Approximately 20,000 American women between the ages of 16 and 30 live with a spinal cord injury (SCI), and of those women 14% will become pregnant at least once during the course of their lifetimes. Though pregnancy can still ensue following an SCI, the risk for maternal and obstetric complications is profound, and these pregnancies are often deemed as high risk. Normal physiological changes of pregnancy can exacerbate neurological symptoms, further impede mobility and overall independence, and attribute to circulatory problems. Deep vein thrombosis, progressed muscle weakness and sensory impairment, urinary incontinence, bowel incontinence or constipation, bladder infections, autonomic dysreflexia are only a few of the maternal complications that can occur. Obstetric complications are included but are not limited to preterm labor usually resulting in early delivery and premature rupture of membranes, which pose potential health risks for the neonate. Proper management of such patients requires collaboration among various disciplines and most importantly education of the patient, family, and/or caregivers.
A 28-year-old patient, G1PO, was admitted at 26-week gestation for rule out preeclampsia. The patient presented with an increased severity and complexity of headaches with visual changes. Her blood pressures were elevated on admission. She had a history of an SCI at T9 and T10 following a motor vehicle accident resulting in spastic paraplegia. Preeclampsia was ruled out however, the patient remained hospitalized due to the complex nature of her condition and increased risk for falls. The patient had a spontaneous vaginal delivery at 32-week gestation.
Management of this patient focused on prevention of further neurologic deterioration, optimization of mobility, emotional support, prolongation of pregnancy, and maintenance of maternal and fetal well-being. This required a multidisciplinary team, including Perinatology, Neonatology, Neurology, Physical Therapy, Occupational Therapy, Nutrition, Social Work, and Nursing. Interventions included daily rounds with the medical and nursing team to discuss the status of the mother and infant. Daily education of the nursing team occurred to address specific care needs related to the patient's diagnosis. Daily assessment and communication to anticipate the patient's needs were completed by the multidisciplinary team. In turn, the collaborative efforts set forth by all members of the healthcare team attributed to safe and effective patient care and a positive outcome.