Riina Jernman1, Antti Väänänen2, Hanna-Riikka Kreivi3. 1. Helsinki University Hospital, Obstetrics and Gynecology, Helsinki, Finland. riina.jernman@hus.fi. 2. Helsinki University Hospital, Anesthesiology and Intensive Care, Helsinki, Finland. 3. Helsinki University Hospital, Heart and Lung Center, Pulmonary Medicine, Helsinki, Finland.
Abstract
INTRODUCTION: Pregnancies are rare in patients with severely disabilitating spinal cord injuries (SCI) but increasing alongside social awareness concerning reproductive equality. Physicians should be aware of several potential complications during pregnancy and delivery, particularly autonomic dysreflexia. CASE PRESENTATION: We report a successful pregnancy of a 32-year-old woman with a severe SCI at the C2 level (C1-4 ASIA Impairment Scale grade A) and total dependency on home invasive mechanical ventilation (HIMV), an extremely rare treatment. An elective cesarean section was chosen as the delivery mode at 34 + 0 weeks of gestation. Both the mother and the child recovered well. DISCUSSION: Severe spinal cord injury and dependency on mechanical ventilation are not absolute contraindications for pregnancy. With careful planning, pregnancy is possible also for patients with the most severe forms of SCI. Adequate pain relief during cesarean delivery is required despite complete spinal cord injury in order to avoid excessive hemodynamic responses and spinal reflexes. A multidisciplinary team is needed to ensure safe pregnancy and delivery of these high-risk pregnancies.
INTRODUCTION: Pregnancies are rare in patients with severely disabilitating spinal cord injuries (SCI) but increasing alongside social awareness concerning reproductive equality. Physicians should be aware of several potential complications during pregnancy and delivery, particularly autonomic dysreflexia. CASE PRESENTATION: We report a successful pregnancy of a 32-year-old woman with a severe SCI at the C2 level (C1-4 ASIA Impairment Scale grade A) and total dependency on home invasive mechanical ventilation (HIMV), an extremely rare treatment. An elective cesarean section was chosen as the delivery mode at 34 + 0 weeks of gestation. Both the mother and the child recovered well. DISCUSSION: Severe spinal cord injury and dependency on mechanical ventilation are not absolute contraindications for pregnancy. With careful planning, pregnancy is possible also for patients with the most severe forms of SCI. Adequate pain relief during cesarean delivery is required despite complete spinal cord injury in order to avoid excessive hemodynamic responses and spinal reflexes. A multidisciplinary team is needed to ensure safe pregnancy and delivery of these high-risk pregnancies.