Pelvic Girdle Pain in the Antepartum Population

Publication Date: May 1, 2017

Recommendations

Risk Factors

Clinicians should utilize the following risk factors: prior history of pregnancy, orthopedic dysfunctions, increased body mass index (BMI), smoking, as well as work dissatisfaction and a lack of belief of improvement in the prognosis of pelvic girdle pain (PGP). (A)
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Postural Changes

Clinicians should not consider postural changes as indicative of the development and/or intensity of PGP in the antepartum population. (B)
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Clinical Course

Clinicians should (consider) treat patients with early onset, multiple pain locations, a high number of positive pelvic pain provocation tests (PPPTs), work dissatisfaction, and lack of belief of improvement, as these are strong/moderate factors in determining the potential for persisting PGP in late pregnancy and postpartum. ()
(A/B)
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Diagnosis/Classification

Clinicians may consider the utilization of the classification system for the diagnosis of the type of PGP in antepartum population. (B)
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Differential Diagnosis

PGP, in this population, should be differentiated from signs and symptoms of serious disease and psychological factors when the symptoms are not associated with the described clinical course of PGP, impairments are failing to normalize, and the symptoms are worsening with increased disability. This should include the presence of transient osteoporosis and diastasis rectus abdominis (DRA) as possible comorbidities in this population, as well as the presence of pelvic floor muscle, hip, and lumbar spine dysfunctions. (A)
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Imaging Studies

In the absence of good evidence, expert opinion and foundation science may be used to guide examination with the use of imaging studies. (F)
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Examination—Outcome Measures

Clinicians should administer self-reported outcome questionnaires such as Disability Rating Index (DRI), Oswestry Disability Index (ODI), Pelvic Girdle Questionnaire (PGQ), Fear-Avoidance Beliefs Questionnaire (FABQ), and Pain Catastrophizing Scale (PCS). These scales are practical for the determination of baseline disability, function, and pain belief, as well as change throughout the clinical course. These should be utilized in combination with clinical examination for clinical decision. (A)
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Examination—Activity Limitation and Participation Restriction Measures

While strong evidence exists to support a high risk of falls, no measures have been validated to objectively assess the dynamic balance and fall risk in antepartum population. (E)
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Intervention—Support Belts

Clinicians should consider the application of a support belt in the antepartum population with PGP. The 4 studies reviewed investigated different patient populations and had varied intervention groups and controls, different durations of intervention application, and different timing of follow-up. Further research is needed to clarify initial application, duration, and specific antepartum PGP patient classification for support belt intervention. (D)
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Intervention—Exercise

Clinicians should consider the use of exercise in the antepartum population with PGP. The American College of Obstetrics and Gynecologists (ACOG) and the Canadian Clinical Practice Guidelines (CPGs) have recommended exercise for health benefits because of the low risk and minimal adverse effects for the antepartum population. The 2 systematic reviews as well as the recent randomized controlled trials (RCTs) were nonspecific in the application of exercise to heterogeneous groups of pregnancy low back pain (PLBP) and PGP. The populations varied in early and late pregnancy and demonstrated a variety of exercise interventions. (D)
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Intervention—Manual Therapy

Clinicians may or may not utilize manual therapy techniques including high-velocity, low-amplitude manipulations for the treatment of PBLP and PGP. This evidence is emerging and treatment could be considered, as there is little to no reported evidence of adverse effects in the healthy antepartum population. (C)
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Recommendation Grading

Disclaimer

Overview

Title

Pelvic Girdle Pain in the Antepartum Population

Authoring Organization

Publication Month/Year

May 1, 2017

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Target Patient Population

Pregnant women experiencing pelvic girdle pain

Inclusion Criteria

Female, Adult

Health Care Settings

Ambulatory, Home health, Hospital, Outpatient

Intended Users

Physical therapist, occupational therapist, nurse midwife, nurse, nurse practitioner, physician, physician assistant

Scope

Counseling, Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D059388 - Pelvic Girdle Pain

Keywords

physical therapy, antepartum, pelvic girdle pain

Source Citation

Clinton, Susan C. PT, DScPT, OCS, WCS, FAAOMPT1; Newell, Alaina PT, DPT, WCS, CLT-LANA2; Downey, Patricia A. PT, PhD, DPT3; Ferreira, Kimberly PT, PhD, MSPT4 Pelvic Girdle Pain in the Antepartum Population: Physical Therapy Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Section on Women's Health and the Orthopaedic Section of the American Physical Therapy Association, Journal of Women's Health Physical Therapy: May 2017 - Volume 41 - Issue 2 - p 102-125 doi: 10.1097/JWH.0000000000000081