Autonomic dysreflexia is a major risk during labor for a pregnant woman with SCI at T5 AIS A. Which complication is most likely during labor?

Autonomic dysreflexia is a major risk during labor for a pregnant woman with SCI at T5 AIS A. Which complication is most likely during labor?

• A. Orthostatic hypotension
• B. DVT
• C. Spinal shock recurrence
• D. Autonomic dysreflexia

Answer: (D)

The main idea here is that injuries at or above the level of T6 disrupt the brain’s ability to modulate autonomic signals coming from below the injury. During labor, stimuli such as uterine contractions or bladder distension act as noxious triggers below the lesion. In someone with a high-level SCI (like T5 AIS A), this triggers an unregulated sympathetic surge below the injury while the brain’s inhibitory control cannot dampen it. The result is autonomic dysreflexia: a sudden spike in blood pressure with potential symptoms like pounding headache, flushing above the level of injury, sweating above the level, and sometimes bradycardia. This is the most likely acute complication during labor in this scenario because labor provides the specific stimuli that initiate the reflex, and the SCI level is high enough to prevent normal reflex control. Orthostatic hypotension is more about posture and volume status and isn’t driven by labor-related stimuli. DVT is a longer-term risk in SCI but not an immediate labor complication. Spinal shock recurrence isn’t expected to recur during labor, since spinal shock is an acute phase that typically resolves long before pregnancy.

The main idea here is that injuries at or above the level of T6 disrupt the brain’s ability to modulate autonomic signals coming from below the injury. During labor, stimuli such as uterine contractions or bladder distension act as noxious triggers below the lesion. In someone with a high-level SCI (like T5 AIS A), this triggers an unregulated sympathetic surge below the injury while the brain’s inhibitory control cannot dampen it. The result is autonomic dysreflexia: a sudden spike in blood pressure with potential symptoms like pounding headache, flushing above the level of injury, sweating above the level, and sometimes bradycardia. This is the most likely acute complication during labor in this scenario because labor provides the specific stimuli that initiate the reflex, and the SCI level is high enough to prevent normal reflex control.

Orthostatic hypotension is more about posture and volume status and isn’t driven by labor-related stimuli. DVT is a longer-term risk in SCI but not an immediate labor complication. Spinal shock recurrence isn’t expected to recur during labor, since spinal shock is an acute phase that typically resolves long before pregnancy.