Schwangerschaft, Geburt und Wochenbett bei Paraplegikerinnen

Abstract

Due to better care and better knowledge pregnancies in paraplegic patients nowadays have a good prognosis. We report on 16 deliveries in 13 paraplegic or tetraplegic patients. To minimise the danger of possible further damage it is important to know about the special problems associated with pregnancies in paraplegic mothers. It is particularly important to know about the elevated risk of premature labour and the risk of autonomic hyperreflexia in lesions above D7. To prevent urogenital infections, patients should try to keep the genital region clean and try to empty the bladder as completely as possible. Intermittent catheterisation might be necessary. One should try to prevent decubital ulcers, and therefore an eventual anaemia (below 80%) should be corrected by transfusions. The patients should be instructed how uterine contractions can be palpated manually because sometimes perception of contractions in other ways is not possible. Repeated examinations of the cervix also help to prevent premature birth. Hospitalisation of the mother two to three weeks before the expected date of birth is suggested. If the lesion is higher than D7, symptoms of autonomic hyperreflexia (bradycardia and rise of blood pressure with the risk of cerebral haemorrhagia) are almost always present when labour starts. To prevent this possibly life-threatening complication, early application of epidural anaesthesia is suggested. There is no contraindication to spontaneous delivery. Vacuum extraction or forceps are necessary more frequently. In the post-partal period, prophylaxis of decubital ulcers is important. Breast feeding is not influenced.

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).…”

Anaesthesia for chronic spinal cord lesions

“…If epidural anaesthesia fails to control blood pressure, nifedipine, hydralazine or verapamil may be given. These drugs have no adverse effects on the uterus [86]. As a last resort, general anaesthesia and Caesarean section are occasionally required.…”

Pregnancy and autonomic hyperreflexia in patients with spinal cord lesions

“…Premature onset of labour happens more frequently with paraplegic and quadriplegic patients than with others (Frankel et ai., Rageth, 1986;Ramzin and Hinselmann, 1979;Robertson, 1972). Furthermore, labour pains in case of lesions above D 10 are not identifiable as such with absolute certainty (Aminoff, 1978;Robertson, 1972;Robertson and Guttmann, 1963).…”

“…It has been observed that the symptoms mentioned above usually appear simultaneously with labour pains in patients with autonomic hyper reflexia, whereas in eclampsia labour pains are usually absent(Frankel et al, 1965). If a lesion exists in the cervical region of the spinal cord or below it, then an intensification of the proprioceptive reflexes of the normally innervated muscle implies pre-eclampsia rather than autonomic hyperreflexia(Watson and Downey, 1980).Prophylaxis and therapy of autonomic hyperreflexia during birthAs an urgent measure to lower the blood pressure the Ca-antagonists (Ver apamil, Nifedipin) and Dihydralazin, that has no negative effect on the uterus perfusion, are considered(Rageth et al, 1986). Secondly, ganglion blockers (Trimetaphancamsilat) can be used.Nitroprusside alone proved inadequate in one patient, and only when it was used in combination with epidural anaesthesia could the hypertensive crisis be brought under control(Ravindran et al, 1981).…”

“…Secondly, ganglion blockers (Trimetaphancamsilat) can be used.Nitroprusside alone proved inadequate in one patient, and only when it was used in combination with epidural anaesthesia could the hypertensive crisis be brought under control(Ravindran et al, 1981). At the present time, the best known and most effective method for the prevention and treatment of autonomic hyperreflexia is epidural anaesthesia with Lidocain or its derivatives(Baraka, 1985;Nath et al, 1979;Rageth et al, 1986; Ravindran et al, 198 1; Tabsh et al,…”