[Pregnancy, labor and the puerperium in paraplegic patients]

Due to better care and better knowledge pregnancies in paraplegic patients nowadays have a good prognosis. We report on 16 deliveries in 13 paraplegic or tetraplegic patients. To minimise the danger of possible further damage it is important to know about the special problems associated with pregnancies in paraplegic mothers. It is particularly important to know about the elevated risk of premature labour and the risk of autonomic hyperreflexia in lesions above D7. To prevent urogenital infections, patients should try to keep the genital region clean and try to empty the bladder as completely as possible. Intermittent catheterisation might be necessary. One should try to prevent decubital ulcers, and therefore an eventual anaemia (below 80%) should be corrected by transfusions. The patients should be instructed how uterine contractions can be palpated manually because sometimes perception of contractions in other ways is not possible. Repeated examinations of the cervix also help to prevent premature birth. Hospitalisation of the mother two to three weeks before the expected date of birth is suggested. If the lesion is higher than D7, symptoms of autonomic hyperreflexia (bradycardia and rise of blood pressure with the risk of cerebral haemorrhagia) are almost always present when labour starts. To prevent this possibly life-threatening complication, early application of epidural anaesthesia is suggested. There is no contraindication to spontaneous delivery. Vacuum extraction or forceps are necessary more frequently. In the post-partal period, prophylaxis of decubital ulcers is important. Breast feeding is not influenced.