J - AUTONOMIC DYSREFLEXIA (AD)
Instruct health care professionals that women with SCI who have the potential of developing autonomic dysreflexia are at increased risk of severe autonomic dysreflexia during pregnancy, labour, delivery, and breastfeeding and should be followed by a multidisciplinary team. (PVA-AD 2020, p.644; Level C)
An antepartum consultation with an anesthesiologist and the establishment of a plan for induction of epidural or spinal anesthesia at the onset of labour is recommended to assess the risk of autonomic dysreflexia and to prevent it, in accordance with recommendations of the American College of Obstetricians and Gynecologists. (PVA-AD 2020, p.644; Level C)
In pregnant women prone to autonomic dysreflexia, careful and frequent monitoring of the fetus is recommended, especially during labour and delivery. (PVA-AD 2020, p.644; Level C)
Autonomic dysreflexia must be differentiated from preeclampsia during pregnancy and labour to ensure appropriate treatment. (PVA-AD 2020, p.644; Level C)
Although individuals with SCI may not perceive pain during labour, anesthesia should be used to prevent autonomic dysreflexia in women with SCI at T6 and above. Spinal or epidural anesthesia is the most reliable method of preventing autonomic dysreflexia by blocking stimuli that arise from pelvic organs. (PVA-AD 2020, p.644; Level C)
Educate women who have the potential to develop autonomic dysreflexia that postpartum breastfeeding, breast engorgement, or mastitis may trigger autonomic dysreflexia. (PVA-AD 2020, p.644; Level C)