Clinical Analysis of 7 Cases of Pregnancy Complicated with Traumatic Spinal Cord Injury

doi:10.12280/gjfckx.20210343

Abstract

Abstract:

Objective:To investigate the clinical characteristics and pregnancy outcome of women with traumatic spinal cord injury.Methods: 7 women with spinal cord injury were examined and delivered in Xuanwu Hospital of Capital Medical University from February 2012 to June 2020. We reported the clinical characteristics and analyzed the pregnancy outcome and the management of perinatal period retrospectively.Results: All of 7 women aged 27 to 42 years. The course of disease was 3 ~ 18 years in 6 cases. One case was acute spinal cord injury caused by traffic accident during pregnancy. All 7 cases were spinal cord injury caused by trauma, and the injury level was below T6-T10. There were 5 primipara and 2 multipara patients. EPDS scores ranged from 0 to 17 in first trimester pregnancy, 3 to 27 in the second trimester, 2 to 13 in the third trimester, and 1 to 9 in puerperium. Urinary tract infection was the most common complication during pregnancy, followed by anemia, premature rupture of membrane, fetal growth restriction and gestational diabetes mellitus. The gestational age was 35⁺³-39⁺⁵ weeks. 2 cases were delivered vaginally, and one of two was delivered by forceps. 5 cases had cesarean section. Apgar score of all babies were 10 points at 1, 5, 10 min, the body weight was 2 350-3 250 g. Puerperal complications including 2 puerperal infection, 1 urinary tract infection and 1 lower limb venous thrombosis, 1 postpartum hemorrhage and 1 pneumonia. Four cases were breast-fed.Conclusions: Patients with spinal cord injury should be evaluated before pregnancy, strengthened monitering during pregnancy and supervised by multidisciplinary team. Prenatal patients should be in hospitalized earlier in order to alert to the occurrence of premature labor, and during delivery, it is of great importance to eliminate the risk of abnormal autonomic reflex. Additonally, the prevention of thrombogenesis and bedsore after delivery is crucial. Whether breastfeeding is suitable depends on the individual condition of the patients.

Key words: Pregnancy, Spinal cord injuries, Depression, Psychiatric rehabilitation, Disease management, Multidisciplinary teamwork

ZHANG Xin-hong, YU Rong, WANG Feng-ying. Clinical Analysis of 7 Cases of Pregnancy Complicated with Traumatic Spinal Cord Injury[J]. Journal of International Obstetrics and Gynecology, 2021, 48(6): 675-678.

Figures/Tables 3

References 15

[1]	Sterling L, Keunen J, Wigdor E, et al. Pregnancy outcomes in women with spinal cord lesions[J]. J Obstet Gynaecol Can, 2013,35(1):39-43. doi: 10.1016/s1701-2163(15)31046-x. doi: 10.1016/s1701-2163(15)31046-x pmid: 23343795
[2]	Tan HB, Sloan JP, Barlow IF. Improvement in initial survival of spinal injuries: a 10-year audit[J]. Injury, 2005,36(8):941-945. doi: 10.1016/j.injury.2004.06.019. doi: 10.1016/j.injury.2004.06.019 pmid: 16023908
[3]	刘根红, 周红俊, 李建军, 等. 脊髓损伤女性产前、产时、产后保健管理指南[J]. 中国康复理论与实践, 2020,26(11):1256-1262. doi: 10.3969/j.issn.1006-9771.2020.00.009. doi: 10.3969/j.issn.1006-9771.2020.00.009
[4]	符夏瑜, 陈雄, 张云志. 爱丁堡产后抑郁量表在孕晚期妇女产前抑郁筛查中的临界值分析[J]. 中国妇产科临床杂志, 2018,19(5):453-454. doi: 10.13390/j.issn.1672-1861.2018.05.025. doi: 10.13390/j.issn.1672-1861.2018.05.025
[5]	Bertschy S, Bostan C, Meyer T, et al. Medical complications during pregnancy and childbirth in women with SCI in Switzerland[J]. Spinal Cord, 2016,54(3):183-187. doi: 10.1038/sc.2015.205. doi: 10.1038/sc.2015.205 pmid: 26620876
[6]	Crane DA, Doody DR, Schiff MA, et al. Pregnancy Outcomes in Women with Spinal Cord Injuries: A Population-Based Study[J]. PM R, 2019,11(8):795-806. doi: 10.1002/pmrj.12122. doi: 10.1002/pmrj.12122
[7]	Krassioukov A, Warburton DE, Teasell R, et al. A systematic review of the management of autonomic dysreflexia after spinal cord injury[J]. Arch Phys Med Rehabil, 2009,90(4):682-695. doi: 10.1016/j.apmr.2008.10.017. doi: 10.1016/j.apmr.2008.10.017
[8]	Iezzoni LI, Chen Y, McLain AB. Current pregnancy among women with spinal cord injury: findings from the US national spinal cord injury database[J]. Spinal Cord, 2015,53(11):821-826. doi: 10.1038/sc.2015.88. doi: 10.1038/sc.2015.88 pmid: 25987000
[9]	Pannek J, Bertschy S. Mission impossible? Urological management of patients with spinal cord injury during pregnancy: a systematic review[J]. Spinal Cord, 2011,49(10):1028-1032. doi: 10.1038/sc.2011.66. doi: 10.1038/sc.2011.66 pmid: 21670736
[10]	Tollefsen E, Fondenes O. Respiratory complications associated with spinal cord injury[J]. Tidsskr Nor Laegeforen, 2012,132(9):1111-1114. doi: 10.4045/tidsskr.10.0922. doi: 10.4045/tidsskr.10.0922
[11]	Wöllner J, Krebs J, Pannek J. Sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction[J]. Spinal Cord, 2016,54(2):137-140. doi: 10.1038/sc.2015.124. doi: 10.1038/sc.2015.124 pmid: 26215913
[12]	Camune BD. Challenges in the management of the pregnant woman with spinal cord injury[J]. J Perinat Neonatal Nurs, 2013,27(3):225-231. doi: 10.1097/JPN.0b013e31829ca83f. doi: 10.1097/JPN.0b013e31829ca83f
[13]	Liu N, Fougere R, Zhou MW, et al. Autonomic dysreflexia severity during urodynamics and cystoscopy in individuals with spinal cord injury[J]. Spinal Cord, 2013,51(11):863-867. doi: 10.1038/sc.2013.113. doi: 10.1038/sc.2013.113 pmid: 24060768
[14]	Liu N, Zhou M, Biering-Sørensen F, et al. Iatrogenic urological triggers of autonomic dysreflexia: a systematic review[J]. Spinal Cord, 2015,53(7):500-509. doi: 10.1038/sc.2015.39. doi: 10.1038/sc.2015.39 pmid: 25800696
[15]	Sharpe EE, Arendt KW, Jacob AK, et al. Anesthetic management of parturients with pre-existing paraplegia or tetraplegia: a case series[J]. Int J Obstet Anesth, 2015,24(1):77-84. doi: 10.1016/j.ijoa.2014.11.001. doi: 10.1016/j.ijoa.2014.11.001 pmid: 25499809

病例	年龄（岁）	病程（年）	婚龄（年）	病因	受孕方式	损伤部位	临床表现	查体
1	42	17	20	外伤（骑马跌落）	自然受孕	T6以下	小便失禁,便秘	剑突以下痛觉、感觉消失,截瘫
2	33	8	3	外伤（车祸）	自然受孕	T10以下	小便部分可控,便秘,反复泌尿系统感染	下腹部痛觉、感觉消失,双下肢截瘫
3	28	3	4	外伤（车祸）	自然受孕	T8以下	小便失禁,大便可控	脐以下痛觉、感觉消失,双下肢截瘫
4	37	9	14	外伤（车祸）	自然受孕	T7以下	大小便失禁,长期插尿管,反复泌尿系统感染	上腹部以下痛觉、感觉消失,双下肢截瘫
5	32	9	1	外伤（车祸）	自然受孕	T8以下	小便失禁,便秘	脐以下痛觉、感觉消失,双下肢截瘫
6	27	18	3	外伤（车祸）	自然受孕	T8以下	小便失禁,便秘	脐以下痛觉、感觉消失,双下肢截瘫
7	33	0.5	0.5	妊娠3⁺个月外伤（车祸）	自然受孕	T6以下	膀胱造瘘,大便失禁	剑突以下痛觉、感觉消失,截瘫

病例	年龄（岁）	病程（年）	婚龄（年）	病因	受孕方式	损伤部位	临床表现	查体
1	42	17	20	外伤（骑马跌落）	自然受孕	T6以下	小便失禁,便秘	剑突以下痛觉、感觉消失,截瘫
2	33	8	3	外伤（车祸）	自然受孕	T10以下	小便部分可控,便秘,反复泌尿系统感染	下腹部痛觉、感觉消失,双下肢截瘫
3	28	3	4	外伤（车祸）	自然受孕	T8以下	小便失禁,大便可控	脐以下痛觉、感觉消失,双下肢截瘫
4	37	9	14	外伤（车祸）	自然受孕	T7以下	大小便失禁,长期插尿管,反复泌尿系统感染	上腹部以下痛觉、感觉消失,双下肢截瘫
5	32	9	1	外伤（车祸）	自然受孕	T8以下	小便失禁,便秘	脐以下痛觉、感觉消失,双下肢截瘫
6	27	18	3	外伤（车祸）	自然受孕	T8以下	小便失禁,便秘	脐以下痛觉、感觉消失,双下肢截瘫
7	33	0.5	0.5	妊娠3⁺个月外伤（车祸）	自然受孕	T6以下	膀胱造瘘,大便失禁	剑突以下痛觉、感觉消失,截瘫

病例	妊娠期合并症	孕/产次（次）	终止妊娠孕周（周）	手术指征	分娩方式	麻醉方式	新生儿体质量（g）	Apgar 评分（分）	产后并发症	母乳喂养
1	泌尿系统感染	5/2	39⁺⁵	无	自然分娩	无	2 800	10	无	是
2	妊娠期糖尿病,胎膜早破,反复泌尿系统感染	1/1	35⁺³	第二产程产力性难产	产钳助产	局部阻滞麻醉	3 250	10	无	是
3	轻度贫血	2/1	37⁺⁴	社会因素	剖宫产	全身麻醉	3 100	10	无	是
4	无	3/2	38⁺⁶	瘢痕子宫,臀位	剖宫产	全身麻醉	3 250	10	泌尿系统感染	是
5	胎儿生长受限,胎膜早破	1/1	36	胎儿生长受限	剖宫产	全身麻醉	2 350	10	下肢静脉血栓	无
6	中度贫血,胎膜早破	1/1	38⁺²	胎儿窘迫,羊水Ⅲ°污染	剖宫产	局部阻滞麻醉+ 静脉复合麻醉	2 550	10	产后出血,产褥感染	无
7	体质量下降,胎膜早破	1/1	36⁺³	产道尖锐湿疣	剖宫产	全身麻醉	2 430	10	肺炎,产褥感染	无

病例	妊娠期合并症	孕/产次（次）	终止妊娠孕周（周）	手术指征	分娩方式	麻醉方式	新生儿体质量（g）	Apgar 评分（分）	产后并发症	母乳喂养
1	泌尿系统感染	5/2	39⁺⁵	无	自然分娩	无	2 800	10	无	是
2	妊娠期糖尿病,胎膜早破,反复泌尿系统感染	1/1	35⁺³	第二产程产力性难产	产钳助产	局部阻滞麻醉	3 250	10	无	是
3	轻度贫血	2/1	37⁺⁴	社会因素	剖宫产	全身麻醉	3 100	10	无	是
4	无	3/2	38⁺⁶	瘢痕子宫,臀位	剖宫产	全身麻醉	3 250	10	泌尿系统感染	是
5	胎儿生长受限,胎膜早破	1/1	36	胎儿生长受限	剖宫产	全身麻醉	2 350	10	下肢静脉血栓	无
6	中度贫血,胎膜早破	1/1	38⁺²	胎儿窘迫,羊水Ⅲ°污染	剖宫产	局部阻滞麻醉+ 静脉复合麻醉	2 550	10	产后出血,产褥感染	无
7	体质量下降,胎膜早破	1/1	36⁺³	产道尖锐湿疣	剖宫产	全身麻醉	2 430	10	肺炎,产褥感染	无