SYMPTOM-GIVING PELVIC GIRDLE RELAXATION OF PREGNANCY, POSTNATAL PELVIC JOINT SYNDROME AND DEVELOPMENTAL DYSPLASIA OF THE HIP

Objectives. To describe the clinical characteristics and outcomes of a large group of women with symptom-giving pelvic girdle relaxation of pregnancy and postnatal pelvic joint syndrome. To determine if there i s an increased incidence of developmental dysplasia of the hip in the children of women with such pelvic problems. Methods. A postal survey of 1,609 Norwegian women registered as having pregnancy-initiated pelv ic joint pain. The response rate was 79% and from the answers 1,115 wo men were defined as having had symptom-giving pelvic joint syndrome of pregnancy and/or postnatal pelvic joint syndrome. Results. Pelvic pai ns began in the first pregnancy in 74% of the respondents usually begi nning in the first trimester. Pelvic pain worsened with subsequent pre gnancies and persisted for a mean of 6.25 years, often causing major i ncapacity and lifestyle changes. Rest and physical supports brought te mporary relief only. Sacroiliac joints and the symphysis pubis were th e commonest sites of pain but peripheral joints were also often affect ed. There was a strong family history of both pelvic joint syndrome an d developmental dysplasia of the hip. The incidence of hip dysplasia i n the children of women surveyed was 45/1,000 which is 5 times the Nor wegian incidence. Conclusion. Pelvic joint syndrome nearly always foll ows pelvic girdle relaxation of pregnancy and may have prolonged debil itating effects which do not respond long term to current therapies. T he incidence of developmental dysplasia of the hip in the children of these women was high. A genetic susceptibility to joint dysfunction in both mother and fetus, possibly due to an aberration of relaxin physi ology, is surmized. Identification of possible relaxin receptor change s in affected joints is a hypothesis worthy of testing with a view to the design of selective relaxin receptor modulators in pregnancy.