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Vieira I, Cunha P, Pinto M, Ribeiro S, Sacramento S, Silva A, Almeida C, Guedes I. Anaesthetic management of tetraplegic pregnant patients during child delivery: A systematic review. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:224-230. [PMID: 36842688 DOI: 10.1016/j.redare.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/30/2022] [Indexed: 02/28/2023]
Abstract
BACKGROUND Pregnancy in spinal cord injured patients has specific issues that must be carefully addressed. However, guidelines for their management are scarce. METHODS A systematic review of the literature regarding the anaesthetic management during delivery of pregnant patients with cervical spinal cord injury was performed on the electronic databases of PubMed (Medline) and Cochrane. RESULTS Twenty-two papers were included. A higher incidence of preterm birth and caesarean delivery were seen. Anaesthetic management was diverse, although most pregnant patients received epidural analgesia. Autonomic dysreflexia symptoms were present in 51% of pregnancies. CONCLUSION Timely management of these patients could possibly reduce caesarean and preterm delivery rates, avoid or minimize common complications, as well as reduce costs. An early reference to anaesthesiology consultation and a multidisciplinary approach is recommended.
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Affiliation(s)
- I Vieira
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
| | - P Cunha
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - M Pinto
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - S Ribeiro
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - S Sacramento
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - A Silva
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - C Almeida
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - I Guedes
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
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2
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Ahmed SI, Sikandar R, Barolia R, Hanif Khowaja BM, Memon KA, Cheshire J, Dunlop C, Coomarasamy A, Sheikh L, Lissauer D. Evaluation of the feasibility of the FAST-M maternal sepsis intervention in Pakistan: a protocol. Pilot Feasibility Stud 2022; 8:130. [PMID: 35751098 PMCID: PMC9229426 DOI: 10.1186/s40814-022-01090-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal sepsis is a life-threatening condition, defined by organ dysfunction caused by infection during pregnancy, childbirth, and the postpartum period. It is estimated to account for between one-tenth and half (4.7% to 13.7%) of all maternal deaths globally. An international stakeholder group, including the World Health Organization, developed a maternal sepsis management bundle called "FAST-M" for resource-limited settings through a synthesis of evidence and international consensus. The FAST-M treatment bundle consists of five components: Fluids, Antibiotics, Source identification and control, assessment of the need to Transport or Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). This study aims to adapt the FAST-M intervention and evaluate its feasibility in Pakistan. METHODS The proposed study is a mixed method, with a before and after design. The study will be conducted in two phases at the Liaquat University of Medical and Health Sciences, Hyderabad. In the first phase (formative assessment), we will adapt the bundle care tools for the local context and assess in what circumstances different components of the intervention are likely to be effective, by conducting interviews and a focus group discussion. Qualitative data will be analyzed considering a framework method approach using NVivo version 10 (QSR International, Pty Ltd.) software. The qualitative results will guide the adaptation of FAST-M intervention in local context. In the second phase, we will evaluate the feasibility of the FAST-M intervention. Quantitative analyses will be done to assess numerous outcomes: process, organizational, clinical, structural, and adverse events with quantitative comparisons made before and after implementation of the bundle. Qualitative analysis will be done to evaluate the outcomes of intervention by conducting FGDs with HCPs involved during the implementation process. This will provide an understanding and validation of quantitative findings. DISCUSSION The utilization of care bundles can facilitate recognition and timely management of maternal sepsis. There is a need to adapt, integrate, and optimize a bundled care approach in low-resource settings in Pakistan to minimize the burden of maternal morbidities and mortalities due to sepsis.
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Affiliation(s)
- Sheikh Irfan Ahmed
- Aga Khan University Hospital, National Stadium Road, P.O. Box 3500, Karachi City, 74800, Pakistan.
| | - Raheel Sikandar
- Liaquat University of Health and Medical Sciences, LUMHS Hospital, Hyderabad City, 76090, Pakistan
| | - Rubina Barolia
- Aga Khan University Hospital, National Stadium Road, P.O. Box 3500, Karachi City, 74800, Pakistan
| | | | - Kashif Ali Memon
- Liaquat University of Health and Medical Sciences, LUMHS Hospital, Hyderabad City, 76090, Pakistan
| | - James Cheshire
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Catherine Dunlop
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Arri Coomarasamy
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Lumaan Sheikh
- Aga Khan University Hospital, National Stadium Road, P.O. Box 3500, Karachi City, 74800, Pakistan
| | - David Lissauer
- Institute of Life Course and Medical Sciences, University of Liverpool, William Henry Duncan Building, Liverpool, L7 8TX, UK.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Blantyre, Malawi
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3
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Socioeconomic inequality in barriers for accessing health care among married reproductive aged women in sub-Saharan African countries: a decomposition analysis. BMC Womens Health 2022; 22:130. [PMID: 35468770 PMCID: PMC9036791 DOI: 10.1186/s12905-022-01716-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accessibility of health care is an essential for promoting healthy life, preventing diseases and deaths, and enhancing health equity for all. Barriers in accessing health care among reproductive-age women creates the first and the third delay for maternal mortality and leads to the occurrence of preventable complications related to pregnancy and childbirth. Studies revealed that barriers for accessing health care are concentrated among individuals with poor socioeconomic status which creates health inequality despite many international organizations top priority is enhancing universal health coverage. Therefore, this study aimed to assess the presence of socioeconomic inequality in barriers for accessing health care and its contributors in Sub-Saharan African countries. METHODS The most recent DHS data of 33 sub-Saharan African countries from 2010 to 2020 were used. A total sample of 278,501 married reproductive aged were included in the study. Erreygers normalized concentration index (ECI) and its concentration curve were used while assessing the socioeconomic-related inequality in barriers for accessing health care. A decomposition analysis was performed to identify factors contributing for the socioeconomic-related inequality. RESULTS The weighted Erreygers normalized Concentration Index (ECI) for barriers in accessing health care was - 0.289 with Standard error = 0.005 (P value < 0.0001); indicating that barriers in accessing health care was disproportionately concentrated among the poor. The decomposition analysis revealed that wealth index (42.58%), place of residency (36.42%), husband educational level (5.98%), women educational level (6.34%), and mass media exposure (3.07%) were the major contributors for the pro-poor socioeconomic inequalities in barriers for accessing health care. CONCLUSION In this study, there is a pro-poor inequality in barriers for accessing health care. There is a need to intensify programs that improve wealth status, education level of the population, and mass media coverage to tackle the barriers for accessing health care among the poor.
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Tong CMC, Dew ME, Zimmerman KD, Hopson BD, Blount JP, Rocque BG, Arynchyna A, Wilson T, Joseph D, Dangle P, Powell D, McLain A. A qualitative interview study on successful pregnancies in women with spina bifida. J Pediatr Urol 2022; 18:3.e1-3.e7. [PMID: 34862130 DOI: 10.1016/j.jpurol.2021.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 08/31/2021] [Accepted: 10/31/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Improvements in antenatal medicine and surgical management for conditions associated with spina bifida such as hydrocephalus have extended the lifespan for individuals with spina bifida (SB) into adulthood. Decisions and education regarding reproductive care and pregnancies for patients with spina bifida are increasingly important. Pregnancy in these patients can be particularly challenging due to physical limitations, previous abdominal surgery for urinary or bowel management and presence of a ventriculoperitoneal shunt. To date, little research has examined the unique challenges that women with spina bifida face during pregnancy. OBJECTIVE The purpose of this descriptive study is to characterize the successful pregnancy histories of SB women and describe how pregnancy affected their mobility as well as bladder and bowel management. STUDY DESIGN We conducted semi-structured interviews with women followed in our adult multidisciplinary SB clinic who previously had successful pregnancies. Questions regarding perinatal issues, obstetrical complications, urinary tract infections (UTI) and neurological changes were asked. Baseline mobility, bladder and bowel management were compared with changes during and after pregnancy. RESULTS 121 women of childbearing age were followed per year by our adult multidisciplinary spina bifida clinic between 2009 and 2016. We identified 6 women who successfully carried 8 pregnancies to term. There were no miscarriages. Four women had ventriculoperitoneal (VP) shunts. No children were born with neural tube defects. Mean age at first pregnancy was 23.5 years. Average gestational age at delivery was 37 weeks. 50% of the women had a spontaneous vaginal delivery. Five of six women intended to get pregnant; only one patient consumed folic acid regularly prior to pregnancy. Two of six women had bladder augmentation surgery, one of whom had urologic changes during pregnancy that persisted after childbirth. The other patient had a concomitant bladder neck sling procedure and did not have urologic issues during pregnancy. 50% of the patients experienced bladder-bowel dysfunction during their pregnancy. While 67% patients had full baseline ambulatory function, 4 patients had decreased mobility and required additional assistance during pregnancy. All returned to their baseline functionality afterwards. CONCLUSION Six of our patients had eight successful pregnancies, with no children born with neural tube defects. New changes to mobility, bladder and bowel management were experienced by over half of the women during their pregnancies. Future studies should focus on the role of multidisciplinary teams in reproductive health education and perinatal management of changes to activities of daily living during pregnancy in this population.
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Affiliation(s)
| | - Morgan E Dew
- Department of Neurosurgery, University of Alabama at Birmingham, United States
| | - Kathrin D Zimmerman
- Department of Neurosurgery, University of Alabama at Birmingham, United States
| | - Betsy D Hopson
- Department of Neurosurgery, University of Alabama at Birmingham, United States
| | - Jeffrey P Blount
- Department of Neurosurgery, University of Alabama at Birmingham, United States
| | - Brandon G Rocque
- Department of Neurosurgery, University of Alabama at Birmingham, United States
| | - Anastasia Arynchyna
- Department of Neurosurgery, University of Alabama at Birmingham, United States
| | - Tracey Wilson
- Department of Urology, University of Alabama at Birmingham, United States
| | - David Joseph
- Department of Urology, University of Alabama at Birmingham, United States
| | - Pankaj Dangle
- Department of Urology, University of Alabama at Birmingham, United States
| | - Danielle Powell
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, United States
| | - Amie McLain
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, United States
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5
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Robertson K, Ashworth F. Spinal cord injury and pregnancy. Obstet Med 2021; 15:99-103. [DOI: 10.1177/1753495x211011918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/01/2021] [Accepted: 03/29/2021] [Indexed: 11/17/2022] Open
Abstract
Pregnancy in women with spinal cord injury is considered high risk because it may exacerbate many of their existing problems, including autonomic dysreflexia, spasms, decubitus ulcers, urinary tract infections and respiratory infections. Due to the relative rarity of spinal cord injury in the general obstetric population, clinicians often lack familiarity of these specific problems and the women themselves are usually more experienced in their own management than their obstetric team. However, studies have demonstrated that pregnancy outcomes are generally good with appropriate and experienced obstetric care. In this review, we examine the available literature and provide advice on pre-conception counselling and the antenatal, intrapartum and postnatal management of pregnant women with spinal cord injury.
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Affiliation(s)
| | - Felicity Ashworth
- Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
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6
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Schmidt M, Bertschy S, Fiebag K, Lange U, Kurze I. Schwangerschaft, Geburt und Wochenbett bei Frauen mit Querschnittlähmung. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/a-1109-2258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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8
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Robertson K, Dawood R, Ashworth F. Vaginal delivery is safely achieved in pregnancies complicated by spinal cord injury: a retrospective 25-year observational study of pregnancy outcomes in a national spinal injuries centre. BMC Pregnancy Childbirth 2020; 20:56. [PMID: 31996150 PMCID: PMC6988250 DOI: 10.1186/s12884-020-2752-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/17/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Women with spinal cord injuries (SCI) represent a high risk population during pregnancy with comparatively few studies in the literature regarding their management and pregnancy outcomes, due to the relative rarity of the condition. Our objective was to assess pregnancy outcomes in women with spinal cord injury. METHODS We performed a retrospective observational study of pregnancy outcomes by reviewing maternity records of all pregnant women with SCI attending the National Spinal Injury Centre at Buckinghamshire NHS Trust between 1991 and 2016. The outcome measures were Maternal demographic data, antenatal complications, method of anaesthetic, intrapartum data (gestation at delivery, onset of labour, mode of delivery, indication for obstetric intervention) and neonatal outcomes (low birth weight, stillbirth, neonatal death). RESULTS Fifty women with a total of 68 pregnancies were identified. Five patients sustained SCI during pregnancy and the remaining 63 pregnancies were conceived at least 1 year after SCI, of which 45 pregnancies had a SCI at T10 or above (73%) and 23 pregnancies at T11 or below (27%). The most common antenatal complications in SCI patients were worsening of spasms (38%) and urinary tract infection (24%). Preterm delivery occurred in 18% of women. Vaginal delivery was achieved in 77% of pregnancies, including 14% instrumental delivery rate and 23% Caesarean delivery rate. CONCLUSIONS Our findings support the current evidence that pregnancy outcomes are generally successful and that vaginal delivery can be safely achieved in the majority of women, independent of the level of SCI.
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Affiliation(s)
- Katherine Robertson
- Buckinghamshire NHS Trust, Stoke Mandeville Hospital, Mandeville Rd, Aylesbury, HP21 8AL UK
| | - Rehana Dawood
- Buckinghamshire NHS Trust, Stoke Mandeville Hospital, Mandeville Rd, Aylesbury, HP21 8AL UK
| | - Felicity Ashworth
- Buckinghamshire NHS Trust, Stoke Mandeville Hospital, Mandeville Rd, Aylesbury, HP21 8AL UK
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9
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Guideline for the management of pre-, intra-, and postpartum care of women with a spinal cord injury. Spinal Cord 2019; 58:449-458. [PMID: 31811245 DOI: 10.1038/s41393-019-0389-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 12/14/2022]
Abstract
The German Association of the Scientific Medical Societies guideline for pregnancy, childbirth, and puerperium in women with a spinal cord injury (SCI) addresses a range of topics from the desire to have a child to different stages of pregnancy and birth. Given that a generally accessible and evidence-based presentation of this complex issue does not yet exist, this new guideline contributes to the standardization of gynecological, obstetric, and maternal care of women with SCI. This guideline aims to provide practice-oriented support for the care and counseling of women in the pre-, intra-, and postpartum periods; to close identified gaps in medical care; foster collaboration among clinicians of relevant disciplines; and inspire research.
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10
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Soh SH, Lee G, Joo MC. Autonomic dysreflexia during pregnancy in a woman with spinal cord injury: a case report. J Int Med Res 2019; 47:3394-3399. [PMID: 31187679 PMCID: PMC6683932 DOI: 10.1177/0300060519853659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We herein report a case involving a 35-year-old woman with spinal cord injury (SCI) in whom autonomic dysreflexia (AD) newly developed during pregnancy and resolved after delivery. The neurological level and severity of SCI according to the American Spinal Injury Association Impairment Scale (AIS) was T4 AIS-A. The patient had sustained an SCI 20 years prior. Upon presentation, she reported a newly developed increased need to empty her bladder, facial flushing, palpitation, sweating, and headache during pregnancy. She was hospitalized for careful observation at 33 weeks of gestation. The intensity and frequency of the symptoms of AD increased with time. She underwent a cesarean section under general anesthesia at 36 weeks of gestation. Three weeks after the delivery, her vital signs normalized and AD symptoms improved. This case indicates that careful evaluation and proper management of AD symptoms in pregnant women with SCI are essential. For proper prevention and management of AD, education about AD symptoms and supportive management to prevent AD symptoms are necessary for the patient, physician, and multidisciplinary approach team.
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Affiliation(s)
- Soo-Hyun Soh
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Geonsang Lee
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Republic of Korea
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Crane DA, Doody DR, Schiff MA, Mueller BA. Pregnancy Outcomes in Women with Spinal Cord Injuries: A Population-Based Study. PM R 2019; 11:795-806. [PMID: 30729746 DOI: 10.1002/pmrj.12122] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/26/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pregnant women with congenital or acquired spinal cord injury face challenges due to compromised neurologic function and mobility, factors that may also affect fetal/infant health. Few studies have examined pregnancy course and longer-term outcomes in this population. OBJECTIVE To assess pregnancy outcomes among women with spinal cord injury, paralysis, or spina bifida using population-based data. DESIGN Retrospective cohort study. SETTING Washington state linked birth-hospital discharge records. PARTICIPANTS All women (N = 529) with spinal cord injury, paralysis, or spina bifida with singleton live birth deliveries 1987-2012, and a comparison group of women without disabilities (N = 5282). METHODS Diagnosis codes were screened to identify cases and a 10:1 random sample of comparison women. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated overall and separately for each condition using multivariable regression. Subsequent hospitalizations or death were identified via linkage to hospital discharge/death records for 2 years after delivery. MAIN OUTCOME MEASUREMENTS Pregnancy course (weight gain, gestational diabetes, preeclampsia, infection, venous thromboembolism), delivery/labor characteristics, infant characteristics (birthweight/size, gestational age), and longer-term outcomes (occurrence/reasons for maternal/infant rehospitalization, mortality). RESULTS Women with these spinal conditions had increased adjusted risks of prenatal urinary tract infection/pyelonephritis (RR 26.43, 95% CI 13.97-49.99), venous thromboembolism (RR 9.16, 95% CI 2.17-38.60), preterm rupture of membranes (RR 2.15, 95% CI 1.18-3.90), and cesarean delivery (RR 1.88, 95% CI 1.70-2.09). They had longer hospitalizations and increased rehospitalization (RR 1.54, 95% CI 1.28-1.87), including for postpartum depression (RR 8.15, 4.29-15.48) or injury (RR 13.05, 95% CI 6.60-25.81). Their infants were more often small for gestational age (RR 1.65, 95% CI 1.33-2.06), but had no increased risk of rehospitalization or death. CONCLUSIONS We observed no increased long-term morbidity among infants of women with these conditions. Possible increased maternal morbidities during the first postpartum years indicate areas for intervention. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Deborah A Crane
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - David R Doody
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Melissa A Schiff
- Department of Epidemiology, University of Washington, Seattle, WA.,Department of Obstetrics & Gynecology, University of Washington, Seattle, WA.,Department of Internal Medicine, Division of Epidemiology, Biostatistics & Preventive Medicine, University of New Mexico School of Medicine, Albuquerque, NM (current)
| | - Beth A Mueller
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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12
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Managing Spasticity in a Pregnant Woman with Spinal Cord Injury: a Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0198-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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13
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Hocaloski S, Elliott S, Hodge K, McBride K, Hamilton L, McBride CB, Basso M. Perinatal Care for Women with Spinal Cord Injuries: A Collaborative Workshop for Consensus on Care in Canada. Top Spinal Cord Inj Rehabil 2018; 23:386-396. [PMID: 29339914 DOI: 10.1310/sci16-00036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: In North America, there are currently no clearly defined standards of care for women with spinal cord injury (SCI) during the perinatal periods of preconception, pregnancy, labour/delivery, and postpartum. Women with SCI and their partners say resources specific to their needs are hard to find. Little evidence-informed research exists to guide clinicians in the care of women with SCI during pregnancy. Objectives: To further explore these gaps in knowledge and practices for perinatal care for women with SCI, a 1-day workshop was held in Vancouver, British Columbia (BC), Canada in November 2013. Methods: Twenty-nine attendees included women with SCI, SCI-community service providers, researchers, and health care providers from maternal/fetal medicine, rehabilitation, anesthesiology, and psychiatry. A pre-meeting online survey of stakeholders elucidated 3 themes: lack of knowledge for both consumers and care providers, gaps in access to services and information, and a need for collaboration throughout the perinatal journey. The workshop addressed issues of care providers' lack of knowledge of nonmedical issues during the perinatal period, physical and attitudinal barriers to access to care for women with SCI, and the need for better collaboration and communication between care providers, the latter potentially initiated by providing information to care providers through the women with SCI themselves. Results: Content experts attending the workshop collectively made recommendations for knowledge generation and research priorities, clinical application priorities, and the need for policy and guideline development in this field. Conclusion: Two information sources for women have since been developed and are available online.
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Affiliation(s)
- Shea Hocaloski
- GF Strong Rehabilitation Centre, Vancouver, British Columbia.,The Blusson Spinal Cord Centre, Vancouver, British Columbia
| | - Stacy Elliott
- GF Strong Rehabilitation Centre, Vancouver, British Columbia.,BC Centre for Sexual Medicine, Vancouver, British Columbia
| | - Karen Hodge
- Adaptability Counselling and Consultation, Vancouver, British Columbia
| | - Kate McBride
- GF Strong Rehabilitation Centre, Vancouver, British Columbia.,The Blusson Spinal Cord Centre, Vancouver, British Columbia
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14
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Alexander MS, Aisen CM, Alexander SM, Aisen ML. Sexual concerns after Spinal Cord Injury: An update on management. NeuroRehabilitation 2018; 41:343-357. [PMID: 29036845 DOI: 10.3233/nre-172202] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Spinal Cord Injury (SCI) causes neurological impairment with resultant neurogenic sexual dysfunction which can compound preexisting psychological and medical sexual concerns. Understanding these concerns is important in managing the lifelong needs of persons with SCIs. OBJECTIVES To provide an overview of the impact of SCI on sexuality along with a framework for treatment of sexual concerns. To briefly review male infertility and its treatments and pregnancy in females after SCI. METHODS Interdisciplinary literature review and synthesis of information. RESULTS The average age at SCI is increased, thus persons with SCIs may have preexisting sexual concerns. Sexual activity and satisfaction are decreased after SCI. Psychogenic sexual arousal is related to remaining sensation in the T11-L2 dermatomes. Orgasm occurs in approximately 50% of persons with SCIs with all injuries except subjects with complete lower motor neuron (LMN) injuries affecting the lowest sacral segments A structured approach to treatment including assessing preinjury function, determining the impact of injury, education, assessing and treating iatrogenic sexual dysfunction and treatment of concomitant problems is recommended. Basic and advanced methods to improve sexual arousal and orgasm are discussed and treatment of anejaculation and issues associated with pregnancy and SCI are reviewed. CONCLUSIONS Sexual satisfaction is impaired after SCI; however, education and new therapies can improve responsiveness. Future research is warranted to improve sexual function and fertility potential in persons with SCIs.
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Affiliation(s)
- Marcalee Sipski Alexander
- Birmingham VA Medical Center, Birmingham, AL, USA.,Department of PMR University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.,Department of PMR Harvard School of Medicine, Boston, MA, USA
| | - Carrie Mlynarczyk Aisen
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - Mindy Lipson Aisen
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA.,Department of Neurology, University of Southern California, Los Angeles, CA, USA
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15
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Andretta E, Landi LM, Cianfrocca M, Manassero A, Risi O, Artuso G. Bladder management during pregnancy in women with spinal-cord injury: an observational, multicenter study. Int Urogynecol J 2018; 30:293-300. [PMID: 29600402 DOI: 10.1007/s00192-018-3620-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pregnancy in women with spinal-cord injury (SCI) poses a clinical challenge. We hypothesized that changes in the management of neurogenic bladder during pregnancy are commonly required and should receive more attention. METHODS Data were collected by retrospective analysis of medical records and via cross-sectional survey of 52 women with SCI, representing 67 pregnancies, at ten Italian neurourological clinics. All participants provided informed consent. RESULTS Between 1976 and 2013, 39 participants had one child, 11 had two children, and two had three children. Mean age at the time of SCI was 18 years and at the time of first pregnancy was 30 years. Delivery occurred from weeks 32 to 40 in 98% of first and second pregnancies, and 94% of neonates were healthy. Oxybutynin was used by four women during five pregnancies, which resulted in delivery of healthy babies. Intermittent catheterization was used before 54% of first pregnancies and 39% of second pregnancies. Bladder management was altered during 45% of these pregnancies, and the most common changes were increased use or frequency of intermittent catheterization or use of an indwelling catheter. Urinary tract infections occurred in 48% of pregnancies, and an irregular course was reported in 13% of pregnancies mainly related to tetraplegia and urological complications. CONCLUSIONS Pregnancy in women with SCI generally has good outcomes and limited risks but frequently necessitates changes in the management of neurogenic bladder. High levels of awareness and focused monitoring of bladder issues are recommended.
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Affiliation(s)
- Elena Andretta
- Urology Department, General Hospital, Riviera XXIX Aprile, 2, 30031, Dolo, Venice, Italy.
| | | | | | | | - Oreste Risi
- Neuro-Urology Unit, Treviglio, Bergamo, Italy
| | - Giorgio Artuso
- Urology Department, General Hospital, Riviera XXIX Aprile, 2, 30031, Dolo, Venice, Italy
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Consequences of traumatic spinal cord injury during pregnancy in Pakistan. Spinal Cord Ser Cases 2017; 3:17041. [PMID: 28725486 DOI: 10.1038/scsandc.2017.41] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Traumatic spinal cord injury (SCI) is one of the major causes for poor outcomes of pregnancy. Injury during pregnancy is uncommon; therefore, outcome data are scarce. This case series presents outcomes of pregnancy in five women who sustained SCI during their pregnancies. CASE PRESENTATION Five women who sustained SCIs during pregnancy (age range: 24-38 years) were identified and included in this case series. The causes of SCI in this population were fall from heights (cases 1 and 2), road traffic accidents (cases 3 and 4) and firearm injury (case 5). Two of the females were managed conservatively (cases 1 and 5) and the rest underwent surgical procedures for fixing their spine. Out of these patients, four patients delivered normal healthy babies, while the baby of one patient died within 1 hour after delivery. DISCUSSION Limited data about the outcomes of pregnancy in women who sustained SCIs during pregnancy are available in the literature. The outcomes of pregnancy in women who sustained SCIs during the first trimester are not satisfactory, and special attention may be needed to improve the expected outcomes. Data from our study show similar findings to developed countries.
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Courtois F, Alexander M, McLain AB(J. Women's Sexual Health and Reproductive Function After SCI. Top Spinal Cord Inj Rehabil 2017; 23:20-30. [PMID: 29339874 PMCID: PMC5340506 DOI: 10.1310/sci2301-20] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sexual function and to a lesser extent reproduction are often disrupted in women with spinal cord injuries (SCI), who must be educated to better understand their sexual and reproductive health. Women with SCI are sexually active; they can use psychogenic or reflexogenic stimulation to obtain sexual pleasure and orgasm. Treatment should consider a holistic approach using autonomic standards to describe remaining sexual function and to assess both genital function and psychosocial factors. Assessment of genital function should include thoracolumbar dermatomes, vulvar sensitivity (touch, pressure, vibration), and sacral reflexes. Self-exploration should include not only clitoral stimulation, but also stimulation of the vagina (G spot), cervix, and nipples conveyed by different innervation sources. Treatments may consider PDE5 inhibitors and flibanserin on an individual basis, and secondary consequences of SCI should address concerns with spasticity, pain, incontinence, and side effects of medications. Psychosocial issues must be addressed as possible contributors to sexual dysfunctions (eg, lower self-esteem, past sexual history, depression, dating habits). Pregnancy is possible for women with SCI; younger age at the time of injury and at the time of pregnancy being significant predictors of successful pregnancy, along with marital status, motor score, mobility, and occupational scores. Pregnancy may decrease the level of functioning (eg, self-care, ambulation, upper-extremity tasks), may involve complications (eg, decubitus ulcers, weight gain, urological complications), and must be monitored for postural hypotension and autonomic dysreflexia. Taking into consideration the physical and psychosocial determinants of sexuality and childbearing allows women with SCI to achieve positive sexual and reproductive health.
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Affiliation(s)
- Frédérique Courtois
- Departement of Sexology, Université du Québec à Montréal, Montreal, Canada
- Institut de réadaptation Gingras Lindsay de Montréal, Montreal, Canada
| | - Marcalee Alexander
- Department of Rehabilitative Medicine, Birmingham VA Medical Center, Birmingham, Alabama
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham
- Department of Physical Medicine and Rehabilitation, Harvard School of Medicine, Boston, Massachusetts
| | - Amie B. (Jackson) McLain
- Department of Physical Medicine and Rehabilitation, University of Alabama School of Medicine, Birmingham, Alabama
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Bertschy S, Pannek J, Meyer T. Delivering care under uncertainty: Swiss providers' experiences in caring for women with spinal cord injury during pregnancy and childbirth - an expert interview study. BMC Pregnancy Childbirth 2016; 16:181. [PMID: 27443838 PMCID: PMC4957428 DOI: 10.1186/s12884-016-0976-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 07/16/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND When different health problems such as pregnancy and spinal cord injury (SCI) occur together, providing adequate care becomes even more challenging. Women with SCI may encounter a variety of specific problems and symptoms during pregnancy and childbirth, including urinary tract infections, pressure ulcers, constipation, autonomic dysreflexia, and preterm labour. Therefore, expertise from different medical specialties, especially spinal cord medicine and gynaecology are required. What is totally normal for experts of one specialty could cause a problem for experts from another specialty. Therefore, this study aimed to reconstruct the perceptions and experiences of healthcare providers in Switzerland in caring for women with SCI during pregnancy and childbirth. METHODS The perception and experience of healthcare professionals toward providing care for women with SCI during pregnancy and labour were elicited using qualitative expert interviews and analysed using grounded theory techniques. Fifteen health professionals were interviewed, including gynaecologists (n = 4), midwives (n = 3), physical medicine and rehabilitation professionals (n = 4), urologists (n = 3), and a peer counselor (n = 1). RESULTS Care delivery experiences of health professionals could be described as a forced reaction to decision making under uncertainty. However, health professionals seemed to express three different attitudes while handling the situation: (i) protective concerned attitude, (ii) 'no big deal' attitude, or (iii) precautionary attitude. The applied strategies were influenced by the conditions of the healthcare system, policies in place, and health professionals' behaviours. Consequently, health professionals faced with uncertainty felt like actors in a fragmented treatment process and called for interdisciplinary collaborations. CONCLUSIONS Our findings highlight the diversity of perspectives among different healthcare professionals with respect to the approach to care and delivery services for pregnant women with SCI. A need for more specific services, information, guidance, and guidelines for health professionals caring for woman with SCI during pregnancy and childbirth was identified. We strongly recommend further research on the development of integrated care concepts as well as clinical studies for establishing a more profound knowledge base.
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Affiliation(s)
- Sue Bertschy
- />Swiss Paraplegic Research (SPF), Guido A. Zäch-Strasse 4, CH-6207 Nottwil, Switzerland
- />Department of Health Sciences and Health Policy, University of Lucerne and SPF, Nottwil, Switzerland
| | - Jürgen Pannek
- />Swiss Paraplegic Centre (SPZ), Neuro-Urology, Guido A. Zäch-Strasse 2, CH-6207 Nottwil, Switzerland
| | - Thorsten Meyer
- />Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
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Stothers L, Locke JA, Macnab A, Nigro M. Long-Term Urologic Evaluation Following Spinal Cord Injury. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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