464
CHAPTER 28
Blood tests should be carried out in pregnant paraplegic women at regular intervals.
The conventional treatment with oral iron has its disadvantage in promoting constipation
and thus increasing the intestinal dysfunction already resulting from the spinal cord
lesions. The haemoglobin must not be allowed to drop below 80 per cent and the red
cells below 4 millions and, as proved in some of our patients, blood transfusions are the
quickest and safest method of restoring normal blood counts.
Care of the paralysed bladder during pregnancy is, of course, of paramount import
ance, in particular the avoidance of large amounts of residual urine. It was found in the
cases described above that, during pregnancy, all trained patients, except the one who
had a permanent suprapubic cystostomy, were able to continue their voiding mechanism,
and only in the latest stages ofpregnancy did difficulty develop and catheterization became
necessary. There was no exacerbation of infection of the urinary tract, with one exception
(the case of the woman with a complete lesion below T5 described who had a still-born
child in the 32nd week and who had attacks of pyelitis during her pregnancy). This is
the more remarkable as most patients, with the exception of the polio cases, had an
infected urine at the time of pregnancy. Moreover, no renal or bladder calculosis or
recurrence of calculosis developed in these women, including one case with a complete
lesion below T5 and amputation of the right leg, who, as a result of treatment with an
indwelling catheter for 4 months elsewhere, developed a severe bladder infection resulting
in formation of two huge bladder stones, one lying on top of the other like millstones
(see Fig. 192) and which were removed suprapubically (Dr Walsh) 3 years before preg
nancy. There were no complications during pregnancy and on 17 March 1963 she gave
birth to a healthy girl.
DIAMETER
5 X 3-i-- Cms
WE! GHT
48 G
ms
5 5 •
4 ;>
Cms
WEIGHT
67 0 m$
FIG. 192. From Guttmann (1963)
Proc. Royal Soc. Med.,
56, 383.
