Pregnancy outcomes in women with spinal cord lesions.
OBJECTIVE
Women with spinal cord lesions present special challenges during pregnancy. We studied their pregnancy outcomes with regard to medical, obstetrical, and social concerns.


METHODS
We reviewed the records of pregnant women with spinal cord injury who attended our institution between 1999 and 2009.


RESULTS
Thirty-two women with a total of 37 pregnancies were identified. Most were nulliparous (65%) with either thoracic or lumbar spinal cord lesions due to neural tube defects (69%),  trauma (19%), tumours (9%), or iatrogenic injury (3%). Most had undergone orthopedic surgery (63%) or neurosurgery (53%). The most common medical conditions were neurogenic bladder (53%), anemia (16%), autonomic hyperreflexia (9%), and elevated BMI  > 30 (6%).   Recurrent urinary tract infection occurred in 32%. Antibiotic suppression against bacteriuria was used in 35%. Antenatal hospitalization occurred in 46%, most often because of threatened preterm labour (19%).  There were 33 live births and two stillbirths (6%). Preterm birth < 37 weeks occurred in 24%. Vaginal birth occurred in 33%.


CONCLUSIONS
Pregnant women with spinal cord lesions generally have successful pregnancy outcomes. However, their pregnancies are at significant risk for preterm birth, infection, and Caesarean section. Coordinated multidisciplinary care is recommended for optimal management of these pregnancies.
Medical Disorders of Pregnancy Program, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON.
Lynn
L
Sterling
Johannes
J
Keunen
Emilie
E
Wigdor
Mathew
M
Sermer
Cynthia
C
Maxwell
D005260:Female; D006801:Humans; D009436:Neural Tube Defects / Q000150:complications; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D013118:Spinal Cord Diseases / Q000150:complications* / Q000601:surgery; D013119:Spinal Cord Injuries / Q000150:complications; D013120:Spinal Cord Neoplasms / Q000150:complications; D050497:Stillbirth / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000150:complications