Obstetric Management of Patients with Spinal Cord Injuries: ACOG Committee Opinion Summary, Number 808.

Obstetric Management of Patients with Spinal Cord Injuries: ACOG Committee Opinion Summary, Number 808. Obstet Gynecol. 2020 May;135(5):1247-1249 Authors: Abstract Approximately 17,730 new spinal cord injuries (SCIs) occur per year in the United States. Effective rehabilitation and modern reproductive technology may increase the number of these patients considering pregnancy. Obstetrician-gynecologists and other obstetric care professionals who care for such patients should be familiar with problems related to SCIs that may occur throughout pregnancy and during the postpartum period. Autonomic dysreflexia (sometimes called autonomic hyperreflexia) is the most serious medical complication that occurs in women with SCIs and is found in 85% of patients with lesions at or above T6 level. It is important to avoid stimuli that can lead to autonomic dysreflexia, such as distension or manipulation of the vagina, bladder, urethra, or bowel. Women with SCIs may give birth vaginally. Although pain perception is impaired in women with SCIs at or above T10, neuraxial anesthesia is the treatment of choice to reduce the risk of autonomic dysreflexia because it blocks neurologic stimuli arising from the pelvic organs. Adequate anesthesia, spinal or epidural if possible, is needed for cesarean births in all patients with SCIs. In addition to routine postpartum care, obstetrician-gynecologists and other obstetric care professionals should ensure that perineal and cesarea...
Source: Obstetrics and Gynecology - Category: OBGYN Tags: Obstet Gynecol Source Type: research

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