1. Pelvicarthropathy andpuerperalskeletalchangesPresented By NAMES COMPUTER NUMBER Getrude Banda 220300045 Watson Kakonya 25004841 Sharon Mambwe Ngulube 25005049 Ngoni Mpande 2303008799 Pezo Malesu 25005719 RabeccaKabinda 230300821 Bertha BupeMusonda 25002014 John Soko 220600064 KapembwaNtembula 230300764 10. Royd Kabole 25003278

2. INTRODUCTION Pelvic arthropathy refers to a range of disorders affecting the pelvic region, particularly involving the joints and surrounding structures. This condition can have significant implications for women, particularly during and after pregnancy. Onset usually occurs by 17 to 19 weeks gestation and peaks by 24 to 36 weeks.Some women have persisting pain 1 to 3 months post delivery and may last up to 2 years post delivery. .

3. Puerperal skeletal changes refer to the physiological and anatomical transitions the maternal skeleton and its supporting structures undergoe during puerperium. Understanding these changes is crucial for providing effective care and management for woman experiencing pelvic pain or dysfunction r elated to arthropathy in the context of pregnancy and postpartum recovery

4. PELVIC ARTHROPATHY Definition Pelvic arthropathy (or arthropathy of the pelvis) is a musculoskeletal condition characterized by excessive relaxation or instability of the joints of the pelvic girdle specifically the sacroiliac (SI) joints and the pubic symphysis. It involves the degeneration of cartilage, inflammation, or structural impairment of the ligaments supporting these joints, leading to instability, pain, and reduced mobility.

5. Types of Pelvic Arthropathy • Pelvic arthropathies are generally classified by their cause, ranging from pregnancy-related changes to chronic degeneration. • Pelvic Girdle Pain (PGP) / Symphysis Pubis Dysfunction (SPD): This is a common form of pregnancy-related arthropathy caused by excessive laxity in the ligaments of the pelvic joints (particularly the pubic symphysis). It causes pain in the groin, hips, or lower back, often triggered by movement.

6. Hypermobility-Related Pelvic Arthropathy: Individuals with Generalized Joint Hypermobility (GJH) or Hypermobility-type Ehlers-Danlos Syndrome (HEDS) often suffer from chronic pelvic instability because their ligaments stretch more than normal, causing increased load on the sacroiliac joints. • Sacroiliitis: Inflammation of the sacroiliac joint, where the spine connects to the pelvis. It is often associated with inflammatory arthritis types like ankylosing spondylitis, which primarily affects this joint.

7. Osteoarthritis of the Pelvis/Hip: Degenerative "wear and tear" of the cartilage in the hip joint or pelvic joints (such as the sacroiliac joint), common in older adults or following previous trauma. • Osteitis Pubis: A non-infectious inflammatory condition of the pubic symphysis. It is common in athletes due to repetitive stress on the pelvic joints or after pelvic surgery.

8. Causes of pelvic girdle pain. Hormonal Relaxin hormone : Its primary role is to loosen the ligaments between the pelvic bones(sacroiliac join and pubic symphysis) but leads to pain and instability when joints move beyond their normal range. .

9. Progesterone and oestrogen hormone These hormones also increase during pregnancy and contribute to overall ligamentous laxity and joint instability Mechanical strain : As the joints move unevenly the surrounding muscles must overwork to compensate for the instability and this results into pain

10. RISKFACTORS • Riskfactorsfordevelopingpelvicarthropathyduringpregnancyareas follows: • Previoushistoryofjoin disorders. • Weightgainduring pregnancy. • Changesin postureand biomechanicsduetothegrowingfoetus. • Multiparity- Each subsequent pregnancy can amplify pre-existing weakness making the joint more vulnerable to instability. • Lack of exercise.

11. SIGNS AND SYMPTOMS • Commonsymptomsofpelvicarthropathyare as follows: • Paininthepelvicarea,lowerbackor hips. • Stiffnessandreducedrangeof motion. • Difficultywith walking and weight bearing activities..

12. Radiating pain into the lower abdomen,,groin and perineum. • Clicking ,snapping or grinding heard or felt within the symphysis pubis. • Dyspareumia. • Tenderness over symphysis pubis. • Syprapubic edema

14. MANAGEMENT In most most cases pelvic athropathy resolve on its own within weeks to a few months postpartum as the hormones settle however the following can be done to ease the symptoms. Activity modification. Avoid movement the strain the pelvis, eg lifting heavy weight. Postural training: educating woman on the proper body mechanics during activities. Pelvic Floor Exercises: Initiating Kegel exercises shortly after birth can help restore muscle tone.

15. Physical exercise: Encouragemild exercise to improve circulation to the pelvic region to aid in healing. Vitamin/Mineral Support: Ensuring adequate calcium and vitamin D intake supports the recovery of bone mineral density

16. PAIN MANAGEMENT Analgesia such as paracetamol can be prescribed in antenatal mothers and Medications such as NSAID can be used to manage pain in postnatal mothers.

17. EDUCATION Providing education on the normal changes that occur and after pregnancy can empower woman to manage their symptoms effectively.

18. PUERPERAL SKELETAL CHANGES Puerperium is the roughly six weeks period span following childbirth when a woman’s body including reproductive organs and hormones, reverts to a non-reproductive state. Puerperal skeletal changes involve the reversal of pregnancy-related hormonal effects, joint laxity, and postural adjustments over 6–8 weeks postpartum. Key adjustments include tightening of ligaments, reduction of increased pelvic mobility, and potential reversal of foot size changes. Musculoskeletal discomfort, such as pubic symphysis separation or sacroiliac dysfunction, may occur.

19. Pelvic Joint Stabilization In the puerperium, these ligaments gradually regain their strength and tighten, a process that can take up to 5-6 months weeks. Reversal of Pelvic Widening: The pubic symphyseal gap and sacro iliac joint, which increases by an average of 3 mm during pregnancy, narrows back to its pre-pregnant state between 4 and 12 weeks.

20. Postural Re-adjustment: The postural changes of pregnancy, such as exaggerated lumbar lordosis and forward shoulder slump, begin to reverse as the abdominal muscles tighten and the center of gravity shifts back to its original position. Decrease in Bone Density (Reversible): There is a decrease in maternal bone density during pregnancy and breastfeeding as calcium is transferred for fetal development

21. Permanent widith changes:Some women may experience permanent increase in hip width residue softening and slight sapreading of pelvic bones during delivery. Thoracic changes:The rib cage which may have expanded by 10 to 15 cm during pregnancy slowly returns to its pre pregnancy state.

22. Bone Remodeling: The skeleton undergoes remodeling to adapt back to pre-pregnancy load-bearing levels after the loss of weight from the placenta, fetus, and amniotic fluid. Resolution of Joint Pain: Joint pain and ligamentous discomfort, particularly in the pelvis and lower back, generally resolve by 6 weeks postpartum

23. Complications The most skeletal changes resolve, but some woman may experience. Symphysis pubic diastasis: excessive separation of the pubic symphysis which may require clinical management or in rare cases external fixation. Coccydynia: Trauma or mechanical stress during labor can cause inflammation or displacement if sacrococcygeal joint which may remain painful for weeks.

24. CONCLUSION Pelvic arthropathy and puerperal skeletal changes are significant issues that affect many women during and after pregnancy. Understanding the mechanisms behind these changes and their implications is essential for healthcare providers. By applying comprehensive management strategies, we can help woman navigate these challenges and improve their quality of life and support their overall health during the postpartum period.

25. REFERENCES • Dungy C I & Dungy, B.A (2020). pelvic pain in pregnancy: A Review of the literature. Journal of obstetric, Gynaecologic & neonatal Nursing. • McDonald ,D & McDonald, A (2021). the effects of pregnancy on musculoskeletal Health. Journal of Musculoskeletal pain. • Hentz, j, G, & Lentz G M (2019) management of pelvic pain in the postpartum period. American Family physician.