CASE OF A SPINAL-CORD INJURED WOMAN WHO WISHES VAGINAL BIRTH: ASSESSMENT BY THE PHYSICAL AND REHABILITATION MEDICINE SPECIALIST.
Dr Jose ESTAY GIRARDIa, Dr Jeinner Daniel PEREIRA RESPLANDORa, Dr Miguel ARCHANCO OLCESEa
a Hospital Clinico San Carlos, Madrid, Spain.
Pregnancy in spinal cord-injured women represents a complex scenery.
A 39 year-old pregnant woman with a traumatic, complete, T9 level, 10 year-old spinal cord injury wished to have vaginal birth. Obstetric assessment by the PRM specialist included risk estimation of developing autonomic dysreflexia (low according to her spinal injury); positioning and adaption of the obstetric chair (possible because complete passive hip and knee range of motion); education of strategies to improve maternal effort during second stage of labour (peak-push technique, with thoracic and viable abdominal muscles and upper limbs anchors) and bladder-bowel regimen.
Although cervical dilation was completed, caesarean was needed for cephalopelvic disproportion. The healthy newborn weighted 4200 grams and the patient was satisfied and happy with her life experience and the care provided.
In conclusion, multidisciplinary care improves outcomes and patient’s satisfaction, even if the results are not as expected.
LIEN KC et al. Biomechanical Analyses of the Efficacy of Patterns of Maternal Effort on Second-Stage Progress. Obstet Gynecol. 2009 April ; 113(4): 873-880.
CAMUNE BD. Challenges in the management of the pregnant woman with spinal cord injury. J Perinat Neonatal Nurs. 2013 Jul-Sep;27(3):225-31
EARL GP. Autonomic dysreflexia. MCN AM J Matern Child Nurs. 2002 Mar-Apr;27(2):93-7.
Keywords : Spinal cord injury, pregnancy, labour, vaginal birth