Musculoskeletal considerations in pregnancy.

Publisher Website
Google Scholar
Abstract
During the nine months of pregnancy, the female body undergoes a number of hormonal and anatomical changes. Many of these changes cause, or contribute to the cause of, musculoskeletal conditions such as low-back pain, carpal tunnel syndrome, and other painful conditions. In an unpublished retrospective study of 126 consecutive postpartum patients, we found that virtually every woman had some degree of musculoskeletal discomfort during the course of the pregnancy, and as many as one in four had at least temporarily disabling musculoskeletal symptoms of some type. Heretofore, because of the special condition of pregnancy, it has been thought that these symptoms should be allowed to resolve spontaneously, that overzealous intervention is inappropriate or dangerous to the mother or the fetus, or that nothing could be done to alleviate these problems short of the mother completing the pregnancy. In addition to musculoskeletal symptoms that are characteristic of pregnancy, some pre-existing musculoskeletal conditions, such as rheumatoid arthritis and scoliosis, can be affected by pregnancy. Knowledge of these effects can help the patient and her attending physician deal with them during the course of the pregnancy. In this paper, we highlight the musculoskeletal conditions that commonly occur during pregnancy and point out, through a review of the literature, the effects that pregnancy has on pre-existing musculoskeletal conditions. We also describe preventive measures that can help the patient to avoid or to minimize some of these problems. The hormonal changes that occur during the thirty-eight to forty-two weeks of a normal pregnancy are reflected by many physical changes. One of the most dramatic of these changes is widening and increased mobility of the sacro-iliac synchondroses and the symphysis pubis, which begins at the tenth to twelfth week of pregnancy. The increased width of the symphysis pubis provides radiographic evidence of this relaxation as early as the first trimester and becomes maximum near term. The hormone relaxin has been identified as a major contributor to these changes in joint laxity during pregnancy [52]. Comparison studies of samples of ovarian venous plasma have shown relaxin to be secreted by the corpus luteum, and measurement of this hormone has come to be used as an index of the activity of the corpus luteum in pregnancy. Concentrations of relaxin are elevated during the first trimester and then decline early in the second trimester to a level that remains stable throughout the rest of the pregnancy and into labor. Interestingly, the levels of relaxin are not associated with the number of fetuses--that is, serum concentrations of relaxin in women who have a single fetus are the same as in women who have twins. Lower concentrations have been found, however, after forty-three weeks of gestation and in women in premature labor [93]. One of the most common complications of pregnancy is low-back pain; it occurs in as many as one-half of all pregnant women [60] and has been accepted as almost inevitable. Eighty-eight (70 per cent) of the 126 postpartum patients in our retrospective review had low-back pain at some time during the pregnancy. It occurs approximately twice as often in women who have had back pain before becoming pregnant. It also occurs more often in women who have been pregnant previously, and these women tend to have more prolonged periods of pain as well [69].

This publication has 70 references indexed in Scilit: