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[Emma Davey M.D.]

We had a woman referred to us by the antenatal clinic (!). This is a miracle in itself but not the point of the story.

This woman is 34 weeks pregnant, and with a high grade placenta previa. The Obs Gobs guys are doubtful that it will shift between now and 38 weeks when they plan to do an elective Cesarean Section.

The problem is that she has had Harrington rods inserted during her teens to correct a severe scoliosis. She has no X-rays from  that time, and refuses an X-Ray before the baby is born. Her scar extends down to the mid-lumbar area. She is otherwise well.

I would like to give this woman a regional anesthetic, either an epidural or preferably a spinal, but I am not sure what degree of anatomical disturbance she has had resulting from the Harrington rods. I am assuming an epidural would be pachty and possibly ineffective because of the scarring and/or deformation in this area. Assuming I can get a spinal in, would it be effective? or would there be too much tethering/scarring/streching of the dura and spinal canal to render it inefective?

I would appreciate whatever input into this problem.

[Geoffrey Parkins]

While by no means an expert, I have given at least 2 successful spinals to women with Harrington rods . There were no issues, as the rods extended to the mid lumbar region, and I could easily get the needle in at L3/4.

I would expect that an epidural block would be patchy, not so much because of scar tissue, but because of the anatomical displacement of the cord and nerve roots due to the rods. The epidural space would be compressed on the previously concave side and may not come into contact with anesthetic solution.

[Emma Davey M.D.]

Thank you kindly for your response.

As an update, I gave her a spinal without any problems (single pass, 27G Sprotte needle) and a superb block.

Unfortunately, she developed what seemed like a dural puncture headache on day 2. It was mild enough for her to function, but was clearly postural. It went away with conservative measures on about day 4. I'm very glad I did not have to perform a blood patch on her! 

[Russell Coupland]

A caudal could have been considered, but I agree that a spinal is your best bet.

[brndette21]

  Well, I have never been pregnant so I have no idea about being cesarean but  I am lucky to know about that. My sister gave birth to her second child through CS and she told me how painful it is after the surgery.     online