Pregnancy in spinal cord-injured women, a cohort study of 37 pregnancies in 25 women.
METHODS
A retrospective observational study.


OBJECTIVE
To describe specificities of pregnancy in a traumatic spinal cord-injured (SCI) population managed by a coordinated medical care team involving physical medicine and rehabilitation (PMR) physicians, urologists, infectious diseases' physicians, obstetricians and anaesthesiologists.


METHODS
NeuroUrology Department in a University Hospital, France.


METHODS
All consecutive SCI pregnant women managed between 2001 and 2014 were included. A preconceptional consultation was proposed whenever possible. Obstetrical and urological outcomes, delivery mode and complications were reported.


RESULTS
Overall, thirty-seven pregnancies in 25 women, of a mean age of 32±4 years, were included. Thirty-five children were born alive (three miscarriages, a twin pregnancy) without complications except for a case of neonatal respiratory distress in premature twins born at 33 weeks. The mean birth weight was 2979±599 g. Twenty-one (57%) pregnancies benefited from preconceptional care. A weekly oral cyclic antibiotic programme was prescribed in 28 (75%) pregnancies. The main complications during pregnancy included pyelonephritis (30%), lower urinary tract infections (UTI) (32%), pressure sores (8.8%) and prematurity (12% deliveries before 37 weeks, with only one delivery before 36 weeks). Two patients suffered from autonomic dysreflexia, one with serious complication (brain haematoma). Caesarean sections were performed for 68% of deliveries (23/34) to prevent syringomyelia deterioration (n=10), stress urinary incontinence aggravation (n=3) or for obstetrical reasons (n=7).


CONCLUSIONS
Mothers' and infants' outcomes were satisfying after pregnancy in SCI women, but required many adjustments. Pregnancy must be prepared by a preconceptional consultation, and managed by a multidisciplinary team involving specialists of neurological disability and pregnancy.
PMR Department, Hôpital Raymond Poincare, Paris Ile de France Ouest University, Garches, France.|PMR Department, Hôpital Rothschild, Pierre and Marie Curie University, Paris, France.
H
H
Le Liepvre
Infectious Diseases Department, Hôpital Raymond Poincare, Paris Ile de France Ouest University, Garches, France.
A
A
Dinh
Department of Obstetrics, Institut Mutualiste Montsouris, Paris, France.
B
B
Idiard-Chamois
Urology Department, Hôpital Pitié Salpétrière, Pierre and Marie Curie University, Paris, France.
E
E
Chartier-Kastler
Urology Department, Hôpital Pitié Salpétrière, Pierre and Marie Curie University, Paris, France.
V
V
Phé
PMR Department, Hôpital Raymond Poincare, Paris Ile de France Ouest University, Garches, France.
A
A
Even
PMR Department, Hôpital Rothschild, Pierre and Marie Curie University, Paris, France.
G
G
Robain
PMR Department, Hôpital Raymond Poincare, Paris Ile de France Ouest University, Garches, France.
P
P
Denys
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy
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