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10 - Spinal cord disorders

from Section 3 - Nervous system disorders

Published online by Cambridge University Press:  19 October 2009

By
Roanne Preston
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Robert S. F. McKay
Roanne Preston
Affiliation:
Department of Anesthesia, BC Women's Hospital, Vancouver, BC, Canada
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Robert S. F. McKay
Affiliation:
University of Kansas
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Summary

Introduction

Patients with spinal cord injuries and spina bifida are not commonly encountered in the obstetrical population, but their numbers will increase in the future as a result of improved surgical techniques and rehabilitation therapy. Also, women with degenerative spinal cord diseases such as spinal muscular atrophy, and amyotrophic lateral sclerosis are surviving to child-bearing age and choosing to become pregnant despite the risks. Unusual diseases of the spinal cord such as tethered cord, syringomyelia and postpolio syndrome are also known to occur in pregnant women.

Spinal cord injury

The incidence of spinal cord injury (SCI) is 25–30 per million of population in North America, or 10,000 new cases per year in the USA. Most victims are young, and in Canada 20% of them are female. Advances in both acute and rehabilitation care have led to improved outcomes resulting in higher levels of independent function after SCI. Rehabilitation emphasizes integration back into society and cord-injured patients are encouraged to work, establish relationships, and have families.

Pregnancy in SCI patients is no longer rare; a 1999 survey looked at 472 women with SCI, all at least one year post injury. Fourteen percent became pregnant after their injury, and in 60% it was their first pregnancy. The average time to pregnancy following SCI is 4 to 13 years, but the average age at pregnancy and time interval since injury have decreased in the last few years. The first successful pregnancy in a quadriplegic was reported in 1953.

Type
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Information
Obstetric Anesthesia and Uncommon Disorders , pp. 191 - 214
Publisher: Cambridge University Press
Print publication year: 2008

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