TOG

Question 1

What are the features associated with all levels of SCI?

Answer 1

1- increased risk of anemia
2- increased risk of pressure ulcers
3- requirement for adequate analgesia for operative delivery or perineal repair
4- VTE score (1) for immobility for wheel chair users

Question 2

What are the features associated with SCI > T4?

Answer 2

Ventilation assessment in pregnancy is advised

Question 3

What are the features associated with SCI > T6?

Answer 3

Low baseline pressure 80/50
Bradycardia 40-50
Risk of autonomic dysreflexia
* a rise 20 - 40 mmhg is diagnostic of autonomic dysreflexia

Question 4

What are the features associated with SCI > T10?

Answer 4

1-Late preterm labour & UTI
2- altered perception of FM
3- unable to feel labour pain
4- higher frequency of breech &transverse lie 👉 offer external cephalic version ECV for uncomplicated breech presentations

Question 5

What are the features associated with SCI > T12?

Answer 5

Increased risk of malpresentation at term

Question 6

What are the features associated with SCI > L2 - L4 ?

Answer 6

Scar tissue in epidural space cause inadequate epidural analgesia

Question 7

What are the potential causes of autonomic dysreflexia?

Answer 7

> T6
1- urinary system:UTI- bladder distention-calculi -catheterization
2- gastrointestinal tract: gallstones- bowel distention- ulcers
3- skin: pressure ulcers- burns- blisters
4- reproductive system: intercourse- menstruation- vaginitis- pregnancy- labour- delivery
5- other : DVT - PE - substance abuse- trauma

Question 8

What are the clinical features of autonomic dysreflexia?

Answer 8

1- symptoms: nausea- anxiety- prickling in the skull- throbbing headache
2- signs: tremor- sweating- blushing- nasal congestion- ⬆️BP - papillary dilation- retinal bleed- sub arachnoid bleed- stroke- death
3- fetal signs: fetal bradycardia

Question 9

What is the main treatment of autonomic dysreflexia?

Answer 9

1- Removing the noxious stimuli
2- medical treatment in the absence of an identifiable trigger

Question 10

What is the pharmacological treatment of autonomic dysreflexia?

Answer 10

1- nifidipin / tab
2- nitroglycerin / ointment
3- IV / labetalol
4- hydrazine
5- nitroprusside

Question 11

Drug is used to control bladder spasms in pregnancy with SCI?

Answer 11

Oxybutinin

Question 12

What is the best choice to control spasms in pregnancy with SCI?

Answer 12

Baclofen intrathecal pump
📌 because orally associated with neonatal withdrawal symptoms

Question 13

What is the type of anaesthesia preferred in labour in women with SCI?

Answer 13

📌 above T6👉 early epidural to prevent AD ( effectiveness of epidural is determined by the absence of AD)
📌 above T10 May not require analgesia ( nerves from the uterus enter between L1- T11)

Question 14

What are the precautions in CS with suprapubic catheter in situ?

Answer 14

1-Skin incision 2cm above the catheter insertion
2- catheter should be changed 24h before surgery
3- non absorbable sutures for rectus sheet
4- interrupted non absorbable sutures for the skin

Question 15

What analgesia should be performed in suturing episiotomy?

Answer 15

Standard analgesia
Because pain fibers are stimulated ( not perceived as pain but can stimulate spasms & AD)

Question 16

What postnatal analgesia is prescribed in women with SCI?

Answer 16

Same as patients with no SCI
( to prevent spasms & AD)

Question 17

Which group of women with SCI would have difficulties in breastfeeding?

Answer 17

Above T4
May need oxytocin nasal spray
( from the breast enter T4-T6)

Question 18

What is the preferred methods of contraception in women with SCI ?

Answer 18

📌POP-PROGESTERONE INJECTIONS
female sterilization- male contraception
📌combined OC NOT recommended 👉⬆️risk of thrombosis
📌 coils : may be used but insertion may trigger AD