Paraplegia and Pregnancy: A Rare Case of Autonomic Dysreflexia

Abstract

Paraplegia involves the loss of motor and sensory functions in the trunk, lower limbs, and pelvic organs. While primarily traumatic, paraplegia can also stem from medical conditions. Women with spinal cord injury (SCI) can still conceive, but pregnancy carries unique risks, particularly autonomic hyperreflexia (AHR), a serious condition due to disrupted hypothalamic control over spinal reflexes. AHR, occurring in about 85% of pregnant women with SCI at or above the sixth thoracic vertebra, manifests as severe hypertension, headache, and cardiac arrhythmia, and can cause significant maternal-fetal morbidity. Pregnancy in women with SCI sees a 25% higher complication rate, including urinary tract infections, pressure ulcers, impaired pulmonary function, anemia, and venous thromboembolism. Urinary complications are common; regular monitoring and self-catheterization are recommended. Vaginal delivery is preferred unless AHR necessitates a cesarean section. Neuraxial analgesia is advised to reduce spasticity and prevent AHR during labor. Postpartum, local anesthetics should be extended to prevent AHR, ensuring better outcomes for both mother and child.