A Physiatrist’s Role in Managing Unique Challenges During Pregnancy and Delivery in an Individual with Incomplete Lumbar SCI: A Case Report

Case Diagnosis: Patient is a pregnant 32-year-old ambulatory female with a lumbar motor incomplete spinal cord injury.

Case Description or Program Description: This patient achieved pregnancy seven years after a crush injury resulted in a lumbar motor incomplete spinal cord injury (SCI). She faced several challenges throughout pregnancy secondary to neurogenic bladder, pelvic floor weakness, and impaired mobility. Early on, physiatry worked with her to increase frequency of straight catheterization, but she continued to experience intermittent incontinence. This progressed in the second trimester, provoked by increased pelvic pressure with ambulation, leading her to rely entirely on her wheelchair for mobility. The physiatry team assisted in the procurement of a replacement wheelchair and referred her to pelvic floor physical therapy in the setting of reduced antepartum mobility and anticipated postpartum recovery. Obstetrics initiated prophylactic antibiotics for urinary tract infection prevention and trialed a pessary for incontinence management. Importantly, the physiatry team aided in the development of a birth plan in the setting of her SCI and a difficult epidural placement due to lumbar spinal hardware placement. This plan transitioned from scheduled induction of labor to planned cesarean delivery in the setting of fetal malpositioning.

Setting: Outpatient Physiatry Clinic

Assessment/Results: The patient had a successful cesarean section delivery and was discharged home with home therapy. She returned to modified independent mobility with ankle-foot-orthoses and a lofstrand crutch and continued pelvic floor therapy in the postpartum period.

Discussion (relevance): Individuals with SCI are likely to face multiple medical complications in pregnancy, most commonly urologic complications, which can have profound functional sequelae. They are more likely to have cesarean sections, longer hospitalizations, and early readmission due to complications such as falls. In this case, physiatry took an active role in managing and preventing these complications through a multidisciplinary approach.

Conclusions: There is a need for a multidisciplinary approach to patients with SCI during pregnancy, and the role of physiatry is critical to optimizing medical and functional outcomes.