Journal: Arch Phys Med Rehabil 1996; 77:501-7.
Baker E, Cardenas D
A spinal cord injury during pregnancy is a frightening prospect, but it does not necessarily mean that damage has been done to the fetus. In fact, the fetus is remarkably well protected from trauma injuries by the amniotic fluid in which it floats.
Though fractures of bones, including the skull, do occasionally occur, it's much more likely that the fetus will be harmed by the mother's subsequent response to her own traumatic injury, transmitted to the fetus through the placenta. A drop in blood pressure or hypoxia (a lack of oxygen) can affect the fetus in different ways. Generally such a condition retards the structural development of the fetus in the first trimester, and causes neural damage in the second or third trimesters. If the injury is sufficiently severe to cause the detachment of the placenta, the fetus will die. Most, however, survive and are born healthy.
Emergency care and the first steps following injury:
This generally good prognosis does not diminish the physician's responsibility to tell the mother that her injury does somewhat increase the risk of miscarriage or malformation of the fetus, and that there's no guarantee that malformation will be detected prior to birth. If the patient is already in the third trimester, an obstetrician should be called in to look at the possibility of an immediate delivery. This is really only an option in one of two very specific sets of circumstances: either when the fetus is in distress and the mother is stable enough to undergo labour, or when the mother is certain not to survive her injury, and the obstetrician believes the fetus can be saved.
In all other cases, physicians will attempt to stabilize the mother and, at the same time, carry the pregnancy to full term. It will, however, be necessary to balance the need to diagnose the extent of spinal cord injury with the fetus's sensitivity to radiation exposure. Provided the radiologists are reasonably judicious and conservative in the number of x-rays and angles they shoot, there is no reason for the fetus to receive a damaging dose of radiation, generally held to be over five rads. Anesthesia and surgery may also be necessary after a spinal cord injury, but there is no evidence that these increase the risk of fetal malformation (although they do slightly increase the risk of miscarriage).
Stabilization of the spine should not have to endanger the fetus in any way, though if it becomes necessary to implant an orthosis, this should be done in consultation with an obstetrician to ensure that it will not make it difficult for mother to breathe or obstruct fetal growth. Moreover, the mother should not lie flat on her back during the last trimester of pregnancy, as this impedes the proper flow of blood to the uterus. The best position for the fetus is when the mother rolls sightly to one side. |
