Pelvic Girdle Pain in Pregnancy: Symptoms, Causes & Treatment
📊 Quick facts about pelvic girdle pain
💡 The most important things you need to know
- PGP doesn't harm your baby: Pelvic girdle pain is a musculoskeletal condition affecting only the mother's joints, not fetal development
- Early treatment helps: Seeking physiotherapy early leads to better outcomes and faster recovery
- Keep legs together: When moving in bed or sitting down, keep your knees together to reduce pelvic strain
- Exercise is beneficial: Swimming, water aerobics, and specific stabilizing exercises help strengthen pelvic muscles
- Recovery is likely: About 90% of women recover within 3-6 months after giving birth
- Support belts help: A properly fitted pelvic support belt can provide significant pain relief during activities
- Vaginal birth is usually possible: Most women with PGP can have normal deliveries, though positions may need adapting
What Is Pelvic Girdle Pain During Pregnancy?
Pelvic girdle pain (PGP) is a pregnancy-related condition causing pain in the pelvic joints, including the symphysis pubis at the front of the pelvis and the sacroiliac joints at the back. It affects approximately 20% of pregnant women and is caused by increased joint mobility due to hormonal changes, combined with the physical demands of carrying a growing baby.
Pelvic girdle pain, sometimes called symphysis pubis dysfunction (SPD) or pregnancy-related pelvic girdle pain (PRPGP), is one of the most common musculoskeletal conditions affecting pregnant women. The condition involves inflammation and increased mobility in the pelvic joints, which can lead to significant discomfort and functional limitations during daily activities.
During pregnancy, the body produces a hormone called relaxin, which softens the ligaments and connective tissues throughout the body to prepare for childbirth. While this hormonal change is essential for allowing the pelvis to expand during delivery, it can also lead to excessive joint mobility, particularly in the pelvic region. When the joints become too mobile or move unevenly, it can cause pain and instability.
The pelvis is made up of three bones held together by strong ligaments: the two hip bones on either side and the sacrum at the back. The symphysis pubis is the joint where the two pubic bones meet at the front of the pelvis, while the sacroiliac joints connect the sacrum to the hip bones at the back. PGP can affect any or all of these joints, with varying degrees of severity.
Understanding the anatomy and mechanism behind pelvic girdle pain is important because it explains why certain movements cause pain and how targeted exercises and lifestyle modifications can help manage the condition effectively. The good news is that PGP is a temporary condition that typically resolves after pregnancy when hormone levels return to normal.
Symphysis Pubis Dysfunction vs Pelvic Girdle Pain
While the terms are sometimes used interchangeably, there is a technical difference between symphysis pubis dysfunction (SPD) and pelvic girdle pain (PGP). SPD specifically refers to pain and dysfunction at the front of the pelvis where the pubic bones meet, while PGP is a broader term that encompasses pain anywhere in the pelvic girdle, including the symphysis pubis, sacroiliac joints, and surrounding areas.
Healthcare professionals increasingly prefer the term "pelvic girdle pain" because many women experience pain in multiple pelvic joints simultaneously, not just the symphysis. However, if your pain is primarily at the front of your pelvis, over the pubic bone, your healthcare provider may refer to it as SPD.
Who Is at Higher Risk for PGP?
While pelvic girdle pain can affect any pregnant woman, certain factors increase the likelihood of developing this condition. Women who experienced PGP in a previous pregnancy have a significantly higher risk of recurrence, with studies showing up to 85% will experience symptoms again. Other risk factors include a history of lower back pain or pelvic trauma, joint hypermobility syndrome, physically demanding work that involves heavy lifting or prolonged standing, and having had multiple pregnancies.
Having risk factors doesn't mean you will definitely develop PGP, and many women without any risk factors still experience pelvic pain during pregnancy. Early awareness and preventive measures can help manage symptoms if they do occur.
What Are the Symptoms of Pelvic Girdle Pain?
Common symptoms of pelvic girdle pain include pain over the pubic bone at the front of the pelvis, pain in the lower back and sacroiliac joints, difficulty walking (especially for longer distances), pain when climbing stairs or standing on one leg, clicking or grinding sensations in the pelvis, and pain when turning in bed or getting in and out of a car.
The symptoms of pelvic girdle pain can vary significantly from woman to woman, ranging from mild discomfort to severe pain that makes everyday activities extremely difficult. The pain is typically described as a deep aching or sharp stabbing sensation, often worsening with weight-bearing activities and improving with rest.
Most women notice that their symptoms are worse at the end of the day, after prolonged activity, or when performing movements that require asymmetric loading of the pelvis. Activities like walking, climbing stairs, turning in bed, or getting in and out of a car often become particularly challenging. Some women report a clicking, grinding, or popping sensation in their pelvis when moving.
The onset of symptoms typically occurs somewhere between weeks 14 and 30 of pregnancy, although PGP can begin at any point during pregnancy or even during the postpartum period. For some women, symptoms appear quite suddenly, while others experience a gradual worsening over weeks or months.
Pain Locations and Patterns
Understanding where your pain is located can help your healthcare provider determine the best treatment approach. Pain at the front of the pelvis, over the pubic bone, is often described as a bruised feeling and may radiate down the inner thighs. Pain at the back of the pelvis, in the sacroiliac joints, often feels similar to lower back pain and may radiate into the buttocks or legs.
Many women experience pain in multiple locations simultaneously. The pain may shift between locations or be more prominent on one side than the other. This variability is completely normal and reflects the interconnected nature of the pelvic joints.
| Severity Level | Common Symptoms | Impact on Daily Life | Recommended Action |
|---|---|---|---|
| Mild | Occasional aching, minor discomfort with certain movements | Minimal impact, can continue most activities | Self-care measures, posture awareness |
| Moderate | Regular pain, difficulty with stairs and long walks, sleep disruption | Some activities become difficult, may need to modify daily routine | Physiotherapy referral, pelvic support belt |
| Severe | Constant pain, unable to walk without aid, significant sleep disruption | Major limitations, may need mobility aids or time off work | Specialist referral, comprehensive treatment plan |
| Very Severe | Unable to bear weight, needs wheelchair or crutches | Significantly disabled, requires assistance with daily activities | Multidisciplinary team care, consider early delivery planning |
Symptoms That Require Immediate Medical Attention
While pelvic girdle pain itself is not dangerous, certain symptoms require prompt medical evaluation to rule out other conditions. These warning signs should not be ignored and warrant immediate contact with your healthcare provider.
- Sudden, severe pelvic pain that doesn't improve with rest
- Vaginal bleeding or unusual discharge
- Fever or signs of infection
- Loss of bladder or bowel control
- Numbness or tingling in the groin, legs, or feet
- Contractions or signs of preterm labor
These symptoms may indicate a different condition requiring immediate evaluation. Find your emergency number →
What Causes Pelvic Girdle Pain During Pregnancy?
Pelvic girdle pain is caused by a combination of hormonal changes that loosen pelvic ligaments, increased mechanical stress from the growing uterus and baby's weight, altered posture and center of gravity, and possible asymmetric movement of the pelvic joints. Previous pelvic injury, hypermobility, and strenuous physical activity can increase the risk.
The development of pelvic girdle pain during pregnancy is multifactorial, meaning several different factors work together to cause the condition. Understanding these causes helps explain why the condition affects some women more severely than others and informs treatment approaches.
The primary contributor to PGP is the hormone relaxin, which is produced in increasing amounts during pregnancy. Relaxin's main function is to soften the ligaments and connective tissues, particularly around the pelvis, to prepare for childbirth. While this process is necessary and beneficial for delivery, it can result in excessive joint laxity that destabilizes the pelvic ring.
As pregnancy progresses, the growing uterus and increasing baby weight place significant mechanical stress on the pelvic structures. The center of gravity shifts forward, causing changes in posture that can strain the pelvic joints. Many women unconsciously adopt a more pronounced lumbar curve (lordosis) to counterbalance the weight of the growing belly, which can further stress the sacroiliac joints.
Another important factor is the potential for asymmetric movement between the left and right sides of the pelvis. When the pelvic joints don't move evenly or in coordination, it can create shearing forces that cause pain. This asymmetry may be due to pre-existing differences in leg length, previous injuries, or habitual movement patterns.
The Role of Muscle Weakness and Coordination
The pelvic floor muscles and deep abdominal muscles play a crucial role in stabilizing the pelvic joints. When these muscles are weak or poorly coordinated, the joints rely more heavily on the ligaments for support. During pregnancy, when the ligaments are already softened by hormones, this lack of muscular support can contribute to joint instability and pain.
Research has shown that women with PGP often have altered muscle activation patterns and reduced strength in their core stabilizing muscles. This is why strengthening exercises, particularly for the pelvic floor and deep abdominal muscles, are an important component of treatment.
Psychosocial Factors
While the primary causes of PGP are physical, psychological factors can influence how the pain is experienced and managed. Stress, anxiety, and depression can amplify pain perception and make it harder to engage with rehabilitation exercises. Fear of movement (kinesiophobia) can lead to avoiding activities, which may actually worsen symptoms by causing muscle deconditioning.
When Should You See a Doctor for Pelvic Pain?
You should see a healthcare provider if pelvic pain significantly affects your daily activities, makes walking or climbing stairs difficult, disrupts your sleep, is getting progressively worse, or doesn't improve with self-care measures. Early treatment leads to better outcomes and faster recovery.
Many women experience some degree of pelvic discomfort during pregnancy and wonder whether their symptoms warrant medical attention. While mild aches and pains can often be managed with self-care measures, there are clear indicators that you should seek professional help.
If your pelvic pain is interfering with your ability to work, care for yourself or your family, sleep properly, or maintain your normal daily activities, it's time to consult a healthcare provider. Pain that is progressive, meaning it's getting worse rather than staying stable or improving, should also prompt a medical evaluation.
Early intervention is important because treatment is generally more effective when started early. Women who receive physiotherapy and appropriate support in the early stages of PGP typically have better outcomes than those who wait until symptoms become severe. Don't feel that you need to "just put up with it" because you're pregnant - effective treatments are available.
What to Expect at Your Appointment
When you see your healthcare provider about pelvic pain, they will take a detailed history of your symptoms, including when they started, what makes them better or worse, and how they affect your daily life. A physical examination will assess your posture, gait, and the movement and tenderness of your pelvic joints.
Your provider may perform specific tests to evaluate the stability and function of your pelvic joints. These tests are gentle and should not cause significant discomfort. Based on the assessment, your provider can determine the severity of your condition and recommend appropriate treatment.
In most cases, imaging studies like X-rays or MRIs are not needed to diagnose PGP. However, if your symptoms are unusual or don't respond to treatment as expected, your provider may recommend imaging to rule out other conditions.
How Is Pelvic Girdle Pain Treated?
Treatment for pelvic girdle pain typically includes physiotherapy with specific exercises to strengthen pelvic stabilizing muscles, use of a pelvic support belt, activity modification, pain management with pregnancy-safe medications like paracetamol, and in some cases acupuncture or manual therapy. Most women see significant improvement with consistent treatment.
The treatment of pelvic girdle pain is multimodal, meaning it combines several different approaches to address the various factors contributing to the condition. The goal of treatment is to reduce pain, improve function, and help you maintain as much normal activity as possible during your pregnancy.
Physiotherapy is the cornerstone of PGP treatment and has the strongest evidence for effectiveness. A physiotherapist specializing in women's health or musculoskeletal conditions can assess your specific issues and develop a personalized treatment program. This typically includes exercises to strengthen the muscles that support the pelvis, particularly the pelvic floor and deep abdominal muscles, as well as manual therapy techniques to reduce pain and improve joint function.
A pelvic support belt (also called a maternity support belt or SI belt) can provide significant relief by mechanically supporting the pelvic joints and reducing strain during activity. The belt should be worn low around the hips, below the belly, not around the waist. Research shows that pelvic support belts are most effective when combined with exercise therapy rather than used alone.
Activity modification is an important part of managing PGP. This doesn't mean complete rest - staying active is actually beneficial - but it may mean changing how you do certain activities to minimize stress on the pelvic joints. Your physiotherapist can teach you techniques like keeping your knees together when moving in bed, taking smaller steps when walking, and avoiding asymmetric movements.
Pain Medication During Pregnancy
Paracetamol (acetaminophen) is considered safe during pregnancy and can help manage pain when used as directed. It's important to follow the recommended dosage and not exceed the maximum daily amount. While paracetamol may not eliminate all pain, it can reduce it enough to help you stay active and engage with physiotherapy exercises.
Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen should generally be avoided during pregnancy, particularly after 20 weeks, as they can affect fetal kidney function and amniotic fluid levels. Always consult your healthcare provider before taking any medication during pregnancy.
Paracetamol is generally considered safe during pregnancy when used at recommended doses. However, always consult your midwife or doctor before taking any medication. Some recent studies have raised questions about prolonged paracetamol use during pregnancy, so it's best to use it only when needed and for the shortest time necessary.
Complementary Therapies
Acupuncture has been studied for pregnancy-related pelvic pain and some research suggests it can provide relief. If you're interested in acupuncture, ensure you see a practitioner experienced in treating pregnant women, as some acupuncture points should be avoided during pregnancy.
Manual therapy, including gentle manipulation and mobilization techniques performed by trained physiotherapists or osteopaths, can help reduce pain and improve joint function. These techniques should always be performed by practitioners experienced in treating pregnant women.
Water-based exercise is particularly beneficial because the buoyancy of water supports your body weight and reduces stress on the pelvic joints while allowing you to exercise. Swimming and aqua aerobics classes specifically designed for pregnant women can be excellent options.
What Exercises Help with Pelvic Girdle Pain?
Beneficial exercises for PGP include pelvic floor exercises (Kegels), deep abdominal muscle activation, gentle core stabilization exercises, swimming and water aerobics, and specific stretches for tight muscles. Exercises should be performed pain-free and preferably prescribed by a physiotherapist to ensure they're appropriate for your condition.
Exercise is a crucial component of PGP management, but it's important to do the right type of exercise. The goal is to strengthen the muscles that stabilize the pelvis without placing excessive strain on the already vulnerable joints. A physiotherapist can prescribe a personalized exercise program based on your specific needs and limitations.
Pelvic floor exercises (also known as Kegel exercises) strengthen the muscles that support the pelvic organs and help stabilize the pelvic joints. To perform these exercises, squeeze the muscles you would use to stop urinating mid-stream, hold for a few seconds, then relax. Repeat this 10-15 times, several times a day. It's important to fully relax the muscles between contractions.
Deep abdominal muscle activation targets the transversus abdominis, the deepest layer of abdominal muscles that wraps around the torso like a corset. To activate these muscles, gently draw your lower belly in toward your spine while breathing normally. You should feel a subtle tightening, not a forceful contraction. This exercise can be performed in various positions and combined with pelvic floor exercises.
Swimming and water-based exercise are excellent choices because the water supports your body weight, reducing stress on the pelvic joints while allowing you to exercise your muscles. Gentle swimming, particularly backstroke or sidestroke, and aqua aerobics classes can help maintain fitness and muscle strength without aggravating PGP symptoms.
Exercises to Avoid
While exercise is beneficial, certain types of exercise can worsen PGP symptoms and should be avoided or modified. These include high-impact activities like running or jumping, exercises that involve standing on one leg (such as lunges), movements that require spreading the legs wide apart (like certain stretches or some yoga poses), and any exercise that causes pain.
It's also important to avoid exercising to the point of exhaustion, as fatigue can compromise your ability to maintain good form and may worsen symptoms. If an exercise causes pain, stop immediately and consult your physiotherapist about alternatives.
Sample Daily Exercise Routine
A simple daily routine for PGP might include 10 pelvic floor exercises performed three times daily, 10 deep abdominal muscle contractions performed twice daily, gentle stretching of tight muscles (such as hip flexors and inner thighs) for 5-10 minutes daily, and 20-30 minutes of swimming or walking (if tolerated) most days of the week. Always warm up before exercising and cool down afterward.
How Can You Manage PGP at Home?
Home management of pelvic girdle pain includes keeping your knees together when moving, sleeping with a pillow between your legs, avoiding asymmetric activities, taking regular rest breaks, applying ice or heat for pain relief, wearing a pelvic support belt, and planning activities to minimize walking and standing time.
Many aspects of PGP management can be implemented at home as part of your daily routine. These self-care strategies can significantly reduce your symptoms and make daily activities more manageable.
Movement techniques are one of the most important self-care strategies. When getting in or out of bed, roll onto your side first, then push yourself up while keeping your knees together. When getting in or out of a car, sit down first with your legs outside, then swing both legs in together. When climbing stairs, go one step at a time, leading with your stronger leg going up and your weaker leg going down.
Sleep positioning can significantly affect your symptoms. Sleep on your side with a pillow between your knees and ankles to keep your pelvis aligned. Some women find that a full-length pregnancy pillow provides additional support. Try to avoid sleeping on your back, which can strain the lower back and pelvis.
Pacing activities means spreading activities throughout the day rather than doing everything at once, and taking regular rest breaks before pain becomes severe. It's easier to prevent pain from building up than to reduce it once it's established. Plan your day to minimize the amount of standing and walking required.
Practical Tips for Daily Activities
- Dressing: Sit down to put on pants, socks, and shoes. Avoid standing on one leg.
- Housework: Avoid activities like vacuuming that require twisting or bending. Sit down for tasks that can be done seated. Ask for help with heavy lifting.
- Shopping: Use a shopping cart for support. Avoid carrying heavy bags, especially on one side only.
- Childcare: Sit down to pick up and hold children. Avoid carrying children on your hip.
- Work: If you have a desk job, ensure your chair provides good support. Take regular breaks to move around. If your job requires standing or walking, discuss modifications with your employer.
Can You Have a Normal Delivery with PGP?
Most women with pelvic girdle pain can have a normal vaginal delivery. Birth positions may need to be adapted to avoid excessive leg separation. It's important to discuss your condition with your midwife and create a birth plan that includes your comfortable range of leg movement. Water birth can be beneficial as the buoyancy reduces stress on pelvic joints.
Having pelvic girdle pain does not automatically mean you'll need a cesarean section or that labor will be more difficult. However, planning ahead and communicating with your healthcare team about your condition is essential for a positive birth experience.
One of the most important considerations for labor with PGP is limiting leg abduction - how far apart your legs can comfortably spread. Before labor, you should know what your comfortable range is and communicate this to your birth team. This can be noted in your birth plan. Positions that require excessive leg spreading, such as some assisted delivery positions or lithotomy, should be avoided if they cause pain.
Upright and forward-leaning positions during labor can be beneficial for women with PGP. These positions use gravity to help with labor progression while minimizing stress on the pelvic joints. Kneeling, standing and leaning on a birth ball, or being on all fours are all options that many women with PGP find comfortable.
Water birth can be an excellent choice for women with PGP. The warm water provides pain relief and the buoyancy supports your body weight, reducing stress on the pelvic joints. Many women find they can move more freely in water than on land.
Important Points for Your Birth Plan
- Document your comfortable range of leg abduction
- Request that medical staff avoid forceful or sustained leg spreading
- Ask for help with position changes during labor
- Consider which positions you find most comfortable
- Discuss pain management options that allow you to remain mobile
- If assisted delivery is needed, discuss gentle techniques that minimize pelvic strain
What Is the Prognosis for Pelvic Girdle Pain?
The prognosis for pelvic girdle pain is generally excellent. About 90% of women experience significant improvement or complete resolution within 3-6 months after delivery as hormone levels return to normal and the pelvic joints stabilize. Approximately 5-10% may have persistent symptoms beyond 6 months, but treatment can still help these women recover.
For most women, pelvic girdle pain is a temporary condition that improves significantly after pregnancy. The recovery process typically begins within days to weeks after delivery, though the timeline varies considerably between individuals.
Several factors influence recovery time, including the severity of symptoms during pregnancy, whether treatment was received, the type of delivery (vaginal versus cesarean), and individual variation in how quickly the body returns to its pre-pregnancy state. Women who engaged with physiotherapy and exercises during pregnancy often recover more quickly.
Postpartum care is important for recovery. Continuing exercises that strengthen the pelvic floor and core muscles can help restore stability to the pelvic joints. Avoiding heavy lifting in the early postpartum weeks allows the ligaments time to tighten back to their normal tension.
When Recovery Takes Longer
A minority of women continue to experience symptoms beyond 6 months postpartum. If you're in this group, don't lose hope - continued physiotherapy, exercises, and in some cases specialized treatment can still lead to improvement. Some women find that symptoms gradually improve over 12-18 months.
If you had severe PGP during pregnancy or continue to have significant symptoms postpartum, you may benefit from referral to a specialist pelvic health physiotherapist or a women's health clinic. In rare cases where conservative treatment is not effective, other interventions may be considered.
If you experienced PGP in this pregnancy, you have a higher risk of recurrence in future pregnancies. However, being aware of the condition and starting preventive measures early (such as pelvic floor exercises before conception and throughout pregnancy) may help reduce severity. Discuss your history with your healthcare provider early in any subsequent pregnancy.
Frequently Asked Questions
Pelvic girdle pain (PGP) causes specific, localized pain in the pelvic joints - the symphysis pubis at the front and/or the sacroiliac joints at the back. Unlike general pregnancy discomfort, PGP typically causes pain during weight-bearing activities like walking, climbing stairs, or turning in bed. The pain is often described as stabbing or grinding and may be accompanied by clicking sounds in the pelvis. Normal pregnancy discomfort is usually milder and more generalized. If your pain is affecting your ability to perform daily activities, it's worth seeking evaluation.
Pelvic girdle pain does not harm your baby directly. PGP is a musculoskeletal condition affecting the mother's pelvic joints and does not impact fetal development or health. However, severe PGP may affect your mobility and quality of life during pregnancy. Most women with PGP can have normal vaginal deliveries, though birth positions may need to be adapted to avoid excessive strain on the pelvis. Always discuss your specific situation with your healthcare provider to ensure you receive appropriate support.
You should see a healthcare provider if pelvic pain significantly affects your daily activities, makes it difficult to walk or climb stairs, disrupts your sleep, or is getting progressively worse. Seek immediate medical attention if you experience sudden severe pain, vaginal bleeding, fever, loss of bladder or bowel control, or numbness in the groin area. Early treatment leads to better outcomes, so don't hesitate to seek help if you're concerned about your symptoms.
For most women, pelvic girdle pain significantly improves or resolves completely within weeks to months after giving birth as hormone levels return to normal and the pelvic joints stabilize. Research shows that about 90% of women recover within 3-6 months postpartum. However, approximately 5-10% may experience persistent symptoms beyond 6 months. Physiotherapy and exercises during pregnancy and postpartum can speed recovery and improve outcomes.
Yes, appropriate exercise is actually recommended for pelvic girdle pain. Low-impact activities like swimming, water aerobics, and prenatal yoga can help strengthen pelvic muscles without aggravating symptoms. Specific stabilizing exercises prescribed by a physiotherapist are particularly beneficial. However, you should avoid high-impact activities, asymmetric movements, and any exercises that cause pain. Walking may need to be done in shorter intervals to prevent worsening symptoms.
A pelvic support belt can provide significant relief for many women with pelvic girdle pain by mechanically supporting the pelvic joints and reducing strain during movement. Research shows that support belts are most effective when combined with exercise therapy rather than used alone. The belt should be worn low around the hips, not around the waist, to provide proper support to the pelvis. A physiotherapist or midwife can help ensure proper fitting and advise on when to wear the belt for maximum benefit.
References and Sources
This article is based on the following peer-reviewed sources and clinical guidelines:
- Vleeming A, et al. European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal. 2008;17(6):794-819. doi:10.1007/s00586-008-0602-4
- Liddle SD, Pennick V. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database of Systematic Reviews. 2015;(9):CD001139. doi:10.1002/14651858.CD001139.pub4
- American College of Obstetricians and Gynecologists. Physical Activity and Exercise During Pregnancy and the Postpartum Period. ACOG Committee Opinion No. 804. 2020.
- Royal College of Obstetricians and Gynaecologists. Pelvic Girdle Pain and Pregnancy: Information for You. Patient Information Leaflet. 2015.
- Wu WH, et al. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. European Spine Journal. 2004;13(7):575-589.
- Gutke A, et al. Predicting persistent pregnancy-related low back pain. Spine. 2008;33(12):E386-E393.
- Stuge B, et al. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy. Spine. 2004;29(4):351-359.
- Mens JM, et al. Understanding peripartum pelvic pain. Spine. 2009;34(17):1809-1812.
Last fact-checked: December 23, 2025. This information follows the GRADE evidence framework for medical recommendations.
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