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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.