Spinal Cord Injury and Pregnancy
There are currently over 50,000 people living with a spinal cord injury (SCI) in the UK and research published by the Spinal Injuries Association, Back Up Trust and Aspire (three of the UK’s leading spinal injury charities) show that the number of women suffering a spinal cord injury is increasing. In turn, this will lead to more women with a spinal cord injury falling pregnant.
As fertility and foetal development is not generally affected by a spinal cord injury, the positive news is that roughly 98% of these women will be able to enjoy a natural and healthy pregnancy, albeit with the usual discomforts of pregnancy.
However, there are some specific difficulties that can arise during pregnancy, which are usually exacerbations of existing complications associated with their SCI. The aim of this blog is to touch upon some of these more common complications.
The need for specialist multi-disciplinary support
In the early stages of their injury, patients with an SCI usually undergo a period of inpatient rehabilitation treatment at one of several rehabilitation centres around the country. Most patients will then have lifelong support from their rehabilitation centre, including an annual or bi-annual review.
Some pregnant women with an SCI will live close enough to a specialist centre that they will be able to easily access specialist obstetric clinics within their usual rehabilitation clinic; they may even be able to give birth at the same hospital site. However, for those who live far away, a multidisciplinary approach will be needed between the specialist and non-specialist healthcare providers to ensure each expectant mother’s individual needs are met throughout pregnancy into labour and their postnatal care.
Common complications associated with pregnancy and SCI
Autonomic Dysreflexia (AD)
Autonomic dysreflexia is a condition that is most frequently found in people with a spinal cord injury above the sixth thoracic vertebrae (T6), which is located just below the level of the shoulder blades.
During an episode of AD, blood pressure suddenly rises causing the person to suffer a range of symptoms, which can include (but are not limited to) intense headaches, sweating or blurred vision. AD is a serious condition for all those with SCI and, if left untreated, can result in stroke or death. For pregnant women, labour and the enlargement of the uterus can trigger an AD episode. This can have very serious complications for both the mother and the baby, including intracranial bleeding, a low foetal heart rate and, in the most serious of circumstances, it can even prove fatal.
Clinically, there are a lot of similarities between the symptoms of AD and a fairly common complication for all pregnancies called ‘pre-eclampsia’. Pre-eclampsia also results in high blood pressure and swelling, which can make it difficult to distinguish from AD. That said, whilst the symptoms are similar, they are treated very differently and therefore it will be vital for any obstetric team to be aware of the differences and their different approaches to treatment.
Urinary Tract Infections (UTI) and Bladder Function
Anyone with an SCI is at constant risk of UTIs throughout their life. However UTI’s are particularly prevalent in women with an SCI during pregnancy and are the most common reason for their hospitalisation. Generally, UTI’s in a pregnant mother with a SCI occur due to incomplete bladder emptying; a growing baby increases the downward pressure on the bladder restricting the volume of urine it can hold and increasing the frequency that it needs to be emptied. Such an infection can trigger early labour or, in women with an injury at T6 or higher, an AD episode. Again it will be vital for any obstetric team to be aware of this increased risk so that effective advice can be given.
Pressure sores are a common but thankfully preventable side effect of a SCI. The main cause of pressure sores is immobility. A SCI disrupts the signals between the brain and body so someone with a SCI isn’t aware that they are putting pressure on certain parts of their body.
Too much pressure for a prolonged period can reduce, or even cut off, the blood supply and this in turn injures the tissue. If left untreated, the pressure can lead to a variety of secondary complications, including sepsis and an infection. Even when they are identified early on, pressure sores are a frustrating complication that sometimes require extensive periods of bed rest.
The risk of pressure sores increases during pregnancy due to changes in weight, an altered centre of gravity and reduced mobility. The vast majority of women will be aware of the risks of pressure sores regardless and be practiced in the art of pressure relief and regular skin checking. However, the multidisciplinary approach will again be needed to ensure correct advice is given as part of their antenatal care. That said, it is also required to ensure that correct nursing care is provided by non-specialist staff in the event of any prolonged hospital admission for pregnancy or labour.
As I touched upon at the start of this blog, the above list is not an exhaustive list of all potential complications and there are additional issues that can arise. However, it hopefully does provide a brief overview of some of the more common complications. The good news for pregnant women with a spinal cord injury is that all the risks detailed above are manageable with the correct preparation and care. Although, in all cases that care will need to be multi-disciplinary in nature; sometimes within a hospital setting; sometimes across multiple NHS trusts.