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Obstetric management of patients with spinal cord injury
Publication year - 1993
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/0020-7292(93)90640-i
Subject(s) - medicine , obstetrics and gynaecology , citation , spinal cord injury , family medicine , gynecology , obstetrics , spinal cord , pregnancy , library science , psychiatry , genetics , computer science , biology
Approximately 11,000 new spinal cord injuries (SCIs) are reported per year in the United States. More than 50% occur in persons between 15 and 25 years of age, and women constitute approximately 15% of these cases. Effective rehabilitation and modem reproductive technology may increase the number of these patients considering pregnancy. It is important that obstetricians caring for patients with SC1 acquaint themselves with problems related to SC1 that may occur throughout pregnancy. Ideally, women with SC1 should have an appropriate preconceptional evaluation. Both partners should be interviewed together, and they should be counseled regarding the anticipated course and outcome of pregnancy. Chronic medical conditions and the woman’s adaptation to her disability must be evaluated. Baseline pulmonary and renal function studies may be appropriate if not performed previously. Family planning should be discussed. It should be recognized that fertility in these patients is usually not affected by their condition. Experience has shown that women with complete transverse lesions, including those who are quadriplegic, can give birth vaginally; cesarean delivery is rarely necessary except for obstetric indications. Knowledge of the patient’s lesion and the clinical course of her pregnancy may help predict problems that may arise during childbirth. Common problems are anemia (which occurs in 63% of women with SCI), urinary tract infections (which occur in SO%), and pressure sores (which occur in 26%). Patients with high thoracic or cervical lesions may require ventilatory support during late pregnancy or labor.