To the Editor:

Abstract

As a result of increased survival rates in women with spinal cord injuries (SCI), the number of parturients with SCI is increasing [ [1] Pereira L Obstetric management of the parturient with spinal cord injury. Obstet Gynecol Surv. 2003; 58: 678-686 Crossref PubMed Scopus (55) Google Scholar ]. Any parturient with SCI whose level of spinal cord transsection is at T6 or higher is at risk for uterine contraction–induced acute autonomic hyperreflexia. Coincidently, the literature documenting peripartum management of pregnant patients with SCI is limited [ 1 Pereira L Obstetric management of the parturient with spinal cord injury. Obstet Gynecol Surv. 2003; 58: 678-686 Crossref PubMed Scopus (55) Google Scholar , 2 Kuczkowski K.M Peripartum anaesthetic management of a parturient with spinal cord injury and autonomic hyperreflexia. Anaesthesia. 2003; 58: 823-824 Crossref PubMed Scopus (10) Google Scholar ]. Pregnant patients with SCI should be admitted to a specialized medical facility whenever possible and carefully evaluated before labor. Three years ago at the University of California, San Diego, we established a High-Risk Obstetric Anesthesia Clinic where all high-risk pregnant patients (including pregnant women with SCI) can be evaluated several weeks before their date of confinement. Pregnant women with SCI are usually assessed by a multidisciplinary team of experts, involving the obstetrician, obstetric anesthesiologist, neurologist, urologist, physical therapist and nursing staff who work together to develop an intrapartum care plan aimed at provision of labor analgesia and avoidance of labor-induced autonomic hyperreflexia.