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Pelvic Pain During Pregnancy: A Descriptive Study of Signs and Symptoms of 870 Patients in Primary Care

Röst, Cecile C. M., PT, MT*; Jacqueline, J, MSc*; Kaiser, A, PT, MT, PhD; Verhagen, Arianne P., PhD; Koes, Bart W., PhD

doi: 10.1097/01.brs.0000145416.22782.9f
Health Services Research

Study Design. The authors conducted a cross-sectional analysis.

Objective. The objective of this study was to describe the signs and symptoms of pregnant women with pain and dysfunction in the pelvic area.

Summary of Background Data. Pelvic pain during pregnancy is common with incidence rates of 48% to 56%. The exact cause of pelvic pain during pregnancy is still unclear. Also unclear is the association between physical examination and the occurrence of pelvic pain during pregnancy.

Methods. Pregnant women with pelvic pain were sent for treatment to 2 physical therapy practices between January 1997 and January 2002. A standardized clinical examination protocol and an extensive questionnaire were used to obtain relevant clinical and demographic characteristics.

Results. In total, 870 women were included. The average score of the overall severity of the complaints was 7.8 (scale 0–15). Main complaints were located around the sacroiliac joints (76.6%) and the pubic symphysis (57.2%). The area of pain was not related to positive signs in passive hip movements and sacroiliac tests. The highest positive test results were found for Patrick sign (71.7%), active straight leg raise (ASLR) test (66.4%), resisted adduction (54.4%), and passive hip abduction (36.9%). Overall severity of complaints was related to age, number of weeks pregnant, passive hip flexion and internal rotation, and swimming. The total explained variance of these factors was 15.9%. No relationship was found between overall complaints and sacroiliac tests, pelvic pain during a previous pregnancy, extremely painful or type of previous deliveries.

Conclusions. Pregnant patients with pelvic pain show a considerable level of complaints. The overall severity of complaints is not related to previous peripartum pelvic pain or type of deliveries or to commonly used tests. Further study on the role of clinical examination, including passive flexion and internal rotation of the hip joints, is recommended.

This study concerns a cross-sectional analysis to describe the signs and symptoms of pregnant women with pain and dysfunction in the pelvic area. A standardized examination protocol and an extensive questionnaire were used. The overall severity of complaints is related to age, duration of pregnancy, passive hip flexion and internal rotation, and swimming; previous peripartum pelvic pain and type of previous deliveries are not related.

From the *Practice for Physiotherapy, Oegstgeest, The Netherlands; and †Erasmus Medical Center University, Rotterdam, The Netherlands.

Acknowledgment date: September 5, 2004. First revision date: December 18, 2003. Acceptance date: January 12, 2004.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Foundation funds were received to support this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Arianne P. Verhagen, Department of General Practice, Room Ff 318, Erasmus MC, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands; E-mail:

© 2004 Lippincott Williams & Wilkins, Inc.