Cervical spinal cord injury following cephalic presentation and delivery by Caesarean section

Abstract

We describe a term infant with an acute spinal cord injury following emergency Caesarean section. Foetal movements were normal on the day that the mother was admitted for postterm induction of labour. Caesarean section was performed because of foetal distress and failure to progress during labour. The initial clinical picture suggested acute birth asphyxia. The presence of a high cervical spine injury became more obvious as the clinical picture evolved over the next 7 days. A discontinuity of the cervical spinal cord at C4–5 was confirmed on MRI. Spontaneous respiration failed to develop and intensive care was withdrawn on day 15. No evidence of trauma, or a vascular, neurological, or congenital anomaly of the cervical spinal cord was found at post mortem. The absence of a similar case following cephalic presentation and Caesarean section made bereavement couselling of the parents especially difficult.

Syringomyelia and chronic respiratory failure in a term infant delivered by Caesarean section

“…The infant had a history of difficult head extraction and all the non-specific symptoms of spinal cord injury: severe perinatal asphyxia, generalized hypotonia, absent tendon reflexes, and paradoxical breathing. 1,[4][5][6][7][8][9] Syringomyelia, without associated abnormalities or trauma, is usually asymptomatic in early life. In adolescence or early adulthood, symptoms such as sensory disturbances, muscular weakness, and spastic paraparesis can be present.…”

“…4 To date, only one case of cervical spinal cord injury (without syringomyelia or any associated abnormalities) following cephalic presentation and delivery by Caesarean-section (Csection) has been reported. 5 This article reports a case of an infant delivered by C-section with an extensive cervical syringomyelia who presented with respiratory failure at birth. The absence of any detectable conditions commonly associated with this process made the post-traumatic aetiology the most probable one.…”

Part 2

“…Surgical success is limited because delayed diagnosis and subsequent continued displacement of the fracture cause secondary insults that are irreversible. 49 …”

Part 1

“…33 Because the injuries were localized, rather than global (as seen with hypoxic ischemic encephalopathy), ischemia of the spinal cord was considered to be the cause of SCI in these infants. 12,19 Spinal cord ischemia with subsequent paraparesis or paraplegia is a rare complication of operations on the descending aorta (risk is 0.5% to 1.5% during primary repair of coarctation). Hypothermic cardiocirculatory arrest or the use of heparinized shunts to maintain adequate distal perfusion pressure after aortic clamping are used to protect the spinal cord from ischemic injury.…”

“…6,11 Advances in diagnostic imaging that improve the accurate estimation of fetal size and presentation and the use of cesarean birth to avoid difficult deliveries has reduced the incidence of SCI related to obstetrical maneuvers. 9,11,12 Although the diagnosis is primarily considered following a difficult or instrumented delivery, some caregivers may be unaware that SCI can occur in utero, at birth, and in the nursery setting after birth. 13,14 Spinal cord injuries are not always related to trauma and intrapartum events.…”