Clinical Practice Guidelines Antenatal Care — Module II
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- Incidence in pregnancy
- Factors influencing pelvic girdle pain
- Discussing pelvic girdle pain
- Advice on managing pelvic girdle pain
- Practice summary: pelvic girdle pain
- 7.12Resources
7.11Pelvic girdle painThe severity of pelvic girdle pain (symphysis pubis dysfunction) during pregnancy varies widely. Advice should be aimed towards minimising pain. BackgroundPelvic 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 (Kanakaris et al 2011). Pelvic girdle pain usually resolves spontaneously after the birth (Elden et al 2008), although symptoms may recur during subsequent pregnancies (Leadbetter et al 2004). Incidence in pregnancyThe true incidence of pelvic girdle pain in pregnancy is unknown and estimates from low-level evidence are contradictory, ranging from approximately 4% to 84% (Bastiaanssen et al 2005; Morgren & Pohjanen 2005; Robinson et al 2006; 2010). 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 (Gutke et al 2006; Leadbetter 2006; Van de Pol et al 2007; Robinson et al 2010; Kovacs et al 2012) and among women with a higher BMI (Kovacs et al 2012). There is currently no evidence regarding the incidence of pelvic pain in specific population groups.
pelvic pain is more common in women with a previous history of low back pain (Albert 2006; Bjelland et al 2010) or trauma of the back or pelvis (Albert 2006); and risk factors for developing pelvic pain include: increased number of previous pregnancies (Albert 2006; Bjelland et al 2010; Robinson et al 2010); physically demanding work (Morgren 2005; Bjelland et al 2010); high BMI (Albert 2006; Eberhard-Gran & Eskild 2008; Bjelland et al 2010); emotional distress (Bjelland et al 2010); and smoking (Albert 2006; Biering et al 2010). The evidence on age as a risk factor for pelvic pain in pregnancy is inconsistent (Eberhard-Gran & Eskild 2008; Bjelland et al 2010). Discussing pelvic girdle painSummary of the evidenceNICE (2008) 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. Treatments for pelvic painSystematic 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 (Pennick & Young 2007); acupuncture was more effective than standard treatment, physiotherapy, or stabilising exercises (Ee et al 2008); exercise, pelvic support garments and acupuncture improved functional outcomes (Richards et al 2012); and exercise during pregnancy may decrease pelvic girdle pain (Schiff Boissonnault et al 2012). RCTs have found benefits from a multimodal approach (manual therapy, stabilisation exercises, patient education) (George et al 2012) and no reduction of pain with exercise (Eggen et al 2012; Stafne et al 2012). Lower level evidence supports acupuncture as an effective intervention (Ekdahl & Petersson 2010). No serious adverse effects were reported (minor side effects included bruising, pain on needle insertion, bleeding, haematoma and fainting). Recommendation 18 Grade C Advise women experiencing pelvic girdle pain that pregnancy-specific exercises, physiotherapy, acupuncture or using a support garment may provide some pain relief.
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 getting in/out of cars, baths or squatting); and applying heat to painful areas.
7.12ResourcesCommon discomforts in pregnancy. In: Minymaku Kutju Tjukurpa Women’s Business Manual, 4th edition. Congress Alukura, Nganampa Health Council Inc and Centre for Remote Health. Directory: internet -> main -> publishing.nsf -> Content internet -> 3G300m-how to setup the 3g router Mode? Product line: 3g question categories: Function configurations Note internet -> Installation Work has never been simpler or easier Content -> Mbs review Taskforce Newsletter Message from the Chair Content -> National pathology accreditation advisory council Content -> National Framework for Action to Promote Eye Health and Content -> Review of the National Mental Health Commission Content -> Australia Ingredients Report Download 2.59 Mb. Share with your friends:
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