Spinal cord injury (SCI) resulting in paraplegia in pregnancy is rare and alters the function of multiple organ systems. The obstetric management and nursing care of these women present specific challenges requiring a multidisciplinary approach for maternal and fetal health.
A 24-year-old G2P0 patient was transferred to our high-risk antenatal unit at 29-week gestation from a rehabilitation facility. Her history indicated a gunshot wound sustained at 15 weeks resulting in paraplegia at level T3 T4. She had severe neuropathic pain control issues controlled with narcotics; neuropathic bowel and neuropathic bladder complicated by urinary tract infections. A Foley catheter was in place with Macrobid for suppression. She was on deep vein thrombosis (DVT) prophylaxis. She had been started on Baclofen for increased muscle tone, as well as multiple medications for gastrointestinal prophylaxis. She had a history of depression/anxiety and was being assessed for posttraumatic stress disorder. She was admitted for preterm labor monitoring and the potential for associated autonomic dysreflexia (ADR).
A multidisciplinary team met multiple times to plan and manage her care. She challenged the obstetric nursing staff with unfamiliar rehabilitation regimens. Educational materials were compiled to provide information on her multiple medications, as well as the pathophysiology, signs, symptoms, and treatment for ADR. She was initially quite depressed over her transfer from rehab and refused patient care assistant help. Several primary nurses were scheduled to facilitate her care. Fetal surveys showed a normally developing fetus. She presented to labor and delivery (L&D) at 31.5 weeks with signs of preterm labor and concern for ADR. Her blood pressure remained normotensive and she returned to antepartum. At 33.5 weeks, she returned to L&D for labor management. She was given an epidural for prevention and management of ADR. She had a forceps assisted vaginal delivery. She was discharged to rehab on postpartum day 4. Her infant remained in the neonatal intensive care unit for treatment of prematurity and withdrawal.
There is little current literature on the care of the pregnant patient with SCI. Nurses serve a crucial role in the facilitation of a multidisciplinary approach to care these complicated patients. Understanding the chronic medical conditions as well as the potentially life-threatening complication of ADR will allow obstetric nurses to provide optimal care to patients with SCI during pregnancy and delivery.