Prenatal & Postnatal Care

It is common enough to be ordinary. A systematic review of the prevalence research found that about 45% of pregnant women, and about 25% of women after pregnancy, have pregnancy-related pelvic girdle pain, pregnancy-related low back pain, or both — figures that fall by around 20% once mild complaints are excluded. Serious pain occurs in about 25% during pregnancy and severe disability in about 8%; after the birth, problems are serious in about 7%.^[1]

Common does not mean interchangeable. That review argues the two are distinct entities rather than one problem under two names, and counts roughly half of patients with pelvic girdle pain, a third with low back pain and a sixth with both at once. The European guideline puts the point prevalence of pelvic girdle pain in pregnancy at about 20% and describes it as a specific form of low back pain that can occur separately or alongside it.^{[1, 2]}

That guideline is also specific about what raises the risk and what does not. A history of previous low back pain and previous trauma to the pelvis are most probably risk factors. Contraceptive pills, the time since the last pregnancy, height, weight, smoking and — most probably — age are not.^[2]

By examination, not by imaging. The European guideline diagnoses pelvic girdle pain from pain provocation tests — the posterior pelvic pain provocation or thigh thrust test, Patrick’s FABER, Gaenslen’s test and a modified Trendelenburg — together with palpation of the long dorsal ligament and of the symphysis, and it recommends the active straight leg raise as the functional test.^[2]

It is equally specific about what it does not recommend: mobility or palpation tests of joint movement, X-rays, CT, scintigraphy, diagnostic injections and diagnostic external pelvic fixation. MRI has a defined place rather than a general one — to exclude ankylosing spondylitis, and where red flags are positive.^[2]

The months after the birth are the same conversation with a different clock on it. About a quarter of women postpartum still have pelvic girdle or low back pain, and in around 7% it is serious.^[1]