الفهرس 
Anatomical and Physiological ConsiderationsOnly 14 pages are availabe for public view
 |  | from | 84 |  |  |
| | | from | 84 | | |
Abstract
Labour may trigger autonomic hyprreflexia. As previously discussed, the level of autonomic hyperreflexia depends on the level of the injury, and is thus common in patients with injuries above T5
It is estimated that 90% of parturients with cord injuries above T6 are at a risk of autonomic hyperreflexia. There are case reports of intracranial hemorrhage associated with autonomic hyperreflexia in laboring cord injured women. Other triggers are aminiotomy, augmentation with oxytocin, perineal distension and vaginal instrumentation. The lower the segment receiving stimulation, the more severe the hypertension.
An epidural may prevent this life threatening complication and should be considered in patients with a history of autonomic hyperreflexia and possibly those with lesions above T5. Bupivacaine 0.125% with fentanyl 2-5µs/ml has been used. A urinary catheter is needed to stop bladder distension as a trigger for autonomic hyperreflexia. There are reports of autonomic hyperreflexia within 24 hours of birth, and it is recommended that local anesthetic epidural infusions be continued for 24-48 hours. However, the presence of spinal instrumentation may preclude sitting an epidural. Nifedipine or hydralazine may be used if the epidural fails to control autonomic hyperreflexia in pregnancy. ECG monitoring during labour shows episodes of vagally induced first and second degree heart block (Surkin et al, 2000).