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Prise en charge des troubles de la reproduction de la femme blessée médullaire

Management of pregnancy and delivery in spinal cord injured women

Resume

La grossesse de la femme paraplégique est d’un pronostic favorable sous la condition d’un suivi spécialisé. Les complications sont dominées par la fréquence des infections urinaires, le risque de thrombophlébites, la survenue d’escarres. La gravité est liée au possible déclenchement d’un syndrome d’hyperréflexie autonome dans les lésions supérieures à T6, syndrome qui doit être prévenu par la mise en place d’une analgésie péridurale au début du travail. L’accouchement doit s’envisager par voie basse, parfois aidé sur le plan instrumental (forceps). Les indications de césariennes ne doivent être qu’obstétricales ou lors d’un syndrome d’HRA non jugulable. Le risque d’accouchement prématuré apparaît plus important dans cette population, imposant une surveillance drastique lors du 3° trimestre.

Abstract

The overall outcomes of pregnancies and deliveries in spinal cord injured women are generally favorable. However, several antepartum complications may occur, the most frequent being urinary tract infection. There is also a risk of pressure sores and thrombophlebitis. Autonomic hyperreflexia is a serious problem and a potential danger to spinal cord injured women with neurological levels above T6, particularly during the third trimester and during labor. Autonomic hyperreflexia is generally prevented by continuous epidural anesthesia. Concerning the mode of delivery, most patients are able to deliver vaginally, but forceps are sometimes necessary. Cesarean section must only be performed for obstetric reasons and in cases of intractable autonomic hyperreflexia.

Références

  1. 1.

    BAKER E. R., CARDENAS D.D.: Pregnancy in spinal cord injured women. Arch. Phys. Med. Rehabil., 1996, 77: 501–507.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    BAKER E. R., CARDENAS D.D., BENEDETTI T. J.: Risks associated with pregnancy in spinal cord injued women. Obstet. Gyneco., 1992, 80: 425–428.

    CAS  Google Scholar 

  3. 3.

    CHARLIFUE S.W., GERHART K.A., MENTER R.R., WHITENECK G.G., MANLEY M.S.: Sexual issues of women with spinal cord injuries. Paraplegia, 1992, 30: 192–199.

    PubMed  CAS  Google Scholar 

  4. 4.

    CROSS L.L., MEYTHALER J.M., TUEL S.M., CROSS A.L.: Pregnancy, labor and delivery post spinal injury. Paraplegia, 1992, 30: 890–892.

    PubMed  CAS  Google Scholar 

  5. 5.

    DE VIVO M.J., BLACK K.J., STOVER S.L.: Causes of death during the first 12 years after spinal cord injury. Arch. Phys. Med. Rehabil., 1993, 74: 248–254.

    Google Scholar 

  6. 6.

    HEAD H., RIDDOCH G.: Autonomic bladder excessive sweating and some reflex conditions in gross injuries of spinal cord. Brain, 1917, 46: 188–263.

    Article  Google Scholar 

  7. 7.

    National Institute on Disability and Rehabilitation Research Consensus Statement. The prevention and the management of urinary tract infection among people with spinal cord injury. J. Am. Paraplegia Soc., 1992.

  8. 8.

    ROBERTSON D.N.S., GUTTMAN L.: The paraplegic patient in pregnancy and labour. Proc. R. Soc. Med., 1963, 56: 381–387.

    PubMed  CAS  Google Scholar 

  9. 9.

    TURK R., TURK M., ASSEJEV.: The female paraplegic and mother-child relations. Paraplegia, 1983, 21: 186–191.

    PubMed  CAS  Google Scholar 

  10. 10.

    WANNER M. B., RAGETH C.J., ZACH G.A.: Pregnancy and autonomic hyperreflexia in patients with spinal cord lesions. Paraplegia, 1987, 25: 482–490.

    PubMed  CAS  Google Scholar 

  11. 11.

    WESTGREN N., HULTING C., LEVI R., WESTGREN M.: Pregnancy and delivery in women with a traumatic spinal cord injury in Sweden, 1980–1991. Obstet. Gynecol., 1993, 81: 926–929.

    PubMed  CAS  Google Scholar 

  12. 12.

    WESTGREN N., LEVI R.: Motherhood after traumatic spinal cord injury Paraplegia, 1994, 32: 517–523.

    PubMed  CAS  Google Scholar 

  13. 13.

    WHITENECK G. G., CHARLIFUE S.W., FRANKEL H.L., et al: Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago. Paraplegia, 1992, 30: 617–630.

    PubMed  CAS  Google Scholar 

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Correspondence to J. J. Labat.

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Communication à la Session SALF-AFU des 6° Journées de la Fédération Française d’Étude de la Reproduction, Lyon, 5–7 septembre 2001

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Labat, J.J., Perrouin-Verbe, B. Prise en charge des troubles de la reproduction de la femme blessée médullaire. Androl. 11, 247–252 (2001). https://doi.org/10.1007/BF03034639

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Mots clés

  • Paraplégie
  • blessé médullaire
  • procréation
  • conception
  • grossesse
  • reproduction
  • accouchement

Key words

  • Spinal cord injury
  • paraplegia
  • procreation
  • conception
  • pregnancy
  • reproduction
  • delivery
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