Musculoskeletal Considerations in Pregancy and Post Pregnancy

- Use of Medications in Pregnancy:
    - calcium supplementation 
    - intra-articular steroids 
            - note that intra-articular steroids may interfere w/ lactation in nursing mothers;
    - ref:
            The use of antirheumatic medication during pregnancy and in the puerperium

- Surgical Considerations:
    - positioning:
            - avoid supine positioning because of hypotensive effects from aortocaval compression by the enlarged uterus (decreased cardiac output);
            - consider use of right hip wedge, lateral tilt positioning (left side down), or manual displacement of the uterus;

- DVT Prophylaxis:
    - pregnancy causes a hypercoagulable state;
    - w/ orthopaedic injuries consider need for subcutaneous fractionated heparin and SCDs;
    - warfarin is contraindicated.

- Widening of the Symphysis Pubis:
    - begins at the 10-12 week of pregnancy and becomes maximum near term;
    - ref:
            Relaxin in normal and pathogenic pregnancies.  
            Separation of the symphysis pubis in association with childbearing. A case report.   
            Parturition-Induced Pelvic Dislocation: a report of four cases.   
            Internal Fixation in Postpartum Symphysis Pubis Rupture: Report of 3 Cases. Rommens PM. J Orthop Trauma. 1997;11(4):273-276.

- Low Back Pain:
    Backache in pregnancy.   
    Previous back pain and risk of developing back pain in a future pregnancy.   
    Reduction of back and posterior pelvic pain in pregnancy.   
    The effects of pregnancy on idiopathic scoliosis. A preliminary report on eight cases and a review of the literature.  
    Scoliosis and pregnancy.  
    Prevalence of lumbosacral intervertebral disk abnormalities on MR images in pregnant and asymptomatic nonpregnant women.  

- Ankylosing Spondylitis:
    - unlike rheumatoid arthritis (which temporarily improves with pregnancy),  ankylosing spondylitis may be activated or worsened by pregnancy;
          - among female patients w/ AS, up to 20% may develop initial symptoms during pregnancy;
    - ref:
          Ankylosing spondylitis and motherhood.   
          Pregnancy worsens course of ankylosing spondylitis. Steinberg CL. Orthop Rev. 1980;9:81. 

- Wrist:
    Carpal tunnel syndrome in pregnancy. A prospective study.   
    DeQuervain tenosynovitis in pregnant and postpartum women.  
    Occurrence of De Quervain's tendinitis during pregnancy.   
    Carpal tunnel syndrome in pregnancy and lactation.  

- Transient Osteoporosis

- Avascular Necrosis of Femoral Head

- Outside Links:
    - Iowa Family Practice Handbook
    - Merck Manual 

Musculoskeletal considerations in pregnancy

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, January 3, 2013 11:14 am