Paralysis: Pregnancy, Fertility & Contraception

1. Signs and symptoms of autonomic dysreflexia that should be monitored for and treated immediately in pregnant females with spinal cord injury/paralysis include all of the following, EXCEPT:

A. loss of deep tendon reflexes

B. paroxysmal hypertension (more than 200/100)

C. piloerection and cold/clammy skin below the level of the SCI

D. flushed and sweaty skin above the level of the SCI

Answer is A, which could occur with a lesion in the reflex arc due to peripheral neuropathy caused by diabetes, alcoholism, amylodosis, uremia, vitamin deficiencies such as pellegra, beriberi, pernicious anemia, remote cancer or toxins including lead, arsenic, isniazid, vincristine and diphenylhydantoin. The other 3 answers (B, C, and D) are typical signs and symptoms of autonomic dysreflexia which if not recognized, treated and the cause corrected rapidly can lead to negative maternal and fetal outcomes, including death.

2. Which of the following is NOT an assisted reproductive method that can improve the fertility outcomes for SCI males:

A. vibratory stimulation

B. electroejaculation

C. vacuum tumescence device

D. prostate massage

Answer is C, which is an intervention for male erectile dysfunction that can be helpful with intercourse after SCI. The other 3 answers are methods to assist in sperm harvesting for fertilization procedures.

3. Which of the following contraceptive methods might be a better choice for a paraplegic woman but not for a quadriplegic woman:

A. oral contraceptives

B. condom or diaphragm

C. IUD

D. sterilization

Answer is B, depending on the increased manual dexterity level of the paraplegic vs. the quadriplegic. Answer A should not be used in either woman due to the increased risk for both for inflammation and blood vessel clots with SCI patients. Answer C would not be a good choice for either woman due to the absence of pelvic sensation that might lead to missing the signs or symptoms of complication(s) from the IUD. Answer D could be used equally as a choice by either woman who had no desire to ever get pregnant.

4. Which of the following is the main reason for decreased fertility in SCI males:

A. erectile dysfunction

B. decline in sperm motility

C. ejaculatory dysfunction

D. prolonged priapism

Answer is B, semen quality deteriorates with decreased sperm motility occurring after SCI due to changes in semen factors. Answers A and C, erectile and ejaculatory dysfunction occur in para- and quadraplegic men, however neither is the main reason for decreased fertility-both can be aided by various assistive methods so that the SCI male can have intercourse and/or release semen. Answer D is a painful, persistent erection unaccompained by sexual desire or excitement that can be caused by dysfunction of the spinal cord as in SCI.

5. All of the following are possible triggers for autonomic dysreflexia in quadraplegic females and should be monitored for and avoided, eliminated or minimized EXCEPT:

a. Perineal manipulation and pressure

b. bowel or bladder distention

c. UTI's

D. Use of stool softeners

ANSWER: is D. Use of stool softeners is advised as part of strict bowel regimen to prevent constipation/impaction or over distention and irritation of the bowel which could trigger AD as could the other 3 answers: A, B & C....all of which should be monitored for and avoided, eliminated or minimized as much as possible to prevent triggering AD and resultant harm to mother and fetus.