PREGNANCY-RELATED PELVIC GIRDLE PAIN: DIAGNOSTIC CHALLENGES AND CONSERVATIVE MANAGEMENT OPTIONS

G. Di Giuseppe¹, I. Olivieri¹, C. Angeletti² | ¹Dip.to Anestesia, Terapia intensiva e Terapia del dolore, Ospedale Mazzini, Teramo, Italy; ²L'Aquila, Italy

Introduction. Pregnancy-related pelvic girdle pain (PRPGP) is a multifactorial musculoskeletal condition involving the sacroiliac joints and/or the pubic symphysis. It may coexist with low back pain (LBP) and is a significant source of pain, disability, and reduced quality of life during pregnancy. Although often perceived as a physiological consequence of pregnancy, PRPGP can significantly affect daily activities, mobility, sleep, and peripartum well-being. We aim to provide a clinically oriented overview of diagnostic challenges and available management strategies for PRPGP.
Methods. This work was developed as a narrative clinical overview based on selected relevant literature covering epidemiology, proposed mechanisms, risk factors, clinical presentation, diagnostic assessment, and treatment options for PRPGP. Attention was given to distinguishing PRPGP from LBP and to conservative, pharmacological, and complementary approaches applicable during pregnancy.
Results. Reported prevalence estimates vary widely, reflecting heterogeneous definitions, diagnostic criteria, and study designs. PRPGP usually develops during pregnancy and may persist into the postpartum period. Its pathophysiology remains incompletely understood and is likely multifactorial, involving biomechanical load redistribution, altered pelvic stability, hormonal influences, and individual vulnerability factors. Previous PGP and LBP are among the most consistently reported risk factors. Diagnosis is primarily clinical and relies on the location of pain, functional limitations and specific provocation tests. Clinical overlap with LBP may contribute to under-recognition or delayed diagnosis. Imaging is not routinely required but may be considered in severe, atypical, or persistent cases, particularly when pubic symphysis diastasis or alternative diagnoses are suspected. Management is primarily conservative and should be individualized. Education, activity modification, pelvic support belts, physiotherapy, and targeted exercise-based interventions may reduce pain and disability. Pharmacological treatment should be carefully tailored to gestational age, maternal comorbidities, pain severity, and fetal safety, with paracetamol generally considered the first-line analgesic. Invasive or surgical approaches have a limited role and should be reserved for selected non-PRPGP differential diagnoses or exceptionally severe cases.
Conclusions. PRPGP is a common yet often underestimated pain condition during pregnancy. A multidisciplinary, individualized approach is needed to improve recognition, reduce disability, and support maternal functioning. Current management remains limited by heterogeneity in diagnostic criteria and treatment protocols, as well as by the generally low quality of evidence supporting many interventions. Further well-designed studies are needed to clarify diagnostic pathways and define effective, safe, and pregnancy-specific treatment strategies. Greater clinical awareness may help avoid normalization of pain, delayed diagnosis, and unnecessary functional limitation during pregnancy.