Pregnancy Following a Spinal Cord Injury: Inpatient Management of a Paraplegic Patient

Background: Approximately 20,000 American women, between the ages of 16 and 30, live with a SCI and of those women;  14% will become pregnant at least once during the course their lifetime.  Although pregnancy can still ensue following a SCI, the risk for maternal and obstetrical complications is profound.  In turn, these pregnancies are often deemed as “high risk.”  Normal physiological changes of pregnancy can exacerbate neurological symptoms, further impede mobility and overall independence, and attribute to circulatory problems.  Deep Vein Thrombosis, progressed muscle weakness and sensory impairment, urinary incontinence, bowel incontinence or constipation, bladder infections, autonomic dysreflexia are only a few of the maternal complications that can occur. Obstetrical complications include, but are not limited to, preterm labor usually resulting in early delivery and premature rupture of membranes; thus attributing to potential health risks for the neonate.  Proper management of such patients requires collaboration amongst various disciplines and most importantly education of the patient, family and/or caregivers.

Case: At INOVA, we had a 28-year-old patient, G1PO, who was admitted at 26 weeks gestation for rule out preeclampsia.  The patient presented with an increased severity and complexity of headaches with visual changes.  Her blood pressures were elevated on admission.  She had a history of a SCI at T9 and T10 following a motor vehicle accident resulting in spastic paraplegia.  Preeclampsia was ruled out, however, the patient remained hospitalized due to the complex nature of her condition and increased risk for falls.  The patient had a spontaneous vaginal delivery at 32 weeks gestation.

Conclusion: Management of this patient focused on prevention of further neurologic deterioration, optimization of mobility, emotional support, prolongation of pregnancy and maintenance of maternal and fetal well-being.  This required a multidisciplinary team to include Perinatology, Neonatology, Neurology, Physical Therapy, Occupational Therapy, Nutrition, Social Work and Nursing.  Interventions included daily rounds with the medical and nursing team to discuss the status of the mother and baby.  Daily education of the nursing team occurred to address specific care needs related to the patient’s diagnosis.  Daily assessment and communication to anticipate the patient’s needs were completed by the multidisciplinary team.  In turn, the collaborative efforts set forth by all members of the healthcare team attributed to safe and effective patient care and a positive outcome.

Keywords: Spinal Cord Injury, Paraplegia, Multidisciplinary, Pregnancy, Maternal, Fetal