Spinal cord injury and pregnancy

Abstract

Pregnancy in women with spinal cord injury is considered high risk because it may exacerbate many of their existing problems, including autonomic dysreflexia, spasms, decubitus ulcers, urinary tract infections and respiratory infections. Due to the relative rarity of spinal cord injury in the general obstetric population, clinicians often lack familiarity of these specific problems and the women themselves are usually more experienced in their own management than their obstetric team. However, studies have demonstrated that pregnancy outcomes are generally good with appropriate and experienced obstetric care. In this review, we examine the available literature and provide advice on pre-conception counselling and the antenatal, intrapartum and postnatal management of pregnant women with spinal cord injury.

Neurologic Emergencies in Pregnancy

“…Perception of labor can be altered or even absent in patients with spinal cord injury or may be experienced in referred ways, including scalp tingling or spasms, present as autonomic dysreflexia, stroke-like symptoms, or any range of symptoms. 73 If upper extremity sensation is intact, the patient should be taught self-palpation of the uterus to assess for contractions. 73 After delivery, the epidural should be left in place through the early postpartum period to allow fundal checks, perineal assessment, and other painful stimuli.…”

“…73 If upper extremity sensation is intact, the patient should be taught self-palpation of the uterus to assess for contractions. 73 After delivery, the epidural should be left in place through the early postpartum period to allow fundal checks, perineal assessment, and other painful stimuli. Care should be taken with pericare and ice therapies, areas prone to pressure ulcer formation, and bladder care to avoid overdistention because these are all common autonomic dysreflexia triggers.…”