Obstetric Management of the Patient With Spinal Cord Injury

Pregnancies in spinal cord-injured patients present unique clinical challenges to obstetric providers. Spinal cord injury (SCI) alters the function of multiple organ systems, and chronic medical conditions are extremely common in this patient population. Autonomic dysreflexia (ADR) is a potentially life-threatening complication of SCI, usually involving patients with spinal cord lesions at or above the T6 level. Intrapartum care of women with SCI is particularly complicated, and labor is the period during which ADR is most likely to arise. A multidisciplinary team in a unit capable of invasive hemodynamic monitoring should deliver these patients. Epidural anesthesia should be administered early in labor to prevent ADR. If proper precautions are taken, most patients with SCI will have successful vaginal deliveries at term. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to describe how spinal cord injury alters the function of individual organ systems, to list the medical complications associated with spinal cord injury, and to outline the signs and symptoms of autonomic dysreflexia.