Pelvic Pain in Mid and Late Pregnancy

Patient may experience difficulty with walking, standing, going down stairs, turning in bed, and, in severe cases, immobility.

 Pathophysiology:

By the influence of relaxin and progesterone, the fibrocartilaginous symphysis pubic joint relaxes by 2-3 mm in normal pregnancy to widen the pelvis before delivery. If this is increased, it causes pelvic girdle instability and pain.

 Examination shows:

• Tenderness over symphysis pubis and sacroiliac joints.
• Reduced hip movement range.

 Management:

• Consult an obstetric physiotherapist for advice on posture and gentle exercises.
• Pelvic support.
• Paracetamol and Codeine.
• Crutches, walking frame, or wheelchairs in severe cases.
• Avoid heavy lifting and prolonged standing.
• When getting out of the car or turning in bed, avoid hip abduction by keeping knees together.
• During labor, avoid leg separation and excessive hip abduction.

 Symptoms are usually resolved postpartum with high probability of recurrence in subsequent pregnancies.