Helsinki University Hospital, Obstetrics and Gynecology, Helsinki, Finland.
Helsinki University Hospital, Anesthesiology and Intensive Care, Helsinki, Finland.
Spinal Cord Ser Cases. 2022 Jun 28;8(1):62. doi: 10.1038/s41394-022-00528-4.
Pregnancies are rare in patients with severely disabilitating spinal cord injuries (SCI) but increasing alongside social awareness concerning reproductive equality. Physicians should be aware of several potential complications during pregnancy and delivery, particularly autonomic dysreflexia.
We report a successful pregnancy of a 32-year-old woman with a severe SCI at the C2 level (C1-4 ASIA Impairment Scale grade A) and total dependency on home invasive mechanical ventilation (HIMV), an extremely rare treatment. An elective cesarean section was chosen as the delivery mode at 34 + 0 weeks of gestation. Both the mother and the child recovered well.
Severe spinal cord injury and dependency on mechanical ventilation are not absolute contraindications for pregnancy. With careful planning, pregnancy is possible also for patients with the most severe forms of SCI. Adequate pain relief during cesarean delivery is required despite complete spinal cord injury in order to avoid excessive hemodynamic responses and spinal reflexes. A multidisciplinary team is needed to ensure safe pregnancy and delivery of these high-risk pregnancies.
患有严重致残性脊髓损伤 (SCI) 的患者妊娠较为罕见，但随着社会对生殖平等意识的提高，妊娠率逐渐上升。医生应注意到妊娠和分娩期间的一些潜在并发症，尤其是自主神经反射异常。
我们报告了一例罕见的成功妊娠病例，患者为 32 岁女性，C2 节段严重 SCI（C1-4 ASIA 损伤分级 A 级），完全依赖家用有创机械通气（HIMV）。选择在妊娠 34 周+0 天行择期剖宫产术。母婴均恢复良好。
严重脊髓损伤和对机械通气的依赖并不是妊娠的绝对禁忌证。通过精心计划，即使是最严重的 SCI 患者也有可能妊娠。尽管完全性脊髓损伤，剖宫产术中仍需要充分的镇痛以避免过度的血液动力学反应和脊髓反射。需要多学科团队来确保这些高危妊娠的安全妊娠和分娩。
