Pregnancy care and intrapartum management of a woman with high-level cervical spinal cord injury and neurogenic bladder: a case report

Pregnancy in women with high-level cervical spinal cord injury presents complex challenges, particularly related to autonomic instability, neurogenic bladder dysfunction, and risks of autonomic dysreflexia. Optimal management requires coordinated multidisciplinary care and individualized delivery planning. The case is presented of a 32-year-old woman (gravida 4, para 1) with a chronic spinal cord injury involving the sixth and seventh cervical levels, with neurogenic bladder and bilateral vesicoureteral reflux. Her urodynamic profile evolved from detrusor areflexia to reduced compliance with terminal detrusor overactivity, managed with clean intermittent catheterization. Pregnancy was closely monitored with multidisciplinary collaboration. At 38 weeks and 3 days of gestation, she presented in spontaneous active labor with stable hemodynamics and no features of autonomic dysreflexia. Continuous bladder drainage was instituted, and rapid cervical progression precluded neuraxial anesthesia. A supervised vaginal delivery was achieved in a semi-recumbent position without autonomic instability. A healthy male neonate was delivered with Apgar scores of 9 and 9. Postpartum recovery was uncomplicated, including postpartum tubal ligation and structured bladder management with temporary Foley drainage followed by resumption of clean intermittent catheterization. Renal surveillance and early outpatient follow-up confirmed stable maternal and neonatal outcomes. This case demonstrates that vaginal delivery can be safely accomplished in select women with high-level cervical spinal cord injury when multidisciplinary care, optimized bladder management, and vigilant intrapartum monitoring are available. Individualized, condition-based decision-making should guide the mode of delivery rather than neurological level alone.