Pregnancy and autonomic hyperreflexia in patients with spinal cord lesions

Abstract

Symptoms of autonomic hyperreflexia in patients with complete and incomplete paraplegia above D 7 can be caused by almost any stimulus in the abdominal area or in the lower extremities, specifically during parturition by the uterine contractions. The symptoms vary from pilo-erection and outbreaks of sweating to serious blood pressure crises and cerebrovascular accidents. Epidural anaesthesia and general anaesthesia are effective as therapy and also as prophylaxis. Frequent complications are anemia and urinary tract infections. Changes in bladder function as a result of pregnancy and childbirth were observed. Paraplegic expectant mothers experience premature labour pains more frequently than do others, and this implies the necessity for earlier clinical surveillance up to the time of delivery. The secondary uterine inertia frequently requires an operative termination of the birth. The perception of labour pains is clearly possible also with lesions above D 10.

Mission impossible? Urological management of patients with spinal cord injury during pregnancy: a systematic review

“…One was a prospective cohort study, 22 nine were retrospective case series [9][10][11][12][13][14]16,18,21 and four were case reports. 15,17,19,20 In the case series and the case reports, information was gathered by a retrospective review of the medical records or by interviews of women with SCI who have borne children (Table 2).…”

Anesthesia for cesarean section in a patient with paraplegia resulting from tumour metastases to spinal cord

“…There is no increase in the incidence of preeclampsia in spinal cord injured parturients than in the normal population. 7,8,9 The level of the spinal cord injury is the best predictor of developing AH. Lesions higher than T 5 are very prone to develop AH, while in lesions below T 11 it is uncommon.…”

“…At 29 wk gestation she presented with lower extremity weakness, proceeding to paraplegia. MRI revealed metastases at the T [8][9][10][11] and L 4-5 vertebral bodies and anterior extradural space at the T 9-10 level. The patient underwent an uncomplicated decompressive laminectomy at the T 9 level for severe central canal stenosis and moderate compression of the spinal cord.…”

“…[12][13][14] The presence or development of autonomic hyperreflexia is related to the level of the spinal cord lesion, with a quoted incidence of 85% if the lesion is higher than T 7 . 15 This syndrome is relatively uncommon in lesions below T [8][9][10] . 16 The exaggerated sympathetic response relates to the development of presynaptic boutons that develop in a haphazard, chaotic fashion over a period of weeks following injury.…”

Die Auswirkungen einer R�ckenmarkverletzung auf Sexualit�t und Reproduktion

“…Um eine zusätzliche Sympathikusaktivierung zu vermeiden, sollte eine vollständi-ge Entleerung von Blase und Enddarm erfolgen. Falls keine Indikation zur Sectio vorliegt,ist bei hoher Para-oder Tetraplegie häufig eine Vakuumextraktion nö-tig [2,21,29,100].…”