Paraplegia and quadriplegia: special considerations during pregnancy and labor and delivery.

Patients with spinal cord injury resulting in paraplegia or quadriplegia increasingly desire to bear children. Management by a health care team attentive to the special problems that may complicate pregnancy offers the best chance for a successful pregnancy outcome. Life-threatening autonomic hyperreflexia may occur in patients with lesions above the T5-6 level. Precautions should be taken to avoid an unsupervised delivery. Vaginal delivery is appropriate unless there is an obstetric indication for cesarean section. Surveillance for urinary tract infection, anemia, and skin ulcers is advisable.