Management of Pregnancy in Patients with Spinal Cord Stimulators:

Background

Conclusion

Spinal cord stimulators (SCS) are increasingly used to treat

refractory chronic pain syndromes such as complex regional

pain syndrome (CRPS), neuropathic pain, and failed back

surgery syndrome. While effective in pain control, SCS presents

unique challenges in pregnancy, including concerns about

device integrity, electromagnetic interference, altered

pharmacological management, and the impact of pregnancy on

pain symptoms.

There is limited literature on obstetric outcomes and optimal

management strategies for pregnant women with SCS in situ.

This case series explores the antenatal, intrapartum, and

postpartum considerations in two pregnant patients with spinal

cord stimulators.

 

Case Presentation

Case 1 involved a 26-year-old G3P1 woman with a history of

complex regional pain syndrome (CRPS) affecting her right

upper limb (post-traumatic) and left lower limb (idiopathic). She

had dual spinal cord stimulator (SCS) systems implanted at

thoracic and lumbar levels at the Walton Centre, Liverpool. The

devices were deactivated during the first trimester on the advice

of the pain team. Despite stepwise analgesia, her pain worsened

in the third trimester. Fetal growth and Doppler studies remained

within normal limits. Labour was induced with a membrane

sweep at 37 weeks followed by prostaglandin induction at 38

weeks. She had an uncomplicated vaginal delivery, and her

postpartum pain improved without the need to reactivate the

device.

Case 2 described a 37-year-old G1P0 woman with severe sciatic neuropathic

pain following a previous discectomy. She had an Intellis SCS (Medtronic)

implanted with wires extending to T8. Her medical history was notable for a

long-term infection treated with a PICC line in 2018 and a diagnosis of

pulmonary embolism at 18 weeks gestation, for which she was started on low

molecular weight heparin. Her SCS had been deactivated prior to conception.

Serial growth scans showed fetal growth above the 97th centile. At 35+1 weeks,

she presented with spontaneous rupture of membranes and rapid labour

progression. Due to an occipito-posterior fetal position and failure to progress,

she underwent an emergency cesarean section. The procedure was

uncomplicated, with careful intraoperative positioning to avoid damage to the

leads or battery

 

Discussion

Pregnancy in women with SCS requires tailored multidisciplinary care.

While no teratogenic risks from SCS have been reported, theoretical risks

from electrical stimulation to fetal development or uterine irritability warrant

deactivation during pregnancy. This can lead to resurgence of pain, requiring

careful analgesic planning with obstetric, pain, and anesthetic teams.

Labor and delivery planning must consider the location of implanted

components, especially for regional anesthesia. In Case 2, the cesarean

section was performed under general anesthesia due to uncertainty regarding

epidural access and urgency. This highlights the importance of early anesthetic

consultation.

Postpartum care includes evaluating the need to reactivate the SCS and

assessing for postpartum exacerbation of pain. Both women in our series

recovered well, and their devices remained structurally intact.

Despite device deactivation, favorable maternal and neonatal outcomes

were achieved, supporting the feasibility of normal pregnancy and delivery with

appropriate monitoring.

 

conclusion 

Pregnancy in patients with SCS is rare but increasing. These cases

reinforce the need for:

• Early multidisciplinary planning

• Risk-benefit discussion around SCS deactivation

• Delivery planning that incorporates anesthetic and device

considerations

There is a pressing need for formal guidelines and registries to

document maternal and fetal outcomes in this population.

 

referrences 

 

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•UK Royal College of Obstetricians and Gynaecologists. Chronic Pain and Pregnancy

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