Pregnancy and Women With Spinal Cord Injuries

Abstract

The ORACLE II study published in 2001 compared use of amoxicillin-clavulanate (co-amoxiclav) and/or erythromycin, with placebo in women with spontaneous preterm labor (SPL) and intact membranes who had no clinical signs of infection, to determine whether these antibiotics could prevent or eliminate perinatal infections presumed to have a causative role in SPL. Neither drug produced any improvement in neonatal mortality or morbidity. The present study, the ORACLE Children Study II (OCS II), assessed long-term outcomes for 4473 children age 7 years, born in the United Kingdom to 4221 women enrolled in the original ORACLE II trial. The mothers completed a detailed structured questionnaire to assess the health status of the children. The primary outcome was the overall level of functional impairment (mild, moderate, or severe). Results from national curriculum tests assessed the education outcome. Follow-up data was obtained for 3196 of the 4473 children (71%).Compared to mothers who had received no erythromycin, more children born to mothers who had received any erythromycin (with or without co-amoxiclav) had any functional impairment: erythromycin (658 [42.3%] of 1554 children) versus no erythromycin (574 [38.3%] of 1498); odds ratio (OR) 1.18, 95% confidence interval (CI) 1.02-1.37. In contrast, there was no difference in the proportion of children whose mothers had received co-amoxiclav (with or without erythromycin) and those whose mothers had not received co-amoxiclav. More children whose mothers had received any erythromycin presented with bowel disorders. A higher proportion of children whose mothers had received either antibiotic developed cerebral palsy compared to those born to mothers who had not received these antibiotics: erythromycin (53 [3.3%] of 1611) versus no erythromycin (27 [1.7%] of 1562), OR 1.93, 95% CI 1.21-3.09; and co-amoxiclav (50 [3.2%] of 1587) versus no co-amoxiclav (30 [1.9%] of 1586), OR 1.69, 95% CI 1.07-2.67. With these two exceptions, neither antibiotic had effects on other medical conditions, or on the number of deaths, behavior, or educational attainment. The investigators conclude that these findings support the viewpoint that antibiotics are not advisable in SPL without clinical signs of infection. EDITORIAL COMMENT(When used for the prevention of preterm birth, antibiotics have for the most part been a disappointment. With few exceptions, this assessment applies whether they were studied before or after the onset of preterm labor. Large randomized trials failed to confirm the promise of screening and treating asymptomatic bacterial vaginosis or trichomonas in the mid-trimester (Carey JC, et al. NEJM 2000;342:534 and Klebanoff MA, et al. NEJM 2001;345:487) and failed to demonstrate a benefit to treating asymptomatic women with a positive mid-pregnancy cervico- OBSTETRICS Volume 64, Number 3 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTOf the estimated 20,000 American women between the ages of 16 and 30 years who have spinal cord injuries, nearly 14% will have at least one subs...

Feasibility of successful pregnancies in women with spinal injury

“…Fetal growth may not be aff ected. Both cases illustrated in this paper reveal the desirable state of both women with regards to pregnancy, which is in contrast with previous reports where the women did not actually want the pregnancies (Ghidini et al 2008). Although in the fi rst case the pregnancy was conceived prior to the injury, the couple still wanted the pregnancy to continue to at least a point when delivery was no longer detrimental to their child.…”

“…Pregnant women with SCI experience more anxiety and uncertainty (Ghidini et al 2008) in coping with the possibility of an obstetric ' journey ' and future child welfare, than able-bodied mothers. Nevertheless, fertility is not impaired (Burns and Jackson 2001), although a negative self-image with physical limitations are oft en debilitating.…”

Medical complications during pregnancy and childbirth in women with SCI in Switzerland

“…Remarkably, they did not describe or named the phenomenon of autonomic dysreflexia, which is a common and severe complication during labour in SCI patients. 32 We would like to point out, however, that this study reports the subjective perspective of the women experiencing medical complications. By not mentioning some medical needs does not mean that they are not important or do not occur.…”

“…32,33 In an American study, 34 the most common reasons for a caesarean section are 'elective repeat procedure, failure in progress in labour and pelvic instability.' In 2013 in Switzerland, every third birth occurred through a caesarean section, 35 which is an average frequency compared with other European countries.…”

Caring for reproductive-aged women with spinal cord injuries: a case report

“…11 Female fertility and sexual function is usually not affected by SCI and about 14% of women with SCI have at least one pregnancy after their injuries.…”