Clinical Case Reports
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Ectopic pregnancy in a woman with T9 AIS A (motor complete, sensory complete) paraplegia secondary to a high-grade spinal cord pilocytic astrocytoma
In the United States, 20,000 women of childbearing age have a spinal cord injury (SCI). While SCI induces transient amenorrhea immediately after injury, women generally have normal reproductive function after SCI, and their fertility is unimpaired. Medications that commonly manage complications of SCI should be avoided or discontinued during pregnancy. Complications inherent to SCI, including urologic issues, are often exacerbated during pregnancy.
This is a case report on a female Veteran who initially presented to the McGuire VA Medical Center’s (VAMC) Spinal Cord Injuries & Disorder (SCI&D) service for a comprehensive evaluation, who’s diagnosed pregnancy warranted coordination of medical care with the VCU Health System.
A 37-year-old female with T9 AIS A (motor complete, sensory complete) paraplegia secondary to a high-grade spinal cord astrocytoma presented to the VAMC SCI&D service. She was evaluated by the interdisciplinary team to assess her functional status and equipment needs, as well as to receive SCI-specific education.
During her evaluation, the patient brought to medical attention her recent missed menstrual period and sexual activity. Labs revealed an elevated and appropriately increasing serum beta-HCG consistent with pregnancy. The VAMC’s Women’s Health Center coordinated for the patient to receive further evaluation by VCU’s Maternal Fetal Medicine team. The patient’s transvaginal ultrasound revealed an ectopic pregnancy, so she underwent a laparoscopic salpingectomy. Prior to diagnosing the pregnancy’s ectopic nature, she was counseled on antepartum medication management and anticipated SCI complications exacerbated by pregnancy.
14-18% of women with SCI have children after injury. There are unique matters related to ante-partum, intra-partum, and post-partum care to consider in injured women whose pregnancy progresses. Our patient’s pregnancy was high-risk, given her advanced maternal age and SCI. Her case raises the importance of coordinated care amongst the physiatry, obstetrics, and anesthesiology teams, as adverse pregnancy and neonatal-related outcomes can occur.
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VCU School of Medicine GME Resident and Fellow Research Day Posters
Interprofessional Education Commons, Nervous System Diseases Commons, Neurosciences Commons, Obstetrics and Gynecology Commons, Rehabilitation and Therapy Commons, Reproductive and Urinary Physiology Commons