The severity of pelvic girdle pain (symphysis pubis dysfunction) during pregnancy varies widely. Advice should be aimed towards minimising pain.
Pelvic girdle pain has been described as a collection of signs and symptoms of discomfort and pain in the pelvis and lower back (lumbopelvic) area, including musculoskeletal pain radiating to the upper thighs and perineum. Symptoms occur due to relaxation of the pelvic ligament and increased joint mobility in pregnancy. Symptoms vary from mild discomfort to severe and debilitating pain that can hinder mobility. Other causes of pain in the pelvic area (eg urinary tract infection, preterm labour) should be excluded. Pelvic girdle pain usually resolves spontaneously after the birth , although symptoms may recur during subsequent pregnancies .
59.1.1 Incidence in pregnancy
- The true incidence of pelvic girdle pain in pregnancy is unknown and estimates from low-level evidence are contradictory, ranging from approximately 4% to 84% . The wide variation can be attributed to various factors including the absence of a precise definition and diagnostic criteria, differences in study design and selection of the study population.
- The incidence of pelvic girdle pain has been found to be higher in late pregnancy BMI . and among women with a higher
- There is currently no evidence regarding the incidence of pelvic pain in specific population groups.
59.1.2 Factors influencing pelvic girdle pain
Low-level evidence indicates that:
- pelvic pain is more common in women with a previous history of low back pain or trauma of the back or pelvis
- risk factors for developing pelvic pain include: increased number of previous pregnancies BMI ; emotional distress smoking . ; physically demanding work ; high
The evidence on age as a risk factor for pelvic pain in pregnancy is inconsistent.
59.2 Discussing pelvic girdle pain
found little evidence on which to base clinical practice. Subsequent evidence is limited by the heterogeneity and low quality of studies and the inconsistency of findings.
59.2.1 Treatments for pelvic pain
Systematic reviews into interventions for women with pelvic girdle pain have found low-level evidence:
- women receiving acupuncture or physiotherapy reported less intense pain in the morning or evening than women receiving usual antenatal care and acupuncture was more effective in reducing evening pain than physiotherapy
- acupuncture was more effective than standard treatment, physiotherapy, or stabilising exercises
- exercise, pelvic support garments and acupuncture improved functional outcomes
- exercise during pregnancy may decrease pelvic girdle pain .
RCTs have found benefits from a multimodal approach (manual therapy, stabilisation exercises, patient education)and no reduction of pain with exercise .
Lower level evidence supports acupuncture as an effective intervention. No serious adverse effects were reported (minor side effects included bruising, pain on needle insertion, bleeding, haematoma and fainting).
Advise women experiencing pelvic girdle pain that pregnancy-specific exercises, physiotherapy, acupuncture or using a support garment may provide some pain relief.
Approved by NHMRC in June 2014; expires June 2019
59.2.2 Advice on managing pelvic girdle pain
There is consensus from low-level evidence and clinical reviews about providing advice on minimising pain, including:
- wearing low-heeled shoes
- seeking advice from a physiotherapist regarding exercise and posture
- reducing non-essential weight-bearing activities (eg climbing stairs, standing/walking for long periods of time)
- avoiding standing on one leg (eg by sitting down to get dressed)
- avoiding movements involving hip abduction (eg taking care getting in/out of cars, baths or squatting)
- applying heat to painful areas.
59.3 Practice summary: pelvic girdle pain
A woman has pelvic girdle pain.
- Aboriginal and Torres Strait Islander Health Practitioner
- Aboriginal and Torres Strait Islander Health Worker
- multicultural health worker
- Provide advice
Reassure the woman that pelvic girdle pain will not harm her or her unborn child, and is likely to resolve after the birth. Advise the woman about steps she can take to minimise pain.
- Take a holistic approach
Consider possible barriers to women being able to make changes to minimise their pain (eg work requirements, cultural attitudes to exercise, costs of allied health services).
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