Vaginal delivery in a paraplegic patient

Abstract

I N ORDER to clarify all factors inherent in pregnancy and its complications, expulsion of the fetus, and relief of pain, during the past quarter century medical research has focused its attention on the study of the female genital tract. A thorough understanding of the musculature and topographic location and specific function of each neuropathway to all organs has been undertaken. During a review of the literature it was found that investigation of uterine innervation and physiology has been carried on since 1’732. It was discussed by Winslow in the eighteenth century ; Tiedemann, Bourgery, Frankenhauser, and Rein in the nineteenth century ; and numerous others in the twentieth century. Sir James Simpson, in 18’71, found normal parturition in sows after removal of the thoracic and lumbar cord, except that the last fetus of the litter remained in the vagina. In the same year, Rieman, upon performing a similar experiment, found the same thing to be true, as did Rein, ten years later, following section of all extrinsic uterine nerves. In 1924, Good,6 after observing a ease of pregnancy and labor complicated by spinal cord injury and reviewing the literature, concluded that the sympathetic nervous system and not the spinal cord controls uterine contractions. Canon, in 1929, described parturition in a cat six weeks after the exclusion of all sympathetic impulses by removal of the sympathetic ganglia. A few years later, Fontaine and Hermann5 testified to parturition with normal delivery in a patient who had undergone resection of the superior hypogastric plexus for dysmenorrhea. Cushney’s experiments on mammalians, early in the twentieth century, established the fact that automatic, rhythmic uterine contractions are myogenic rather than neurogenic and demonstrated completion of the first stage of labor after severance of all uterine nerves. This was confirmed by Clark* in 1911. More recently, Nilsong reported a case of pregnancy and spontaneous labor devoid of first and second stage complications in a quadriplegic patient confined to a respirator. However, absence of secondary forces necessitated a low forceps extraction. Physiology of the Uterus in Labor