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Orthopedic Issues in Pregnancy

Smith, Micah Warren BA*; Marcus, Peter S. MD†; Wurtz, L Daniel MD‡

Obstetrical & Gynecological Survey: February 2008 - Volume 63 - Issue 2 - pp 103-111
doi: 10.1097/OGX.0b013e318160161c
CME Program: CATEGORY 1 CME REVIEW ARTICLES 4, 5, AND 6: CME REVIEW ARTICLE 4

Pregnancy taxes the musculoskeletal system. The enlarging gravid uterus alters the maternal body’s center of gravity, mechanically stressing the axial and pelvic systems, and compounds the stresses that hormone level fluctuations and fluid retention exert. While the pregnant woman is prone to many musculoskeletal injuries, most can be controlled conservatively, but some require emergent surgical intervention. This article describes pregnancy-related orthopedic problems and related conditions, and discusses their pathogenesis, signs, symptoms, physical examination findings, diagnostic work-up, and interventions. Topics specifically covered include the following: pregnancy-related posterior pelvic pain (PRPPP), lumbar disc herniation with cauda equine syndrome, low back pain, kyphoscoliosis and scoliosis issues for anesthesia during pregnancy and delivery, pubic symphysis rupture, transient osteoporosis versus osteonecrosis, management of pregnancy after hip replacement surgery, and carpal tunnel syndrome. Specific musculoskeletal systems discussed in this article include the spine, pelvis, hip joint, and wrist.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this article, the reader should be able to recall that there are many changes which occur during pregnancy that create a strain on the musculoskeletal system, explain that there are differences in the signs and symptoms in the presentation and differentiation of each of the maladies, and state that treatments vary depending on the acuteness and impairments created by the musculoskeletal disorder.

*Orthopedic Resident, Ft. Wayne Medical Education Program, Ft. Wayne, Indiana; †Associate Professor of Obstetrics and Gynecology, and ‡Associate Professor Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana

Chief Editor’s Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credits™ can be earned in 2008. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.

Dr. Marcus has disclosed that he is/was a recipient of an APGO/Ford Foundation Educational Grant.

All staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

Lippincott CME Institute, Inc. has identified and resolved all faculty and staff conflicts of interest regarding this educational activity.

Reprint requests to: Peter S. Marcus, MD, 550 N. University Blvd., Indianapolis, IN 46202. E-mail: pmarcus@iupui.edu.

© 2008 Lippincott Williams & Wilkins, Inc.