Autonomic hyperreflexia in pregnancy and labor: a case report

Acute spinal cord injury in pregnancy: an illustrative case and literature review

Acute trauma is not all that uncommon in pregnancy. It accounts for 15% of non-obstetric maternal deaths. Moreover, about 15% of acute spinal cord injuries involve young women of childbearing age (Gilson et al., 1995). Most of the existing literature on spinal cord injury in pregnancy is concerned with the management of patients with pre-existing lesions; very few articles deal with acute injuries. We report the management of a case of acute spinal cord injury in the third trimester of pregnancy and review the major clinical issues associated with such cases.

Management of autonomic hyperreflexia with magnesium sulfate during labor in a woman with spinal cord injury

Autonomic hyperreflexia, one of the gravest complications of delivery among women with spinal cord injury, has been treated with spinal or epidural anesthesia but not always successfully. We discovered dramatically beneficial effects of magnesium sulfate on autonomic hyperreflexia during labor in a patient with spinal cord injury at a high level.

Pregnancy in spinal cord injured women

The management of pregnancy, labor, and delivery in women with spinal cord injury (SCI) has received increased attention by investigators and clinicians in recent years. Physicians who care for women with SCI need to become familiar with the general principles of care during pregnancy. This article presents a summary of publications identified by a MEDLINE search of the topics spinal cord injury, paraplegia, tetraplegia, and pregnancy, and by reviewing the reference lists of these articles. The current medical literature suggests excellent overall maternal and neonatal outcome. Certain medical complications such as urinary tract infections and autonomic hyperreflexia are predictable and can be managed successfully. Obstetrical management is changed little by SCI but needs to account for the risk of unattended delivery in the patient with a high level of lesion.

Pregnancy, labor and delivery in a woman with a damaged spinal cord

We report here a case involving the pregnancy, labor and delivery of a woman with a damaged spinal cord. In our case, even though the cord was damaged below the Th11, continuous epidural anesthesia was needed to prevent autonomic hyperreflexia. The patient's and infant's subsequent courses were normal.

Pregnancy, labor and delivery post spinal cord injury

There are approximately 3,000 women of childbearing age who become spinal cord injured each year in the United States. There are few reports in the literature that address pregnancy, labor and delivery in this patient population. We are reporting on 22 women post spinal cord injury who had 33 pregnancies. There were equal numbers of paraplegic and quadriplegic women. Three pregnancies aborted, one spontaneously. The babies were near normal or normal weight with one exception. The mothers waited 5 years on average to become pregnant. Cesarean section was performed on 43% of pregnancies. Abnormal presentations occurred in over 10% of pregnancies. Indications for cesarean section included 5 that were repeats; the remainder were necessary due to bleeding (1), breech presentation (1), transverse presentation (2), lack of progress (2), onset of labor 1 day post spinal fusion, and a mother's request to have tubal ligation. Epidural anesthesia was selected for 9 deliveries; 6 of these patients had controlled autonomic hyperreflexia. Five general and 4 local anesthetics were used, and 12 patients received no anesthesia. Diagnostic ultrasound and amniocentesis were used selectively. Complications included autonomic hyperreflexia (9), frequent urinary tract infections, infected pressure sores (3, 2 resulting in below-knee amputations), seizures during and after delivery, pneumonia, bladder stones (2), episiotomy dehiscence (1), and breakdown of spinal fusion. The newborns were healthy, although one double footing breech vaginal delivery had an APGAR of 1 at 1 min, 7 at 5 min and 9 at 10 min. One premature baby, who weighed only 1600 g, was a precipitate birth at home unattended. Implications for the care of pregnant SCI women are discussed.

An audit of five years' experience of pregnancy in spinal cord damaged women. A regional unit's experience and a review of the literature

In a retrospective review of pregnancy and delivery in 8 spinal cord damaged women managed at Hexham General Hospital Spinal and Maternity Units between 1986 and 1991, antenatal complications included urinary tract infection, anaemia, constipation, suspected deep venous thrombosis and pressure sores. Five of the 8 patients had adductor spasms. Autonomic hyperreflexia occurred in 2 patients in the antenatal period, and in one patient in the postpartum period. Four patients were delivered by caesarean section, and 4 of the 8 patients had breech presentation of the foetus at delivery. The perinatal outcome was good.

Autonomic hyperreflexia with spinal cord injury

Autonomic hyperreflexia occurs in up to 85 percent of individuals with spinal cord injuries above the major splanchnic sympathetic outflow. In such cases, paroxysmal reflex sympathetic activity develops in response to noxious stimuli below the level of the neurologic lesion. The clinical features of autonomic hyperreflexia are due largely to reflex sympathetic adrenergic and cholinergic discharges with dysfunctional supraspinal regulatory control. Cephalgia, diaphoresis, flushing, tachycardia or bradycardia, and paroxysmal hypertension are most commonly observed. Although a variety of stimuli can provoke autonomic responses of variable magnitudes, bladder and bowel distention continue to account for most episodes. Removal of the offending stimulus is important to restoring the autonomic nervous system to its baseline activity. Current understanding of the pathophysiology, clinical features, and medical management of this fascinating but potentially serious complication of spinal cord injury are reviewed.

Pregnancy and autonomic hyperreflexia in patients with spinal cord lesions

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.

Spinal cord injured women, pregnancy and delivery

The author presents a review of his personal experience, a patient survey and literature review on 33 spinal cord injured women, who had a total of 50 deliveries.