N Galusca1, K Charvier2, F Courtois3, G Rode4, R C Rudigoz5, A Ruffion6. 1. Service d'urologie, CHU de Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne, France; Service de rééducation neuropérinéale et sexologique, hôpital Henry-Gabrielle, hospices civils de Lyon, 69230 Saint-Genis-Laval, France. Electronic address: nargisse.talji@etu.univ-st-etienne.fr. 2. Service de rééducation neuropérinéale et sexologique, hôpital Henry-Gabrielle, hospices civils de Lyon, 69230 Saint-Genis-Laval, France. 3. Department of sexology, université du Québec, CP 8888 succursale centre-ville, H3C 3P8 Montreal, Quebec, Canada. 4. Service de médecine physique et réadaptation, hôpital Henry-Gabrielle, 69230 Saint-Genis-Laval, France. 5. Service de gynécologie-obstétrique, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon cedex 4, France. 6. Service d'urologie, centre hospitalier Lyon Sud, hospices civils de Lyon, 69495 Pierre-Bénite, France.
Abstract
OBJECTIVE: More and more women with spinal cord injury (SCI) can have a pregnancy. Few data have been published on these pregnancies and their urological impact. We report a series of these cases illustrating the urological experience of specialized centers. METHODS: This is a retrospective study that identified pregnancies in women with SCI followed-up between 2000 and 2014. Data covering all urological and obstetric events during pregnancies, before and after implementation of weekly oral cyclic antibiotics (WOCA) program, were collected from medical records. RESULTS: Fifteen women with SCI who gave birth to 20 children were included. Three of them were quadriplegics and 12 were paraplegics. All of them performed themselves intermittent catheterization: 11 by urethral way and 4 by high way because carrying a continent cystostomy. Mean follow-up period before pregnancy was 14.6 years [3-27 years IC 95%] and the mean follow-up for the study was 8.5 months [6.5-9 IC 95%]. We observed a reduction of symptomatic urinary tract infections after WOCA onset (13/13 before vs. 0/7 after, P=0.001), a reduction of recurrent urinary infections (6/13 vs. 0/7, P=0.03), a reduction of threats to premature births (8/13 vs. 0/7, P=0.001). Multi-resistant bacteria appeared to increase (0/13 vs. 3/7, P=0.01). We also observed a trend to significant reduction of premature births number (4/13 vs. 0/13, P=0.1) and that of low birth weight (3/13 versus 0/7, P=0.1). The overall neonatal survival rate was 100%. CONCLUSION: Our study before/after introduction of a weekly oral cycle antibiotic prophylaxis during pregnancy for women with spinal cord injury showed a significant reduction in symptomatic urinary tract infections and a tendency to improve pregnancy outcomes. LEVEL OF EVIDENCE: 4.
OBJECTIVE: More and more women with spinal cord injury (SCI) can have a pregnancy. Few data have been published on these pregnancies and their urological impact. We report a series of these cases illustrating the urological experience of specialized centers. METHODS: This is a retrospective study that identified pregnancies in women with SCI followed-up between 2000 and 2014. Data covering all urological and obstetric events during pregnancies, before and after implementation of weekly oral cyclic antibiotics (WOCA) program, were collected from medical records. RESULTS: Fifteen women with SCI who gave birth to 20 children were included. Three of them were quadriplegics and 12 were paraplegics. All of them performed themselves intermittent catheterization: 11 by urethral way and 4 by high way because carrying a continent cystostomy. Mean follow-up period before pregnancy was 14.6 years [3-27 years IC 95%] and the mean follow-up for the study was 8.5 months [6.5-9 IC 95%]. We observed a reduction of symptomatic urinary tract infections after WOCA onset (13/13 before vs. 0/7 after, P=0.001), a reduction of recurrent urinary infections (6/13 vs. 0/7, P=0.03), a reduction of threats to premature births (8/13 vs. 0/7, P=0.001). Multi-resistant bacteria appeared to increase (0/13 vs. 3/7, P=0.01). We also observed a trend to significant reduction of premature births number (4/13 vs. 0/13, P=0.1) and that of low birth weight (3/13 versus 0/7, P=0.1). The overall neonatal survival rate was 100%. CONCLUSION: Our study before/after introduction of a weekly oral cycle antibiotic prophylaxis during pregnancy for women with spinal cord injury showed a significant reduction in symptomatic urinary tract infections and a tendency to improve pregnancy outcomes. LEVEL OF EVIDENCE: 4.
Authors: H Le Liepvre; A Dinh; B Idiard-Chamois; E Chartier-Kastler; V Phé; A Even; G Robain; P Denys Journal: Spinal Cord Date: 2016-09-27 Impact factor: 2.772