connective tissue. In pregnant women this leads to the widening and separation of the symphysis pubis. Mens et al.[7] has recently established in his systematic review that patients, who suffer from pelvic girdle pain, have increased motion in their pelvic joints compared with healthy pregnant controls.
The increased motion of the pelvic joints results in negative consequences namely : The efficiency of load transmission will be diminished. Furthermore the increase of motion will increase the shear forces across the joints. It’s possible that these increased shear forces are responsible for the pain in pregnant women with pelvic girdle pain. [1,4]
We can divide the patients who suffer from pelvic girdle pain into five subgroups depending on symptoms. [1,2,3,4,14]

1. Pelvic girdle syndrome : including symptoms of anterior and posterior pelvic girdle, symphysis pubis and bilateral joints
2. Symphysiolysis : including symptoms of the anterior pelvic girdle and pubic symphysis
3. One sided Sacroiliac syndrome : including symptoms of the posterior pelvic girdle and unilateral sacroiliac joint.
4. Double-sided Sacroiliac syndrome : including symptoms of the posterior pelvic girdle and bilateral sacroiliac joints
5. Miscellaneous : including inconsistent findings of the pelvic girdle.

The risk factors for the development of pregnancy–related pelvic girdle pain are :

• A previous history of low back pain [1,3,4,5,6]
• Previous trauma to the pelvis or back [1,3,6]
• Previous history of pelvic girdle pain [3,4,5]
• High-work load or strenuous work (twisting and bending the back several times per hour) [1,3,4,5]

There are also a few factors who do not influence the risk for development of pregnancy–related pelvic girdle pain like :

• The use of contraceptive pills [1,3,4,6]
• Time interval since last pregnancy [1,3,4,6]
• Height [1,4]
• Weight [1,4]
• Smoking [1,3,4]
• Age [1,3,4,6]
• Epidural / spinal anesthetic [3,4]
• Analgesic techniques [4]
• Bone density [3,5]
• Foetal weight [3]
• Number of previous pregnancies [3]
• Maternal ethnicity [3]
  
  

Characteristics/Clinical Presentation

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Differential Diagnosis

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Diagnostic Procedures

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Outcome Measures

Pelvic Girdle Questionnaire (PGQ)

Examination

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Medical Management

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Physical Therapy Management

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Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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