- 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. Brooks, P. M., Rheumat. Dis. Clin. North America, 15: 789-806, 1989.
- 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 SCD's;
- 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. Szlachter, B. Spellacy, W. N.; and Weiss, G.:
Obstet. and Gynec., 59: 167-170, 1982.
Separation of the symphysis pubis in association with childbearing. A case report.
Lindsey, R. W
J. Bone and Joint Surg., 70-A: 289-292, Feb. 1988.
Parturition-Induced Pelvic Dislocation: A report of four cases.
FD Kharrazi J. Orthop. Trauma. 1997. Vol 11. No 4. p 277-282
Internal Fixation in Postpartum Symphysis Pubis Rupture: Report of 3 Cases.
PM Rommens. J. Orthop. Trauma. 1997. Vol 11, No 4. p 273-276.
- Low Back Pain:
Backache in pregnancy.
Mantle, M. J.; Greenwood, R. M.; and Currey, H. L.:
Rheumatol. and Rehab., 16: 95-101, 1977.
Previous back pain and risk of developing back pain in a future pregnancy.
Ostgaard, H. C., and Andersson, G. B.: Spine, 16: 432-436, 1991.
Reduction of back and posterior pelvic pain in pregnancy.
Ostgaard, H. C.; Zetherstrom, G.; Roos-Hansson, E.; and Svanberg, B.:
Spine,19: 894-900, 1994.
The effects of pregnancy on idiopathic scoliosis. A preliminary report on eight cases and a review of the literature. Spine, 7: 76-77, 1982. Berman, A. T.; Cohen, D. L.; and Schwentker, E. P.:
Scoliosis and pregnancy. J. Bone and Joint Surg., 69-A: 90-96, Jan. 1987.
Prevalence of lumbosacral intervertebral disk abnormalities on MR images in pregnant and asymptomatic nonpregnant women.
Weinreb, J. C.;
Radiology, 170: 125-128, 1989.
- Ankylosing Spondylitis:
- unlike rheumatoid arthritis (which temporarily improves with pregnancy),
ankylosing spondylitis may be activated or worsened by pregnancy;
- among female patients w/ AS, upto 20% may develop initial symptoms during pregnancy;
-
ref:
Ankylosing spondylitis and motherhood.
Ostensen, M.; Romberg, O.; and Husby, G. Arthrit. and Rheumat., 25: 140-143, 1982.
Pregnancy worsens course of ankylosing spondylitis.
Orthop. Rev., 9: 81, 1980. Steinberg, C. L.
- Wrist:
Carpal tunnel syndrome in pregnancy. A prospective study.
Ekman-Ordeberg, G.;
Acta Obstet. Gynec. Scandinavica, 66: 233-235, 1987.
DeQuervain tenosynovitis in pregnant and postpartum women. Schned, E. S.
Obstet. and Gynec., 68: 411-414, 1986.
Occurrence of De Quervain's tendinitis during pregnancy.
Schumacher, H. R., Jr.; Dorwart, B. B.; and Korzeniowski, O. M. Arch. Intern. Med., 145: 2083-2084, 1985.
Carpal tunnel syndrome in pregnancy and lactation.
Wand, J. S. J. Hand Surg., 15-B: 93-95, 1990.
- Transient Osteoporosis:
- Avascular Necrosis of Femoral Head:
- Outside Links:
-
Iowa Family Practice Handbook
-
Merck Manual
-
Iowa Family Practice Handbook - 1
-
Iowa Family Practice Handbook - 2
-
Merck Manual
Musculoskeletal considerations in pregnancy.
JD Heckman and R Sassard.
JBJS Vol 76-A. 1994. p 1720-1730.
