title: Obstetric management following traumatic tetraplegia: case series and literature review.
abstract: OBJECTIVE
  Pregnancy in tetraplegia is a rare event, with only sporadic cases reported. This case series describes seven pregnancies in five tetraplegic women, all with spinal cord injuries in the region of C6.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Sydney, Australia.
  
  
  METHODS
  All tetraplegic women presenting to the obstetric service of a university teaching hospital, which also provides a regional spinal injury service, between 1981 and 2006.
  
  
  METHODS
  Hospital records of all patients were examined and information extracted regarding demographics, pregnancies and their complications, labour and delivery and neonatal data.
  
  
  METHODS
  Course, complications, management and outcomes of pregnancy in tetraplegic women.
  
  
  RESULTS
  Mean age at the time of injury was 22 years, and, at the time of pregnancy, 33 years. All patients suffered recurrent, and sometimes severe, urinary tract infections and episodes of autonomic dysreflexia during pregnancy. Frequent and sometimes lengthy hospital admissions were required for these and other reasons. Only two pregnancies required caesarean section and all entered labour spontaneously, at a mean of 37.9 weeks of gestation. Episodes of autonomic dysreflexia were aggressively managed using pre-emptive epidural anaesthesia and sublingual nifedipine. All pregnancies resulted in normal, near-term babies with no serious perinatal problems.
  
  
  CONCLUSIONS
  Pregnancy and childbirth in tetraplegic women can be undertaken safely, usually with spontaneous onset of labour and vaginal delivery. However, hospitalisation for intercurrent problems is common. Management requires a multidisciplinary approach and is best undertaken in major centres with both obstetric and spinal cord injuries medical expertise.
authors.affiliation: Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, Australia. emmasko@optusnet.com.au
authors.forename: Emma
authors.initials: E
authors.lastname: Skowronski
authors.forename: Keith
authors.initials: K
authors.lastname: Hartman
mesh_terms: D000328:Adult; D020211:Autonomic Dysreflexia / Q000453:epidemiology / Q000517:prevention & control; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D007743:Labor, Obstetric / Q000502:physiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control; D011256:Pregnancy Outcome; D011782:Quadriplegia / Q000503:physiopathology*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000503:physiopathology*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control