Pregnancy with previous history of Transverse Myelitis

Patient

Q: I had transverse myelitis 6 years ago but fortunately made a full recovery. I lost part use of my legs but am ok now, I sometimes have flare ups of burning and numbness in feet And extreme tiredness etc and suffer with chronic back pain every day although I work full time but with great difficulty sometimes. I am thinking of trying for a baby soon but worried if my body can handle pregnancy and are the symptoms likely to worsen or Return completely?Thanks Jo

Doctor

A:   The most common complications that women with transverse myelitis may have during pregnancy are as follows: mobility problems which are dependent on your level of function. If mobility issues exist, such as balance problems or spasticity, they may become worse as the pregnancy advances. The growing fetus will change your center of gravity, which can create difficulty with balance. If difficulty ambulating develops, it may become necessary to depend on assistance from a walker or wheelchair in the second and/or third trimester of pregnancy. It is very important to prevent falls, which may cause injury to you or the baby. Keeping safety in mind, try to remain as active as possible during pregnancy. Physical therapy may be helpful, if you have mobility decreased. The other complications are: Deep venous thrombosis, Urinary tract infections, constipation, anemia and possibly preterm labor. The other potential life-threatening complication during the labor to be aware of is the Autonomic Dysreflexia (ADR), it results in rapid onset of hypertension (increased blood pressure), which varies in severity, and may also include bradycardia (low heart rate). ADR is caused by reflex signals of the spinal cord from below the affected lesion, traveling up the spinal cord uncontrolled. Epidural and spinal anesthesia is thought to be safe for women with Transverse Myelitis. An epidural or spinal can actually be very effective at preventing the onset of autonomic dysreflexia. It is recommended that when you get pregnant seek a consultation with an anesthesiologist before labor to discuss potential risks and concerns for care during labor. There is no evidence to suggest that an epidural increases the risk of flares of spinal cord inflammation.

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