Obstetric outcomes in women who sustained a spinal cord injury during pregnancy

Abstract

Methods: Interrogation of our unit database identified only two women who became spinal cord injured while pregnant; their medical records were reviewed and an unstructured follow-up telephone interview conducted 6 years after discharge. Case 1: CC sustained a fracture dislocation with paraplegia at the sixth thoracic level (T6) in a motorbike accident while she was pregnant, 12-week gestational age (GA). Profound shock and hypoxia complicated the injury and recurrent urinary tract infections complicated the rest of her pregnancy. A baby with arthrogryposis multiplex congenita was delivered at full term. Severe cerebral palsy (CP) and deafness were present at follow-up 6 years later. Case 2: A 33-year-old multigravida, 27 weeks GA, developed sudden, spontaneous onset of paraplegia (T3 ASIA B) due to an extradural haematoma, which was evacuated on the day of admission. Systolic blood pressure was maintained above 90 mm Hg during and after surgery. A normal, healthy boy was delivered by caesarean section at 40 weeks GA and remained so at 6 years. Conclusion: Traumatic spinal cord injury (SCI) with its attendant multiple potential insults to the developing foetus results in a high risk of foetal loss and malformation particularly in the first trimester. However, if the injury occurs later in pregnancy and if blood pressure and oxygenation are maintained, the risk of foetal loss and abnormality may be substantially reduced.

Obstetric Outcomes of Women Who Sustained Traumatic Spinal Injury during Pregnancy: A Systematic Review

“…Finally, 16 publications reporting on 26 cases were included in the systematic review. Eleven (68.8%) of the included studies had poor methodological quality, while the remaining 5 (31.2%) had moderate methodological quality [2,6,7,9,10,12,[16][17][18][19][20][21][22][23][24][25] (Table 1).…”

“…1 ). Another study reported two cases, of which one was of non-traumatic origin [ 9 ]. The non-traumatic case was removed, leaving the study solely with the traumatic case.…”

“…Consequences of spinal injuries are significantly exacerbated in women who sustained spinal injuries during pregnancy, and these effects can be worsened further when clinicians are uncertain on the best procedures to save or treat the patient and her baby. Frequent and effective communication among health care professionals, including obstetricians, surgeons, and rehabilitation specialists who form a part of an interdisciplinary team, is necessary for the best management of these patients [ 7 , 9 , 12 ]. Traumatic spinal injuries during pregnancy are not very common; therefore, limited information exists about the clinical characteristics and obstetric outcomes in this population [ 19 , 20 ].…”

“…Severe spinal injury can lead to spinal cord injury (SCI). In these patients, spinal injury and SCI-specific complications such as paralysis, bowel and bladder incontinence, deep venous thrombosis, hypotension, autonomic dysreflexia (AD), and vertebral instability present complex challenges to obstetricians, surgeons, and rehabilitation specialists [6][7][8][9][10]. Thus, an interdisciplinary team approach is neces-sary to manage this unique patient population.…”

“…Spinal injury and SCI commonly occur in young individuals, and the majority of women who sustain these injuries are of childbearing age [ 7 , 9 , 10 ]. Some studies have investigated the outcomes of pregnancy and rehabilitation in women with pre-existing SCI; however, the literature regarding pregnant women who sustained spinal injury during pregnancy is limited [ 8 ].…”