There are approximately 3,000 women of childbearing age who become spinal cord injured each year in the United States. There are few reports in the literature that address pregnancy, labor and delivery in this patient population. We are reporting on 22 women post spinal cord injury who had 33 pregnancies. There were equal numbers of paraplegic and quadriplegic women. Three pregnancies aborted, one spontaneously. The babies were near normal or normal weight with one exception. The mothers waited 5 years on average to become pregnant. Cesarean section was performed on 43% of pregnancies. Abnormal presentations occurred in over 10% of pregnancies. Indications for cesarean section included 5 that were repeats; the remainder were necessary due to bleeding (1), breech presentation (1), transverse presentation (2), lack of progress (2), onset of labor 1 day post spinal fusion, and a mother's request to have tubal ligation. Epidural anesthesia was selected for 9 deliveries; 6 of these patients had controlled autonomic hyperreflexia. Five general and 4 local anesthetics were used, and 12 patients received no anesthesia. Diagnostic ultrasound and amniocentesis were used selectively. Complications included autonomic hyperreflexia (9), frequent urinary tract infections, infected pressure sores (3, 2 resulting in below-knee amputations), seizures during and after delivery, pneumonia, bladder stones (2), episiotomy dehiscence (1), and break down of spinal fusion. The newborns were healthy, although one double footling breech vaginal delivery had an AP GAR of 1 at 1 min, 7 at 5 min and 9 at 10 min. One premature baby, who weighed only 1600 g, was a precipitate birth at home unattended. Implications for the care of pregnant SCI women are discussed.

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Iatrogenic Cushing's syndrome has been reported after the use of nasal, aerosol, oral, and intramuscular steroid preparations. Presented is a case of Cushing's syndrome due to an epidural injection of methylprednisolone. A 24-year-old man had left arm pain after an occupational injury. Electromyography revealed C7 radioculopathy and cervical laminectomy was performed. Postoperatively, the patient noted improvement, however, he had recurrence of his symptoms within 1 month. Significant pain in the left arm, accompanied by swelling, persisted despite non-steroidal anti-inflammatory and anti-depressant medications. Repeat electromyography showed a resolving C7 with increased polyphasic potentials. Reflex sympathetic dystrophy was diagnosed and the patient received 3 stellate ganglion blocks with relief of the swelling, but only temporary relief of pain. He then underwent epidural injection of 60 mg of methylprednisolone. A cushingoid appearance was noted approximately 1 month later. Serum cortisol was undetectable, there was no adrenal response to synthetic ACTH, and urinary-free cortisol was below normal at 12. The patient eventually underwent a second surgical procedure for his pain and required steroid coverage. His pain subsequently showed slow improvement. Urinary-free cortisol normalized 4 months after onset; however, the patient's cushingoid appearance persisted for 12 months.

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