Pelvic instability in pregnancy 

Pelvic instability is possibly related to an increase in the hormone relaxin which acts to create laxity in pelvic ligaments as the pelvic girdle adapts to an anticipated pregnancy.

There may be a relationship between the levels circulating levels of relaxin and pelvic instability, however conclusive evidence remains forthcoming

Most women do not notice symptoms until the later stages of the second trimester of pregnancy

Symptoms

• Sacral-iliac joints, lower lumbar spine and pubic pain
• Pelvic girdle pain
  • Pain between posterior iliac crest and gluteal fold
  • Can radiate to thighs and hips
  • classically: Pain with rolling over in bed, climbing stairs and getting out of the bath
• Imaging usually not helpful if typical
  • Can consider Xr or MRI

• Red flags
  • Pain without weightbearing/stimuli
  • Weight loss
  • Neurolgoical symptoms
  • Trauma
  • Vaginal bleeding
  • Fever
• Differentials not to miss
  • ransient osteoporosis of pregnancy
  • osteonecrosis of hip
  • pubic symphysis diastasis/rupture

Treatment

• Early referral to a physiotherapist specialising in women’s health
• Pelvic floor exercises
• No heavy lifting (this includes toddlers)
• Avoid climbing stairs
• Keep knees together:
  – when getting in and out of bed and the car
  – no breast stroke if swimming
• Consider strapping or belt
• Paracetamol predelivery
• Anti-inflammatories may be taken after delivery
• May benefit from a mobility device such as crutches or a walking frame
• Avoid prolonged legs apart positions during labour

• Usually recover within 3 months postpartum