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2.
PLoS One ; 12(7): e0181495, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28742157

RESUMO

BACKGROUND: Autonomic dysreflexia (AD) is a potentially life-threating complication after spinal cord injury (SCI), characterized by episodic hypertension induced by colon or bladder distension. The objective of this study was to determine the role of impaired baroreflex regulation by the nucleus tractus solitarii(NTS) in the occurrence of AD in a rat model. METHODS: T4 spinal cord transection animal model was used in this study, which included 40 Male rats Colorectal distension (CD) was performed to assess AD and compare the changes of BP, HR, and BRS, six weeks after operation. After that, SCI rats with successfully induced AD were selected. Losartan was microinjected into NTS in SCI rats, then 10, 30, 60 minutes later, CD was performed to calculate the changes of BP, HR, and BRS in order to explicit whether Ang II system was involved in the AD occurrence. Ang II was then Intra-cerebroventricular infused in sham operation rats with CD to mimic the activation of Ang II system in AD. Finally, the level of Ang II in NTS and colocalization of AT1R and NMDA receptor within the NTS neurons were also detected in SCI rats. RESULTS: Compared with sham operation, SCI significantly aggravated the elevation of blood pressure (BP) and impaired baroreflex sensitivity (BRS) induced by colorectal distension; both of which were significantly improved by microinjection of the angiotensin receptor type I (AT1R) antagonist losartan into the NTS. Level of angiotensin II (Ang II) in the NTS was significantly increased in the SCI rats than sham. Intracerebroventricular infusion of Ang II also mimicked changes in BP and BRS induced by colorectal distension. Blockade of baroreflex by sinoaortic denervation prevented beneficial effect of losartan on AD. CONCLUSION: We concluded that the activation of Ang II system in NTS may impair blood pressure baroreflex, and contribute to AD after SCI.


Assuntos
Angiotensina II/metabolismo , Disreflexia Autonômica/complicações , Disreflexia Autonômica/fisiopatologia , Núcleo Solitário/fisiopatologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia , Angiotensina II/análise , Animais , Disreflexia Autonômica/metabolismo , Barorreflexo , Pressão Sanguínea , Masculino , Ratos , Receptor Tipo 1 de Angiotensina/análise , Receptor Tipo 1 de Angiotensina/metabolismo , Receptores de N-Metil-D-Aspartato/análise , Receptores de N-Metil-D-Aspartato/metabolismo , Núcleo Solitário/metabolismo , Traumatismos da Medula Espinal/metabolismo
3.
PM R ; 9(10): 1047-1050, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28366524

RESUMO

The life expectancy of persons with spinal cord injury (SCI) is increasing due to advances in medicine and technology. As a result, there is a higher incidence of age-associated illnesses in this population. Degenerative joint disease is a common age-associated illness that causes pain and thus, in persons with SCI above the T6 level, can serve as a noxious stimulus to trigger autonomic dysreflexia (AD). This is a case report of severe bilateral hip osteoarthritis (OA) causing unyielding AD in a person with tetraplegia leading to bilateral girdle stone surgeries. Hip OA as an etiology for AD has not previously been reported and is important to recognize as this population continues to age and to develop age-associated diseases. LEVEL OF EVIDENCE: V.


Assuntos
Disreflexia Autonômica/complicações , Multimorbidade , Osteoartrite do Quadril/complicações , Quadriplegia/complicações , Disreflexia Autonômica/diagnóstico , Disreflexia Autonômica/reabilitação , Vértebras Cervicais/lesões , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/cirurgia , Quadriplegia/diagnóstico , Quadriplegia/reabilitação , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/diagnóstico
4.
Heart Rhythm ; 14(6): 920-927, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28215570

RESUMO

Spinal cord injury is a clinical syndrome encountered frequently in trauma centers and is accompanied by both acute and chronic heart rhythm abnormalities. The injury is characterized by sympathetic nervous system impairment with preservation of parasympathetic output via the vagus nerve. Severe bradycardia in the form of life-threatening sinus arrest or complete heart block may be observed in the acute recovery phase. Therapy for arrhythmias in the acute phase includes atropine, intravenous chronotropes, methylxanthines for the prevention of episodic bradycardia, and pacemaker implantation in severe cases. In the chronic recovery phase, autonomic dysreflexia in the form of paroxysmal hypertension is often induced by visceral organ distension or other stimuli and can be accompanied by bradycardia or tachycardia. The prognosis for survivors of spinal cord injury is expected to improve with further advances in surgical and medical care, and electrophysiologists will likely be called upon more frequently to help manage heart rhythm disorders in this setting.


Assuntos
Arritmias Cardíacas , Disreflexia Autonômica/complicações , Ablação por Cateter/métodos , Traumatismos da Medula Espinal/complicações , Sistema Nervoso Simpático/fisiopatologia , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Humanos , Prognóstico , Sistema Nervoso Simpático/cirurgia
6.
Hypertension ; 68(5): 1281-1289, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27698067

RESUMO

Autonomic dysreflexia (AD), which describes episodic hypertension, is highly prevalent in people with spinal cord injury (SCI). In non-SCI, primary hypertension depresses cardiac contractile reserve via ß-adrenergic mechanisms. In this study, we investigated whether AD contributes to the impairment in cardiac contractile function that accompanies SCI. We induced SCI in rodents and stratified them into sham, SCI, or SCI plus repetitive induction of AD. At 6-week post-SCI, we assessed cardiac function using in vivo (speckle-tracking echocardiography), ex vivo (working heart), and molecular approaches (Western blot). We also provide unique translational insight by comparing the relationship between the number of daily AD events and cardiac function in 14 individuals with cervical SCI. We found SCI and SCI plus repetitive induction of AD exhibited a reduction in left ventricular dimensions at 6-week post-SCI versus preinjury (P<0.049). Compared with sham, SCI exhibited a reduction in peak radial strain along with a down and rightward shift in the Starling curve (P<0.037), both of which were further depressed in SCI plus repetitive induction of AD (P<0.042). In response to ß-adrenergic stimulation, SCI plus repetitive induction of AD exhibited an attenuated increase in contractile indices (P<0.001), despite no differences in ß-receptor expression within the left ventricle. Our clinical data confirm our experimental findings by demonstrating significant associations between the number of daily AD events and markers of systolic and diastolic function along with left ventricular mechanics. Here, we provide the first evidence from a translational perspective that AD exerts insidious effects on cardiac function in rodents and humans with SCI.


Assuntos
Disreflexia Autonômica/complicações , Hipertensão/fisiopatologia , Contração Miocárdica/fisiologia , Traumatismos da Medula Espinal/complicações , Função Ventricular Esquerda/fisiologia , Animais , Disreflexia Autonômica/fisiopatologia , Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Modelos Animais de Doenças , Hipertensão Essencial , Humanos , Hipertensão/etiologia , Masculino , Análise Multivariada , Distribuição Aleatória , Ratos , Ratos Wistar , Valores de Referência , Análise de Regressão , Medição de Risco , Amostragem , Traumatismos da Medula Espinal/fisiopatologia
7.
World J Urol ; 34(3): 391-7, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26055644

RESUMO

PURPOSE: To investigate autonomic dysreflexia (AD) and repeatability of cardiovascular changes during same session repeat urodynamic investigation (UDI) in women with spinal cord injury (SCI). METHODS: Prospective investigation of 33 consecutive women with suprasacral SCI suffering from neurogenic lower urinary tract dysfunction (NLUTD) undergoing same session repeat UDI and synchronous continuous cardiovascular monitoring [systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR)]. UDIs were performed according to the International Continence Society guidelines. AD was defined according to the International Standards to document remaining Autonomic Function after SCI. Neurological level of SCI was determined using the American Spinal Injury Association impairment scale. RESULTS: Mean age and duration since SCI of the 33 women were 58 ± 19 and 6 ± 11 years, respectively. Overall AD incidence was 73 % (24/33), and 19 of the 33 women (58 %) showed AD in both UDIs. The repeatability of detecting AD between the two same session UDIs was good (κ = 0.67, 95 % CI 0.4-0.94). When applying the Bland and Altman method, wide 95 % limits of agreement for differences in same session SBP, DBP and HR indicated poor repeatability. There was a significant increase in SBP (p < 0.001) and DBP (p < 0.001) and a significant decrease in HR (p = 0.007) in patients with compared to those without AD. CONCLUSIONS: In all women with NLUTD due to suprasacral SCI, we strongly recommend continuous cardiovascular monitoring during UDI and repeat measurements considering the high incidence of AD, the relevant risks involved with sudden hypertension and the poor repeatability of cardiovascular monitoring.


Assuntos
Disreflexia Autonômica/fisiopatologia , Doenças Cardiovasculares/etiologia , Hemodinâmica/fisiologia , Traumatismos da Medula Espinal/complicações , Bexiga Urinária/fisiopatologia , Urodinâmica/fisiologia , Idoso , Disreflexia Autonômica/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Feminino , Seguimentos , Humanos , Incidência , Vértebras Lombares , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Recidiva , Traumatismos da Medula Espinal/fisiopatologia , Suíça/epidemiologia , Fatores de Tempo
8.
Nurs Times ; 111(44): 22-4, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26665385

RESUMO

Autonomic dysreflexia is a medical emergency occurring after spinal cord injury caused by disruption of the normal autonomic responses to a stimulus below the level of spinal cord lesion. Although it can lead to stroke, convulsions, cardiac arrest and death, health professionals are largely ignorant of the condition and it is frequently misdiagnosed. This article gives an overview of autonomic dysreflexia, along with how it can be diagnosed and treated.


Assuntos
Disreflexia Autonômica/complicações , Traumatismos da Medula Espinal/complicações , Humanos
10.
J Neurotrauma ; 32(12): 922-30, 2015 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-25630034

RESUMO

Spinal cord injury (SCI) is associated with rapid and sustained impairments in cardiovascular function that ultimately cause an early onset of cardiovascular disease. We know remarkably little about the temporal progression of cardiovascular disturbances, but such an understanding is critical to inform clinical management and develop appropriate intervention strategies. To characterize the cardiovascular response to SCI, six male Wistar rats were instrumented with telemetry and assessed for continuous arterial blood pressure (BP), core body temperature, and heart rate (HR) 7 days before and up to 28 days after T3 SCI. Hemodynamic variables were averaged day by day and hour by hour. Spontaneously occurring autonomic dysreflexia (AD) was characterized by applying a novel algorithm to continuous BP and HR data, and induced AD was assessed weekly via the BP response to colorectal distension. Systolic BP was reduced at all time points after SCI compared with before SCI (p<0.003), except at 4 and 6 days post-injury. Core body temperature was reduced at 2 days post-SCI only (p=0.001). The nocturnal dip in BP and temperature observed pre-SCI was absent during the first 14 days post-SCI, but returned from 21 days post-SCI on (p<0.024). The frequency and severity of spontaneously occurring AD events were significantly less between days 6 and 10 post-SCI compared all other time points (p<0.037). The pressor response to colorectal distension was greater at 14, 21, and 28 days post-SCI compared with at 7 days post-SCI (all p<0.004). In conclusion, SCI induces rapid and profound alterations in basal hemodynamics and diurnal rhythms that partially recover by 14 days post-SCI. AD, on the other hand, is acutely present post-SCI, but the frequency and severity of AD events increase substantially from 14 days post-SCI on.


Assuntos
Disreflexia Autonômica/fisiopatologia , Pressão Sanguínea , Doenças Cardiovasculares/fisiopatologia , Frequência Cardíaca , Traumatismos da Medula Espinal/fisiopatologia , Animais , Disreflexia Autonômica/complicações , Disreflexia Autonômica/patologia , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/patologia , Frequência Cardíaca/fisiologia , Masculino , Ratos , Ratos Wistar , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/patologia , Telemetria/métodos , Fatores de Tempo
11.
Int J Obstet Anesth ; 24(1): 77-84, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25499809

RESUMO

With improvements in management and rehabilitation, more women with spinal cord injury are conceiving children. Physiologic manifestations of spinal cord injury can complicate anesthetic management during labor and delivery. Patients who delivered at Mayo Clinic, Rochester, Minnesota between January 1, 2001 and May 31, 2012 with a history of traumatic spinal cord injury were identified via electronic record search of all parturients. Eight patients undergoing nine deliveries were identified. Six deliveries (67%) among five patients (63%) involved a trial of labor. Among these deliveries, three (50%) occurred vaginally, all with successful epidural analgesia. Trial of labor failed in the remaining three patients, and required cesarean delivery facilitated via epidural (n=1), spinal (n=1) and general anesthesia (n=1). Three patients (33%) underwent scheduled cesarean delivery via epidural (n=1), spinal (n=1), and general anesthesia (n=1). Four patients having five deliveries had a history of autonomic hyperreflexia before pregnancy. One patient had symptoms during pregnancy, two patients had episodes during labor and delivery, and three patients described symptoms in the immediate postpartum period. These symptoms were not reported by any patient without a history of autonomic hyperreflexia. Neuraxial labor analgesia may have a higher failure rate in patients with spinal cord injury, possibly related to the presence of Harrington rods. Postpartum exacerbations of autonomic hyperreflexia are common in patients with a history of the disorder.


Assuntos
Anestesia Epidural/métodos , Anestesia Geral/métodos , Anestesia Obstétrica/métodos , Raquianestesia/métodos , Paralisia/complicações , Complicações na Gravidez , Disreflexia Autonômica/complicações , Cesárea , Parto Obstétrico , Feminino , Humanos , Paraplegia/complicações , Gravidez , Quadriplegia/complicações , Traumatismos da Medula Espinal/complicações
13.
Hipertens. riesgo vasc ; 31(2): 66-68, abr.-jun. 2014. ilus
Artigo em Espanhol | IBECS | ID: ibc-124619

RESUMO

Presentamos el caso de un paciente con lesión medular cervical de larga evolución que sufre una crisis hipertensiva de consecuencia fatal secundariamente a un cuadro de disreflexia autonómica. Aunque este trastorno vegetativo es frecuente en este tipo de pacientes, y su tratamiento es sencillo y está bien establecido, es escasamente conocido fuera de los ambientes que tratan pacientes con lesiones medulares. Su desconocimiento puede retrasar la instauración del tratamiento y dejar secuelas severas. El cuadro puede ser tan grave como el que presentamos, a pesar de ser diagnosticado y manejado precozmente


We report the case of a male patient with a cervical spinal cord injury who suffered a hypertensive episode secondary to autonomic dysreflexia with fatal outcome. Although this vegetative disorder is common in these patients and its treatment is simple and well established, it is not widely known outside setting in which patients with bone marrow injuries are treated. Lack of knowledge about it may delay the initiation of treatment and result in severe sequelae. This disease can be as severe as the one we present despite being diagnosed and managed Early


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Disreflexia Autonômica/complicações , Hemorragia Cerebral/etiologia , Hipertensão/fisiopatologia , Traumatismos da Medula Espinal/complicações , Infecções por HIV/complicações
14.
Eur J Pediatr ; 173(12): 1683-4, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24535713

RESUMO

UNLABELLED: The scope of paediatric autonomic disorders is not well recognised, and paediatricians seem to be generally unaware of the complexity and diversity of their clinical manifestations. We report a 12-year-old boy presenting with hypertensive encephalopathy caused by autonomic dysreflexia. CONCLUSION: This observation emphasises the importance of the recognition of this rare autonomic disorder, which can have potentially life-threatening neurological complications.


Assuntos
Disreflexia Autonômica/complicações , Pressão Sanguínea , Encefalopatia Hipertensiva/etiologia , Traumatismos da Medula Espinal/complicações , Disreflexia Autonômica/diagnóstico , Vértebras Cervicais , Criança , Diagnóstico Diferencial , Seguimentos , Humanos , Encefalopatia Hipertensiva/diagnóstico , Encefalopatia Hipertensiva/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Traumatismos da Medula Espinal/diagnóstico , Vértebras Torácicas
15.
J Neurosci ; 33(32): 12970-81, 2013 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-23926252

RESUMO

Autonomic dysreflexia (AD), a potentially dangerous complication of high-level spinal cord injury (SCI) characterized by exaggerated activation of spinal autonomic (sympathetic) reflexes, can cause pulmonary embolism, stroke, and, in severe cases, death. People with high-level SCI also are immune compromised, rendering them more susceptible to infectious morbidity and mortality. The mechanisms underlying postinjury immune suppression are not known. Data presented herein indicate that AD causes immune suppression. Using in vivo telemetry, we show that AD develops spontaneously in SCI mice with the frequency of dysreflexic episodes increasing as a function of time postinjury. As the frequency of AD increases, there is a corresponding increase in splenic leucopenia and immune suppression. Experimental activation of spinal sympathetic reflexes in SCI mice (e.g., via colorectal distension) elicits AD and exacerbates immune suppression via a mechanism that involves aberrant accumulation of norepinephrine and glucocorticoids. Reversal of postinjury immune suppression in SCI mice can be achieved by pharmacological inhibition of receptors for norepinephrine and glucocorticoids during the onset and progression of AD. In a human subject with C5 SCI, stimulating the micturition reflex caused AD with exaggerated catecholamine release and impaired immune function, thus confirming the relevance of the mouse data. These data implicate AD as a cause of secondary immune deficiency after SCI and reveal novel therapeutic targets for overcoming infectious complications that arise due to deficits in immune function.


Assuntos
Disreflexia Autonômica , Doenças do Sistema Imunitário/etiologia , Imunossupressão , Traumatismos da Medula Espinal/complicações , Antagonistas de Receptores Adrenérgicos beta 2/farmacologia , Animais , Antígenos CD/metabolismo , Disreflexia Autonômica/complicações , Disreflexia Autonômica/etiologia , Disreflexia Autonômica/imunologia , Pressão Sanguínea/imunologia , Butoxamina/farmacologia , Colo/inervação , Corticosterona/sangue , Modelos Animais de Doenças , Epinefrina/sangue , Feminino , Antagonistas de Hormônios/farmacologia , Humanos , Camundongos , Mifepristona/farmacologia , Norepinefrina/sangue , Ovalbumina/imunologia , Estimulação Física/efeitos adversos , Traumatismos da Medula Espinal/imunologia , Linfócitos T/classificação , Linfócitos T/metabolismo , Telemetria
17.
Kyobu Geka ; 66(6): 505-7, 2013 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-23917059

RESUMO

Autonomic dysreflexia can occur in patients with spinal cord injury and lead to excessive hypertension. A 61-year-old man who had been treated for spinal cord injury 28 years before in an accidental fall, was admitted with an acute aortic dissection and underwent replacement of ascending aorta. He had been injured the 6th cervical neurologic level and he had not been given regular medical care. His incident of aortic dissection during defecation might related to the elevation of blood pressure due to autonomic dysreflexia.


Assuntos
Aneurisma Dissecante/etiologia , Aneurisma da Aorta Torácica/etiologia , Disreflexia Autonômica/complicações , Doença Aguda , Humanos , Masculino , Pessoa de Meia-Idade
18.
J Spinal Cord Med ; 36(3): 250-3, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23809598

RESUMO

BACKGROUND/OBJECTIVES: To report two cases of reversible posterior leukoencephalopathy syndrome (RPLS) in patients with traumatic cervical spinal cord injury. DESIGN: Case report. SETTING: Rehabilitation Inpatient Unit, Pusan National University Hospital, Yangsan-si, Korea. RESULTS: Two men with spastic tetraplegia developed autonomic dysreflexia. Use of antihypertensive medication and Foley catheter insertion prevented further episodes of acute arterial hypertension and development of new symptoms. CONCLUSION: RPLS can occur in the setting of autonomic dysreflexia in patients with traumatic cervical cord injury. The prompt recognition of this syndrome is of importance to prevent further morbidity and mortality in patients with spinal cord injury.


Assuntos
Disreflexia Autonômica/complicações , Síndrome da Leucoencefalopatia Posterior/etiologia , Traumatismos da Medula Espinal/complicações , Anti-Hipertensivos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome da Leucoencefalopatia Posterior/terapia , Cateterismo Urinário
19.
J UOEH ; 35(2): 159-64, 2013 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-23774659

RESUMO

The author reports the case of a 36 year old man with cervical cord injury in whom autonomic dysreflexia developed into intracerebral hemorrhage during inpatient rehabilitation. This patient showed complete quadriplegia (motor below C6 and sensory below C7) due to fracture of the 6th cervical vertebra. An indwelling urethral catheter had been inserted into the bladder for 3 months, diminishing bladder expansiveness. Bladder capacity decreased to 200 ml and the patient frequently experienced headaches whenever his bladder was full.To obtain smoother urine flow, a supra-pubic cystostomy was performed. The headaches were temporarily cured, but soon relapsed with extreme increases in blood pressure, representing typical symptoms of autonomic dysreflexia. However, no potential triggers were identified or removed, and lack of blood pressure management led to left putaminal hemorrhage. Despite operative treatment, the right upper extremity showed progressive increases in muscle tonus and finally formed a frozen shoulder with elbow flexion contracture. Two factors contributed to this serious complication: first, autonomic dysreflexia triggered by minor malfunction and/or irritation from the cystostomy catheter; and second, the medical staff lacked sufficient experience in and knowledge about the management of autonomic dysreflexia.It is of the utmost importance for medical staff engaging in rehabilitation of spinal patients to share information regarding triggers of autonomic dysreflexia and to be thorough in ensuring proper medical management.


Assuntos
Disreflexia Autonômica/complicações , Hemorragia Intracraniana Hipertensiva/etiologia , Traumatismos da Medula Espinal/complicações , Adulto , Humanos , Masculino , Pescoço
20.
Matronas prof ; 14(1): 24-27, ene.-mar. 2013. tab
Artigo em Espanhol | IBECS | ID: ibc-113807

RESUMO

El número de españoles con discapacidad asciende a 3.847.900. De ellos, más de 2,3 millones son mujeres en las que, al igual que en las mujeres sanas, existe la capacidad de ser madre. El embarazo en una mujer con lesión medular es tan posible como en cualquier mujer, pero será una gestación de alto riesgo. La frecuencia de embarazos en estas pacientes es baja, lo que hace que las conductas obstétricas no sean uniformes .Se describe un caso de parto eutócico en una mujer con paraplejía debido a una lesión medular dorsal. Se observó que una actitud expectante, que permitiera la evolución espontánea del parto, con los pertinentes controles maternos y fetales, consiguió la terminación normal del embarazo, con resultados óptimos para madre e hijo (AU)


The number of Spanish people with disabilities rises to 3,847,900, with more than 2.3 million women, among them, as in healthy women, there is a capacity of being mother. Pregnancy in a woman with spinal cord injury is as possible as in any woman, but it will be a high-risk pregnancy. However, the frequency of pregnancies in these women is low, which makes obstetric behavior are not uniform. It narrates a case of normal labor in a woman with paraplegia due to thoracic level spinal cord injury. It was noted that an expectant attitude, which allowed the spontaneous evolution of the birth, with the appropriate maternal and fetal controls, resulted in the normal termination of pregnancy, with optimal results for mother and child (AU)


Assuntos
Humanos , Feminino , Gravidez , Complicações na Gravidez , Gravidez de Alto Risco , Traumatismos da Medula Espinal/complicações , Complicações do Trabalho de Parto , Fatores de Risco , Pessoas com Deficiência , Disreflexia Autonômica/complicações
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