Pregnancy complicated by chronic spinal cord injury and history of autonomic hyperreflexia.

BACKGROUND: Women with spinal cord injuries are at risk for autonomic hyperreflexia during labor. CASE: A 36-year-old woman, gravida 4, para 2, abortus 1, with a spinal cord injury and a positive antibody screen result had had a previous pregnancy complicated by autonomic hyperreflexia during labor. Autonomic hyperreflexia did not occur during serial amniocenteses and fetal transfusions for isoimmunization or intrapartum. CONCLUSION: Intrauterine procedures and vaginal delivery were accomplished without autonomic hyperreflexia in this pregnancy. Intrauterine procedures and vaginal delivery might be done safely in women with histories of autonomic hyperreflexia.

Successful pregnancy outcome with cardiac and severe restrictive lung disease requiring mechanical ventilation: a case report and literature review.

The prognosis for pulmonary hypertension as a single entity is poor, but when it is superimposed on the physiological changes of pregnancy, it produces a lethal condition, with maternal mortality rates greater than 50%. We present a successfully managed case followed by a review and discussion of the available literature on this subject. A 24-year-old woman, a primigravida, was mechanically ventilated for severe restrictive lung disease. Her pregnancy required close surveillance of her labile cardiopulmonary status as well as fetal well-being. Her delivery was scheduled for induction at 34 weeks' gestation, but she required an emergency Cesarean section, which was productive of a healthy infant. Her recovery was complicated by recurrent fever. There is limited literature on restrictive lung disease and pulmonary hypertension with regards to their management during pregnancy. Nevertheless, successful pregnancy outcomes may result with careful multidisciplinary management.

Vacuum extraction in modern obstetric practice: a review and critique.

The practice of obstetric vacuum extraction is controversial. This article discusses several issues concerning vacuum extraction including maternal and fetal injury risks, failure rates, indications and technique. Recently published articles on these topics are presented and summarized. Throughout this review, vacuum extraction is evaluated against its principal alternatives, forceps and cesarean delivery.