Relaxin
- A hormone released during pregnancy to cause ligamentous laxity in preparation for parturition →
- Women with severe pelvic girdle pain in pregnancy have significantly higher serum levels of relaxin than those who are pain free.
Spinal surgery timing
- > = 34-36 weeks’ gestation
- Should undergo induction of delivery or cesarean section before, or at the same time as, they undergo spinal surgery
- Vaginal or Ceasrean delivery ?
- Arguments for Ceasrean
- inducing labor before the neurological injury is treated could cause increased neurological injury in the patient because of the rise in epidural venous pressure that occurs during labor.
- <34 weeks gestation
- Carry out spinal surgery in the normal manner
- Brookfield et al. used the prone position in pregnant patients with lumbar disc herniation after 20- and 32-weeks’ gestation by use of a four-poster laminectomy frame to provide pressure relief over the abdomen;
- it is unnecessary to use the technically difficult lateral decubitus position.
Intraoperative fluoroscopy
- unlikely to deliver teratogenic fetal radiation doses but if any question about termination of pregnancy arises input from both an obstetrician and a medical physicist who can accurately calculate the exact dose of radiation to which the fetus was exposed.
- Discuss with obstetrician as uncertain dating of gestational age could greatly affect the infant’s outcome.
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