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Single-group prospective follow-up study.To assess the functional outcome of internal fixation of the pelvic ring in patients with severe pregnancy-related low back and pelvic pain (PLBP) in whom all other treatments failed.More than half of all pregnant women experience PLBP. In most cases, the pain disappears after childbirth. In some, however, the pain becomes chronic and patients may be wheelchair-bound or bedridden. After failure of all conservative treatment, surgical fixation of the pelvic ring seems to be the only remaining option for those severe cases.The postsurgical functional outcome of 58 severe PLBP patients was evaluated with the Majeed score and endurance of walking, sitting, and standing. Inclusion criteria were serious disability and failure of all conservative treatment. The surgical technique consisted of a symphysiodesis and bilateral percutaneous placement of two sacroiliac screws under fluoroscopic guidance.With a follow-up of an average of 2.1 years, the difference between preoperative and postoperative Majeed score indicated that an improvement of more than 10 points was achieved in 69.8% and 89.3% of the patients at 12 and 24 months, respectively. The most important complications were irritation of nerve roots (8.6%), nonunion of the symphysis (15.5%), failure of the symphyseal plate (3.4%), and pulmonary embolism (1.7%).In this preliminary study, surgical fixation of the pelvic ring yielded satisfactory results in severe PLBP patients in terms of pain relief and improvement in ADL functions. These results should be confirmed in a randomized clinical trial.