Prevention of AD During Pregnancy and Labour
In North America, women represent a third of the SCI population (Ackery et al. 2004). Approximately 3,000 American women of childbearing age are affected by SCI (Cross et al. 1992). The ability of women to have children is not usually affected by SCI once their menstrual cycle resumes (Jackson & Wadley 1999), and there are increasing numbers of women with SCI who have healthy babies (Cross et al. 1992). However, during labour and delivery, women with SCI are at high risk of developing uncontrolled AD (Sipski, 1991; Sipski & Arenas 2006). Thus, recognition and prevention of this life-threatening emergency is critical for managing labour in women with SCI (McGregor & Meeuwsen 1985). The majority of women with SCI above T10 experience uterine contractions as only abdominal discomfort, an increase in spasticity, and AD (Hughes et al. 1991).
Discussion
Numerous observational studies, case reports, and expert opinions recommend adequate anesthesia for women with SCI during labour and delivery, despite the apparent lack of sensation. However, there are only six studies (Cross et al. 1992;Hughes et al. 1991; Cross et al. 1991; Ravindran et al. 1981; Skowronski & Hartman 2008; Sharpe et al. 2015) with observational evidence recording the management specific to AD during labour. The American College of Obstetrics and Gynecology (2002) emphasized the importance of obstetricians being aware of the specific problems related to SCI.
Conclusion
There is level 4 evidence (from one case-series) (Cross et al. 1992) that women with SCI may safely give birth vaginally. With vaginal delivery or when Caesarean or instrumental delivery is indicated, adequate anaesthesia (spinal or epidural if possible) is needed to reduce the episodes of AD associated with birth.
There is level 4 and 5 evidence (from 3 case series and 2 observational studies) (Cross et al. 1992; Hughes et al. 1991; Cross et al. 1991; Skowronski & Hartman 2008; Sharpe et al. 2015) that epidural anaesthesia is preferred and effective for most patients with AD during labour and delivery.
