[Paraplegia and pregnancy]

Abstract

Objectives: To describe the characteristics of the management of pregnancy and child birth in women with spinal cord injury.

Materials and methods: Retrospective cohort study including paraplegics patients with motor deficit (whatever the etiology) who gave birth at the University Hospital of Toulouse between March 2003 and March 2014 (11 years). Monitoring and outcome of pregnancy were studied.

Results: Seventeen deliveries (15 patients) were performed on a total of 46,888 in the studied period (prevalence=0.4‰). All patients had urinary tract infections: lower urinary tract (100%), recurrent cystitis (75%), pyelonephritis (31.3%). One patient (6.3%) presented dysautonomia during pregnancy. The cesarean rate was 47% (the indication was in any case an obstetrical reason). Among vaginal deliveries, four (44%) required an instrumental extraction. Epidural analgesia was the method of choice in the absence of contraindication.

Conclusion: Pregnancy associated with spinal cord injury requires a multidisciplinary approach. Autonomic hyperreflexia syndrome must be known and can be avoided by epidural analgesia in early labor. Vaginal delivery should be the rule.

Keywords: Accouchement; Analgésie péridurale; Autonomic hyperreflexia; Delivery; Dysautonomie; Epidural analgesia; Grossesse; Paraplégie; Pregnancy; Spinal cord injury.