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CHAPTER 28
She lived with her parents and took up full-time secretarial work until her marriage
in 1962. She attended Stoke Mandeville for check-ups in 1960, 1961 and 1962, and on
each occasion her neurological lesion was unchanged. Her urine was sterile and intra
venous pyelograms normal. Her menstrual periods restarted 2 months after the accident
and remained regular 5/28. (During intercourse she had no sensation in the lower part
of body.)
Pregnancy
Last menstrual period 27 November 1962.
Expected date of delivery 4 September 1963.
The pregnancy was uneventful. The BP remained at 120/80 or less, and there was a
trace of albumin on 23 July 1963; a sub-clinical urinary infection was treated with
Furadantin.
As premature labour is anticipated in paraplegics, she was admitted to Stoke Mande
ville Hospital on 8 July 1963. A vaginal examination on 15 July 1963 showed the cervix
to be effaced, a further vaginal examination on 25 July 1963 showed no change. A further
examination on i August 1963 showed the cervix to be 2 fingers dilated.
Labour
At 8 p.m. on 3 August 1963, regular uterine contractions every 5 to 7 min started.
There were no abdominal sensations, but with each contraction the patient noticed
tingling and flushing of the face. During contractions the BP rose from 120/75 to 130/80
and pulse rate dropped from 64 to 56. The cervix was still 2 fingers dilated. As it seemed
that the patient was in early labour, she was transferred to Royal Bucks Hospital. During
the next 7 days, irregular, mild contractions continued but there was no further dilatation
of the cervix.
On ii August 1963 at 8 p.m. uterine contractions became stronger and regular i : 8.
With each contraction the BP rose to 150/100, the pulse dropped to 60, and at the end of
each contraction the patient felt tingling, sweating, flushing of face and a burning feeling
in the feet. Her cervix was 3 fingers dilated. Contractions continued through the night
and by ii a.m. on 12 August 1963 were regular and strong i : 3 with similar subjective
sensations. A vaginal examination was performed and the membranes ruptured, the
cervix was nearly fully dilated, there being only a 0-5 cm rim all round. During this
vaginal examination, patient developed a frontal headache which persisted and became
more severe until the baby was delivered. From this time on there were regular strong
contractions 1:3. With each contraction the headache became more severe, there was
sweating and flushing of the face and neck and she vomited several times. During the last
half-hour of labour, each uterine contraction was accompanied by strong, rapid clonic
spasms in the legs.
During the rest of labour, there was a progressive rise in BP and fall in pulse rate.
At 1.47 p.m., the BP had risen to 210/105 and the headache was severe. As the cervix
was fully dilated the patient was catheterized (6 oz), an episiotomy was performed, forceps
