Obstetric Outcomes of Women Who Sustained Traumatic Spinal Injury during Pregnancy: A Systematic Review

Abstract

Literature regarding pregnant women who sustained traumatic spinal injury during pregnancy is limited. Existing papers are mainly case reports, and this indicates a need for more high-quality research evidence in this area. Therefore, this study was designed to systematically review available literature that reported demographic information, clinical characteristics, and obstetric outcomes of women who sustained spinal injury during pregnancy. Studies published from the earliest record to January 2019, which reported traumatic spinal injury during pregnancy, were included. Studies that have reported pregnancy in patients with pre-existing spinal injury, review articles, commentaries, letter to editors, conference papers, and studies published in languages other than English were excluded. Sixteen studies reporting on 26 women were included. Their mean age was 26.7±5.5 years. Motor vehicle accidents were the main cause of spinal injury (n=15, 58%). Of the cases, four women sustained spinal injury during the 1st trimester of pregnancy, of which one had a spontaneous abortion, one delivered a baby with arthrogryposis multiplex congenital disorder, and the third one delivered a premature baby who died shortly after the delivery. Fifteen women sustained injury during their 2nd trimester, of which 14 delivered normal babies, while six sustained spinal injury during the 3rd trimester. Of these women, five delivered normal babies at term. Outcomes of pregnancy appear significantly affected if a spinal injury occurs during the 1st trimester of pregnancy; however, injuries sustained during the 2nd and 3rd trimesters can have good obstetric outcomes.

Posterior decompression and stabilization in a pregnant patient with traumatic lumbar fracture: A case report

“…Several causes of spinal injury in the pregnant population have been mentioned, with motor traffic accidents as the most commonly reported cause, followed by falls from a height, gunshot wounds [ 1 ] as well as systematic osteoporosis of pregnancy [ 7 , 12 ] which tends to slowly improve postpartum [ 13 ]. In the present case, the patient presented with spine injury secondary to a fall from a fast-moving motorcycle.…”

“…A systematic review analysed the mode of delivery of pregnant patients with SCI (12 cervical, 14 thoraco-lumbar injuries). Nineteen patients delivered vaginally whereas 5 underwent caesarean section; all patients delivered normal healthy babies [ 1 ]. This emphasized the safety and preference of vaginal delivery, as stated by many authors [ 2 , 17 ].…”

“…Physiologically, progression to normal delivery in such neuro-compromised patients is possible because the early stage of labour in gravid women depends on the action of hematogenic hormones, mainly oxytocin, on the uterus wall and does not require the uterine innervation [ 9 ]. In a systematic review by Aatic et al, 65% of the patients were managed conservatively with satisfactory outcomes [ 1 ]. Delayed referral was a major challenge in the present case (the patient reported more than one month after injury) probably due to fear of foetal loss, misconceptions about SCI, surgical management in pregnancy and risk of disability [ 17 ].…”

“…There are just a few case reports and only a single systematic review. Severe spine trauma, if unattended, can lead to neurological deficit in the mother as well as a fatal outcome for the foetus [ [1] , [2] , [3] ]. The global incidence of SCI has been reported to be between 10.4 and 83 per million people per annum [ 4 ].…”