Pregnancy in Spinal Cord Injury Presentation Copy

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Pregnancy In Spinal CordInjury

Review Article

Baker, Cardenas.Arch PhysMed Rehail. !""#



• $itle % Pregnancy In SCI &o'en

• $ype % Review article

•

Method % Su''ary o( pulications(ro' Medline

• Retrospective reports o( clinical

e)perience.• *u'er o( patients range (ro' # + "



• -irst part discussion on SCI duringpregnancy

•

enerally outco'e is good (or 'otherand ay

• Issues addressed %

!. Risk o( ano'alies and spontaneous aortion

. Maternal trau'a and e/ect on (etus

0. Sedation and anesthesia in pregnant wo'en

1. Radiation e)posure to (etus

2. Surgical staili3ation o( spinal (racture#. 4rthosis in 0rd tri'ester pt

5. Positioning and ventilation in 0rd tri'ester



Pregnancy in &o'en withSCI

•

6nderstand nor'al physiologicalchanges in pregnancy

• 7ighlight di/erences o( these

physiological changes in a pt withSCI

• All syste' organs are involved



Issues

!. 6$I

. Ane'ia

0. Spasticity

1. 8eciitus ulcers

2. 89$ : P;

#. Pul' -unction

5. A8<. *eurogenic owel

". *eurogenic ladder



6$I

asy'pto'atic acteriuria

=

Pyelonephritis=

Sepsis : AR8S

Preter' laour



Manage'ent o( neurogenic ladder

• -re>uent urine cultures

• Prophyla)is antiiotics should econsidered

• Mini'i3ing residual urine volu'es

• 6se o( CB8 once di?cult CISC



Ane'ia

• I'portant in SCI ecause o( @ risk o(decuitus ulcer

• ;nteral iron supple'ents can causeconstipation

• 8i?culty in owel evacuation



Spasticity

• Can increase in pregnancy

• Can cause 'ore disco'(ort

•

Increased spasticity can be asymptom of labour.

• Sa(e to use aclo(en ,

datrolene sodiu'



89$ and P;

• 7ypercoagulale state in pregnancy

• I''oility o( SCI pt

•

Bilat ede'a present nor'ally'akes diagnosis di?cult

• &hen to start 89$ prophyla)is

+ pt with prior 89$ on 4CP

• Change in ede'a D look (or 89$

• Sa(e % heparin E ) cross placentaF



Pul'. -unction

• I'pacts pt with orderline resp(unction E in high thoracic or cervicalSCIF

• &orsen in supine lying

• &orsens as pregnancy progress

• Monitoring % serial 9C

• Assisted ventilation i( 9C G !2'kg



A8

• Can have A8 throughout pregnancy

• I'portant to re'e'er it can e)tendpostpartu' and during nursing

• It is a sign o( labour

• 8oes A8 a/ect (etus

H -7R tracings anor'alut no (etal distress



• 8i/erential diagnosis includes

preeclamsia• Manage'ent D

Imp : avoid hypoT → fetal

compromise



8rugs used in A8

• Re'ove no)ious sti'uli

• Phar'aco therapy H verapa'il,ni(edipine, hydrala3ine E no efect onuterus perusionF.

• Regional anes

• eneral anes

• Best treatment for AD %

regional anes



Case discussion•

5 year old had SCI on March !• sustained urst J $1+$2 , C0 and $0

co'pression J including le(t rachialple)us injury,

• spinal stailisation done and is now T4ASIA A.

• 7as een 'arried (or ! year, a(ter

which she sustained an M9A andeca'e paraplegic with right rachialple)us injury.



• A(ter SCI she had relationship issueswith her husand and reconciled !year a(ter injury.

• $hey were se)ually active since -e! and success(ully conceived inMay !.

• MP % !2.2.!.

• She has never een on anycontraception e(ore this .



Her current problems are

!. Neurogenic bladder %

currently on CISC 1+# hourly, ultrasound done on52! shows traeculated ladder ut no calculior hydrocephalus.

68S done in ! shows (airly stale ladder with

leaking at cc volu'e, as she has (re>uent A8episodes detrusitol 'g was started.

2. Neurogenic bowel H 'anual evacuationthrough digital sti'ulation done.

0. Hypertyroidism H 'edication stoppedy physician last year E now euthyroidF.

1. !ecurrent AD + *ot re>uiringhospitalisation.



&hat have we done so (ar%

• stopped detrusitol

• advised (or strict Clean CISC 1 hourly ut shehad A8 sy'pto's and re>uires CISC every 0hours.

• She was also (ound to have 6$I at !5 weeksP4 and started on $. 6nasyn (or weeks astreatment and prophylaxis.

•

It was decided that she e on CB8 in view o(di?culty per(or'ing CISC due to gravid uterusand (re>uent CISC. She also has increased Kuidintake due to thirst.



More prole's

• diagnosed to have 8M at !# weekP4 and is advised diet control.

• She has (a'ily history o( 8M →her'other, her sister also had 8M :PI7 re>uiring 'ultiple ad'issions.

• She has een counselled on dietcontrol and signs o( hyper andhypoglyce'ia.



Counseling

• She was counselled on pressure ulcerprevention, signs o( A8, signs o( 89$, signs o(6$I.

•

e)plained that she has ↑ risk o( recurrent 6$I,89$, constipation,

• Pressure relie( 'ore o(ten as pressuredistriution changes with gravid uterus,

•

Signs o( laour + ↑ A8, ↑ spas's, palpate uterus• told o( @ risk o( pre'ature laour i( she has

recurrent 6$I and co'plicated with 8M.



Plans

• high risk pregnancy

• 'ay re>uire early ad'ission E0weeks onwardsFand (re>uent'onitoring o( C$.

• She will have to have an elective c-section

• ;ither ;pidural A



Luestions

!. Can A8 have an e/ect on thegrowing uterus

. 8i/erential diagnosis o( A8 inpregnancy

0. *eed (or e>uip'ent during laterstages o( pregnancy

1. 7ow to watch out (or signs o(laour

2. Risk o( preter' laour H in SCI :

8M



More >uestions

!. $ea's involved in the laour ande)perience in handling such cases

. Regional anes (or A8 , when and which

level0. Risk o( ano'aly in ay

1. Postpartu' care and co'plications o(persistent A8, change in ladder (unctions

2. Prole's with reast(eeding

#. Support and care o( ay at ho'e



oals



4ther re(erences %

!. &anner et al. "regnancy and autonomicyperre#e$ia in patients wit spinal

cord lesions, Paraplegia 2 E!"<5F 1<+1"

. eland at el. "regnancy following spinalcord in%ury . Rehailitation 'edicine+

adding li(e to years E special issueF. &est Med !""! May% !21, #5+#!!.

0. 8eisaNs te)took.

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Pregnancy in Spinal Cord Injury Presentation Copy

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