29 - Musculoskeletalconsiderations in pregnancy

Summary

Pregnancy causes several changes to the musculoskeletal system that should be remembered when treating injuries during pregnancy. Cauda equina syndrome is caused by lumbar disc herniation compressing the cauda equina. Laminectomy, partial hemi-laminectomy and micro-discectomy are the preferred surgical options for cauda equina. Symphysis pubis diastasis (SPD) is a recognised complication of pregnancy with incidence estimates ranging from 1:600 to 1:3400 among obstetric patients. If X-rays are contraindicated ultrasound scan can be used for diagnosis. When a diagnosis of SPD is made, associated soft-tissue injuries such as bladder injuries or herniation is excluded. Pelvic stabilisation devices can be used initially to achieve reduction in large SPD. Surgical options include external fixation devices and internal fixation devices. It is worth noting that pregnancy does not affect the principles of most fracture management as standard fractures are managed in the same way as in a non-pregnant woman.