Labor analgesia for the parturient with spinal cord injury: what does an obstetrician need to know?

Each year more than 2,000 women of childbearing age in the United States alone sustain a spinal cord injury (SCI). As a result of increased survival rates in women with SCI the number of parturients with SCI is increasing. The literature documenting peripartum obstetric and anesthetic management of pregnant patients with SCI is very limited. Any parturient with SCI whose level of transection is at the level of T6 or higher is at risk for acute autonomic hyperreflexia (AHR) as a result of uterine contractions. Expeditious induction of labor analgesia may prevent or ameliorate peripartum complications (including AHR) in laboring parturients with SCI.