Management of Round Ligament Pain in Pregnancy

Understanding Round Ligament Pain

Round ligament pain is caused by hormonal ligamentous laxity that reduces ligament stiffness and weakens joint stability, increasing demand on stabilizing muscles, as well as biomechanical changes from increased abdominal mass and shifts in the center of gravity, in pregnant women 1, 2
Postural adaptations as pregnancy progresses also contribute to round ligament pain by placing stress on supporting structures 1

Pregnant women should avoid heavy lifting (10-20 kg or 22-44 lb) more than 20 times per week to prevent exacerbation of round ligament pain 1
Maintaining regular moderate-intensity physical activity accumulated over at least 3 days per week is recommended 3
Combining aerobic exercise with resistance training is more effective than aerobic exercise alone for managing round ligament pain 3
Including yoga and gentle stretching can provide additional muscle spasm relief 3

Pregnant women should stop activity and seek immediate medical attention if experiencing persistent excessive shortness of breath, severe chest pain, regular and painful uterine contractions, vaginal bleeding, persistent loss of fluid from the vagina, or persistent dizziness or faintness 3, 4

For opioid-naïve pregnant women with musculoskeletal pain, the American College of Obstetricians and Gynecologists recommends NSAIDs and acetaminophen as first-line treatments, unless contraindicated 4, 5
Opioids should only be considered for severe pain unmanaged by nonopioid options, and severe pain should prompt evaluation for unrecognized complications 4, 5
Muscle relaxants like atracurium and mivacurium should be avoided during pregnancy when possible 3

Underreporting by patients is common, and active questioning is required to identify round ligament pain 1, 2
Inadequate activity modification, such as failing to adjust heavy lifting and physical workload, can worsen symptoms 1
Severe musculoskeletal pain is associated with sleep disturbances, altered daily activities, and depression, highlighting the importance of considering psychosocial factors 2

For most women, round ligament pain resolves spontaneously after delivery 1
Women at highest risk for persistent postpartum pain include those with back pain prior to pregnancy, early symptom onset, higher pain severity, or both low back pain and pelvic girdle pain simultaneously 1