03/26/2013 // Concord, CA, USA // LifeCare123 // Greg A. Vigna M.D., J.D. // (press release)

Medical Perspective of Greg Vigna M.D., J.D.:

Yes ladies, you will be able to have children. Following a spinal cord injury a women will likely on average go without a period for three to four months and ninety percent of patients will have resumed their cycles within a year. Essentially, your periods will likely return towards your conclusion of acute rehabilitation or during your early transition to home. Therefore, if having child is not in your immediate plans one should plan on birth control in the form of condom use since birth control pills increase the risk of deep venous thrombosis and you are at risk for this.

For those who are pregnant there are unique medical and functional needs of a spinal cord patient both during pregnancy and after pregnancy that your obstetrician must be aware of to prevent complications. There will also be a benefit to discuss functional related issues of pregnancy and child rearing with a physiatrist to decrease complications.

During Pregnancy:

Spinal cord patients are at increased risk for deep venous thrombosis and is related to immobility related to the spinal cord injury as well as the growing fetus with resultant impaired venous return from the lower extremities and the pelvis. Therefore, any leg swelling or chest pain that develops during pregnancy should be worked up. Urinary tract infections are also a common complication during pregnancy and this is related to the neurogenic bladder in pregnancy and the growing fetus with pressure on the bladder which may increase the likelihood of urinary reflux back up to the kidneys. Sterile cauterization technique, frequent urinalysis and culture, and good fluid intake is recommended.

Breathing problems are common in high thoracic and cervical spinal cord injury because these injuries have decrease vital capacity (workable lung capacity) and relies more on the diaphragm than the muscles of the chest to breath. As the fetus grows the diaphragm will be pushed up into the chest which will decrease the vital capacity. Patients with these injuries must be monitored for the potential of requiring ventilator support during pregnancy.

Pressure ulcers are also more common during pregnancy because of fatigue and weight gain which may restrict bed mobility, wheel chair pressure reliefs, and increase shear injuries to skin during transfers. Patients must be extra careful with pressure reliefs to prevent sores and skin checks during pregnancy. Patients may need aid and attendant care or increased aid and attendant care to assist with transfers and self care that may become increasingly difficult during pregnancy. Patients may also be more prone to constipation during pregnancy because of the size of the fetus and must adjust their bowel program accordingly.

Autonomic dysreflexia can be a significant problems during pregnancy and should be monitored in those with injuries at T6 and above. Autonomic dysreflexia can cause strokes, headaches, and fetal hypoxia from vasoconstriction. Patients avoid noxious stimuli that can cause this such as bladder infections, decubitus ulcers, ingrown nails, kinked catheters, and constipation.

Delivery:

Patients with injuries above T10 may not be aware of labor pains because of the lack of sensation and should be aware of associated symptoms such as increased spasticity. Further, all patients who are at risk of autonomic dysreflexia should receive a epidural block to the lower thoracic level to prevent autonomic dysreflexia. An obstetrician must understand how to distinguish between autonomic dysreflexia and toxemia of pregnancy. Patients also may have impaired ability to push and may require forceps delivery or an episiotomy. Patients should be monitored closely for decubitus during this period, helped with positioning, and monitored for deep venous thrombosis.

Post Delivery and Care of Newborn:

Patients will need assistance with bed mobility to prevent decubitus ulcers and may need assistance with pressure reliefs. Episiotomy repairs may breakdown because of sitting pressure. Deep venous thrombosis will require monitoring. Breast feeding may cause autonomic dysreflexia and this should be monitored and breaks away from breast feeding with breast pumps may be helpful. An occupational therapist may be helpful in assisting with positioning issues of breast feeding and modifications of cribs to allow access. Paraplegic and quadriplegic patients who use a manual wheelchair will require an electric wheelchair and accessories because of the need to carry the newborn. Quadriplegics with limited hand function may require aid and attendant care for management of the newborn as well.

Life Care Planner Perspective:

A life care planner must include pregnancy related medical issues and functional issues related to pregnancy and child raising to prevent complications, improve outcomes, and improve the overall psychosocial welfare of the catastrophically injured spinal cord patient. A life care planner should include evaluation with an obstetrician prior to pregnancy to evaluate issues related to anemia and pulmonary impairment which are more common in spinal cord patients. During pregnancy there will be increased medical cost related to increase in frequency of routine medical appointments to monitor for infections, deep venous thrombosis, and increased laboratory cost monitoring for urinary tract infections. There may be a need for extra aid and attendant cost for assistance at home and with functional task involving activities of daily living and transfers. During delivery there likely will be increased cost related to anesthesia services to provide an epidural blocks to prevent autonomic dysreflexia. Extra nursing care post-delivery will likely be necessary to prevent decubitus ulcers and assist with positioning and transfers. Occupational therapy services will be needed to assist with child rearing skills and adaptive equipment. Electric wheel chair are necessary to assist with child carrying. Increased aid and attendant care may be necessary for child care.

Serious Injury Lawyer Perspective:

A spinal cord injury to a women who is or will become of childrearing age it essential for the attorney to present evidence of future medical cost associated with pregnancy and child raising to provide an adequate compensation for the injuries suffered. Jurors will generally be sympathetic to these cost and should not be viewed as speculative. A jury should thoroughly understand the different ramifications, complications and what the future will bring to a client suffering this problem and understand the cost required to make this client whole.

Media Information:

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