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Sexual and Reproductive Health

Pregnancy and Labour

In North America, women represent approximately 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 once their menstrual cycle resumes (Jackson & Wadley 1999). Few studies exist that specifically address women’s health and pregnancy after SCI, but they show that women with SCI are able to conceive, carry and deliver a baby despite an increased frequency of complications during pregnancy, labour and delivery (Baker & Cardenas 1996; Jackson & Wadley 1999; Morton et al. 2013; Iezzoni et al. 2015; Bertschy et al. 2016).

Author, Year; Country Score Research Design Total Sample Size

Methods

Outcome

Bertschy et al. 2016; Switzerland Retrospective Interview study
Level 5
N=17

Population: 17 women who are mothers with SCIs who gave birth over to 23 children over the last 15 years (age range= 18-54 years), mean age of SCI= 21yo, mean age of giving birth= 33yo, 13 paraplegic and 4 tetraplegics
Treatment: None. Descriptive study of the most frequent secondary medical problems during the pregnancies of women with SCI.
Outcome Measures: The questionnaire specifically asked about skin problems, bowel function, UTI frequency, mode of delivery, decubital ulcers, hospital admissions, medication changes, respiratory tract problems, and changes in neurogenic lower urinary tract dysfunction symptoms. In addition, patients were asked whether they took prophylactic measures against UTIs, decubitis, and deep vein thrombosis.

  1. All participants practiced independent bladder management. 3 women changed their bladder management techniques during pregnancy. 5 women reported an increased bladder evacuation frequency during pregnancy, and 6 women reported a new onset or increase in incontinence.
  2. 10/17 women performed prophylactic measures against deep vein thrombosis where 9/10 of them used compressive stockings. No incidences of deep vein thrombosis were diagnosed during pregnancy.
  3. 10 women were hospitalized during the course of their pregnancies. Aside from urinary tract infections/ pyelonephritis, women were hospitalized for falls, hypertension, pneumonia, preeclampsia, pre-term labour or tachycardia.
  4. Although medical complications are not infrequent during pregnancy in women with SCIs, pregnancy and delivery in this group of women are possible without posing intolerable risks to the mothers or the children.
  5. 5 women had vaginal births (1 required general anesthesia) while 11 women underwent caesarean sections (8 general and 3 epidural anesthesia).

Iezzoni et al. 2015; USA
Observational Study Level 5
N=22 (8 SCI)

Population: 22 women (34.8±5.3years); most were white, well-educated, and higher income; 8 had SCI, 4 had cerebral palsy, 10 had other conditions; 18 used wheeled mobility aids.
Treatment: None.
Outcome Measures: Interviews.

  1. Some women’s obstetricians had height adjustable examination tables, which facilitated transfers for physical examinations. Other women had difficulty transferring onto fixed height examination tables and were examined while sitting in their wheelchairs.
  2. Family members and/or clinical staff sometimes assisted with transfers; some women reported concerns about transfer safety.
  3. No women reported being routinely weighed on an accessible weight scale by their prenatal care clinicians. A few were never weighed during their pregnancies.

Iezzoni et al. 2015; USA
Observational Study Level 5
N=22 (8 SCI)

Population: 22 women (34.8±5.3years); most were white, well-educated, and higher income; 8 had SCI, 4 had cerebral palsy, 10 had other conditions; 18 used wheeled mobility aids.
Treatment: None.
Outcome Measures: Functional impairment- related complications during pregnancy.

  1. 14 had cesarean deliveries (8 elective).
  2. Impairment-related complications during pregnancy included: falls; urinary tract and bladder problems; wheelchair fit and stability problems that reduced mobility and compromised safety; significant shortness of breath, sometimes requiring respiratory support; increased spasticity; bowel management difficulties; and skin integrity problems (this was rare, but many women greatly increased skin monitoring during pregnancy to prevent pressure ulcers).
  3. Women with mobility disabilities appear to experience problems relating to their functional impairments.
  4. Pre-conception planning and in-depth discussions during early pregnancy could potentially assist women with mobility disabilities to anticipate and address these difficulties.

Iezzoni et al. 2015; USA
Cross-sectional study Level 5 N=1907

Population: 1907 women with traumatic SCI (age range=18-49 years).
Treatment: None
Outcome Measures: Data included SCI clinical details, functional impairments, participation measures, depressive symptoms, life satisfaction, and hospitalizations in the last year relating to pregnancy or its complications.

  1. 2% of participants were hospitalized during the past 12 months for a reason related to pregnancy), which differedsignificantly by the years elapsed since injury.
  2. The highest rate occurred 15 years post injury (3.7%).
  3. Younger age at injury was associated with current pregnancy (P<0.0001).
  4. Those reporting pregnancy were more likely to be married or partnered, have sport-related SCI, have higher motor scores, and have more positive psychosocial status scores.

Bladder problems, spasticity, pressure sores, autonomic dysreflexia and problems with mobility can pose a threat to the pregnant woman with SCI (Baker et al. 1992; Jackson & Wadley 1999; Skrowronski & Hartman 2008). Frequent and sometimes lengthy hospital admissions during pregnancy can occur due to these and other reasons (Skrowronski & Hartman 2008). Impairment-related complications during pregnancy may include: falls, urinary tract and bladder problems, wheelchair fit and stability problems that reduced mobility and compromised safety, significant shortness of breath sometimes requiring respiratory support, increased spasticity, bowel management difficulties, and skin integrity problems (Iezzoni et al. 2015). Although medical complications do happen during pregnancy in women with SCIs, pregnancy and delivery in this group of women are possible without posing intolerable risks to the mothers or the children (Bertschy et al. 2016). Population-based studies that determine the proportion of pregnancies and healthy births among women with or without SCI would be useful information (Horner-Johnson et al. 2016). Obstetric outcomes include higher rates of Cesarean sections and increased incidence of low birth-weight babies (Jackson & Wadley 1999; Morton et al. 2013).

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