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Autonomic hyperreflexia: A mortal danger for spinal cord-damaged women in labor

  • James A. McGregor
    Correspondence
    Reprint requests: James A. McGregor, M.D.C.M., University of Colorado Health Sciences Center, 4200 E. 9th Ave., Box B198, Denver, Co 80262.
    Affiliations
    Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver, USA

    St. Mary-Corwin Hospital Pueblo, Colorado, USA
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  • James Meeuwsen
    Affiliations
    Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver, USA

    St. Mary-Corwin Hospital Pueblo, Colorado, USA
    Search for articles by this author
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      Abstract

      Reproductive care of women with spinal cord damage demands knowledge of such women's reproductive potential and the specific complications to which these women are prone during pregnancy and childbirth, especially autonomic hyperreflexia. Fertility in cord-damaged women of reproductive age is generally undiminished as are libido, ability to have intercourse, and ability to bear children. Frequent complications of cord-damaged pregnant women include urinary tract infection, anemia, pressure sores, sepsis, unattended birth, and autonomic hyperreflexia. Autonomic hyperreflexia or autonomic dysreflexia occurs during labor in up to two thirds of women with cord lesions above T-6. Autonomic hyperreflexia results from noxious stimuli including distention of the bladder, cervix, or rectum, which evokes mass triggering of sympathetic and parasympathetic afferents that are uninhibited by supraspinal centers below the cord lesion. Autonomic hyperreflexia manifests itself with sudden onset of marked hypertension and headache during uterine contractions, as well as bradycardia or tachycardia, various cardiac dysrhythmias, and marked diaphoresis with piloerection and flushing above the level of the cord lesion. We describe the second reported occurrence of intraventricular hemorrhage due to autonomic hyperreflexia during labor and detail recommendations for anticipating and mitigating this potentially lethal complication of parturition in cord-damaged women. Pregnancy and parturition are best carried out with informed cooperation of the patient and of obstetric, cord rehabilitation, anesthetic, and nursing personnel.

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      References

        • Comarr AE
        Observations on menstruation and pregnancy among female spinal cord injury patients.
        Paraplegia. 1975; 3: 63
        • Fitzpatrick WF
        Sexual function of the paraplegic patient.
        Arch Phys Med Rehabil. 1974; 55: 221
        • Silver JR
        Sexual problems and disorders of the nervous system.
        Br Med J. 1972; 2: 480
        • Goller H
        • Paeslack V
        Pregnancy damage and complications of paraplegic women.
        Paraplegia. 1972; 10: 213
        • Ohry A
        • Pelleg D
        • Goldman J
        • et al.
        Sexual function, pregnancy, and delivery in spinal cord injured women.
        Gynecol Obstet Invest. 1978; 9: 281
        • Goller H
        • Paeslack V
        Our experience about pregnancy and delivery of the paraplegic woman.
        Paraplegia. 1970; 8: 161
        • Dickinson FT
        Paraplegia in pregnancy and labor: report of a case and review of the literature.
        J Am Osteopath Assoc. 1977; 76: 537
        • Rossier AB
        • Ruffieux M
        • Ziegler WH
        Pregnancy and labor in high traumatic cord lesions.
        Paraplegia. 1971; 7: 210
        • Verduyn WH
        Spinal cord injured women: pregnancy and delivery.
        in: International Medical Society of Paraplegia, Denver, ColoradoJune, 1984
        • Head H
        • Riddoch J
        The autonomic bladder, excessive sweating, and similar other reflex conditions in gross injuries of the spinal cord.
        Brain. 1917; 40: 188
        • Guttman L
        • Whiteridge D
        Effects of bladder distension on autonomic mechanisms after spinal cord injuries.
        Brain. 1947; 70: 361
        • Kurnic NB
        Autonomic hyperreflexia and its control in patients with spinal cord lesions.
        Ann Intern Med. 1976; 44: 678
        • Thompson CE
        • Witham AC
        Paroxysmal hypertension and spinal cord injuries.
        N Engl J Med. 1948; 239: 291
        • Saunders B
        • Yeo J
        Pregnancy and quadriplegia—the problem of autonomic dysreflexia.
        Aust NZ J Obstet Gynaecol. 1968; 8: 152
        • Abouleish E
        Hypertension in a paraplegic parturient.
        Anesthesiology. 1980; 53: 348
        • Young BK
        • Katz M
        • Klein SA
        Pregnancy after spinal cord injury: altered maternal and fetal response to labor.
        Obstet Gynecol. 1983; 62: 59
        • Robertson DN
        Pregnancy and labor in the paraplegic.
        Paraplegia. 1972; 10: 209
        • Watson DW
        • Downey GO
        Epidural anesthesia for labor and delivery of twins of a paraplegic mother.
        Anesthesiology. 1980; 52: 259
        • Ciliberti BJ
        • Golfein J
        • Robenstein EA
        Hypertension during anesthesia in patients with spinal cord injury.
        Anesthesiology. 1954; 15: 273
        • Tabsh KMA
        • Brinkman CR
        • Ref RA
        Autonomic dysreflexia in pregnancy.
        Obstet Gynecol. 1982; 16: 119
        • Young JS
        Use of guanethidine for the control of sympathetic hyperreflexia in persons with cervical and thoracic cord lesions.
        Arch Phys Med Rehabil. 1963; 44: 204
        • Basta JW
        • Nlejadlik K
        • Pallares B
        Autonomic hyperreflexia: intraoperative control with Pentolinium tartrate.
        Br J Anaesth. 1977; 49: 1087
        • Texter JH
        • Reece RW
        • Hranowsky W
        Pentolinium in the management of hyperreflexia.
        J Urol. 1956; 106: 350
        • Ravindran RS
        • Cummings DF
        • Smith IE
        Experience with the use of nitroprusside and subsequent epidural anesthesia in the pregnant quadriplegic patient.
        Anes Analg. 1981; 60: 61