Medical Problems For Pregnant Woman With SCI

Activities of Daily Living

Body changes during last 3 months of pregnancy may affect one's balance, mobility, and ability to transfer. May be an awkward time. Assistive devices, like a reacher, can be helpful.

Medical personnel: Make needed referrals to occupational therapy and physical therapy as needed.

Autonomic Dysreflexia

May occur from fetus growth, pressure sores, or bladder/bowel problems, as well as normal pre-pregnancy causes. Ask doctor before taking any medications.

Medical personnel: Monitor closely. Use blood pressure lowering medications cautiously. Discuss with delivering physician and anesthesiolgost.

Bladder Management

Pressure from growing fetus decreases bladder capacity. If using intermittent catheterization (ICP), may need to cath more frequently. Bladder spasms may increase causing leakage with or without a catheter in lace. May need to change bladder management program during last few weeks of pregnancy.

Medical personnel: Monitor and make recommendations for changes in bladder management methods.

Bowel Management

May have constipation due to increase in size of uterus and pressure on colon. Increase in hormone progestin and use of iron supplements can delay bowel movements. May need to change bowel program. Increase high fiber in diet, Use laxatives as doctor recommends. Increase exercise when possible. Eating more during pregnancy may require more frequent bowel program or use of stool softeners.

Medical personnel: Review all bowel medications, including supositories, for safety during pregnancy. Encourage diet high in fiber and fluids.

Deep Vein Thrombosis

As fetus grows, pressure on the venous return of blood from the legs increases. May cause swelling/edema. In later stages may need to lay down and elevate feet. Elastic stockings may be used.

Medical personnel: Monitor closely for extremity assymetry.

Medications

Keep all medications to a minimum.

Medical personnel: Examine medications used for spasticity, bladder & bowel management and Autonomic Dysreflexia each trimester. Discuss risks and benefits with the woman.

Nutritional Needs

Calcium supplements are important. Anemia may occur, iron supplements usually recommended. Eat foods high in iron. Take pregnancy vitamins. Many need to change diet to suit bowel program

Medical personnel: Calcium deficits could promote post injury osteoporosis. Find a level of calcium to meet needs during pregnancy and does not increase frequency of urinary stones. Vitamin/iron deficiency delay healing of pressure ulcers and skin breakdown.

Pressure Ulcers

More likely to occur since an increase in weight makes pressure reliefs and transfers more difficult. Pay attention to skin where pressure sores may form - sacrum, heels, ischia, elbows. Keep skin clean and dry.

Medical personnel: Observe skin at check-ups for signs of pressure sores.

Respiratory Capacity Decreases

As fetus and uterus enlarge,,it may affect movement of diaphragm. Diminishes capacity of lungs. Predisposes to pneumonia, especially those with tetraplegia.

Medical personnel: May need regime of incentive spirometry or other breathing exercises.Predisposes to pneumonia, especially those with tetraplegia. May need regimme of incentive spirometry or other breathing exercises.

Urinary Tract Infection

UTIs increase in frequency during pregnancy as fetus presses on bladder, urinary tract, and/or catheter. Limited antibiotics available for use. Drink recommended amount of liquids each day.

Medical personnel: National Task Force on Sexuality and Disability has a partial list of antibiotics to avoid during pregnancy. A few represented are: aminoglycosides, erythromycin, nitrofurantoin, chloramphenicol, sulfonamides, and tetracycline. UTI may cause premature delivery and fetal death in the expectant mother.

Reference: http://www.spinalcord.org/resource-center/askus/index.php?pg=kb.page&id=1586