Spinal Muscular Atrophy Type II - Implications in Pregnancy and Cesarean Delivery
Title: Spinal Muscular Atrophy Type II - Implications in Pregnancy and Cesarean Delivery
- Define spinal muscular atrophy
- Identify risks associated with spinal muscular atrophy and multiple systems affected
- Discuss specific plan of care and interdisciplinary needs for anesthesia, cesarean section and post operative care/pain management
H.A is a 29 year old G3P1111 who presented for a repeat Cesarean section on April 10, 2013. Her case was significant for a history of Spinal Muscular Atrophy II (SMA II), resulting in bilateral lower extremity contractures, surgical rods in spine, severe scoliosis and chronic pain. The patient had no use of her lower extremities and was wheelchair bound. This case study will examine care provided and complications addressed for an expectant mother who was previously diagnosed with SMA II.
Case:
A multi-disciplinary team, consisting of Anesthesia, Maternal Fetal Medicine and Neonatology, identified evidence based interventions based on H.A`s extensive medical history, prenatal records and phone interview. Discussion will include the pre-operative testing and education provided, inpatient plan of care and post operative outcomes. We will focus on H.A.’s Spinal Muscular Atrophy with chronic pain and neuro musculoskeletal complications and how it affects the pregnancy development and outcome.
Conclusion:
H.A. gave birth to a baby girl weighing 4lbs 6 ounces via C-section and assigned APGARs of 1/1/3. A Pediatric team was in attendance at birth and provided bedside resuscitation and intubation. Baby was transferred to NICU for admission. H.A recovered in our Peri-op area with an increased need for pain medicines but recovered appropriately and was transferred to the Postpartum Unit for the remainder of her hospital admission.
Keywords: Spinal muscular atrophy, neuro muscular degeneration, chronic pain