LAUSR

INTRODUCTION Spontaneous spinal epidural haematomas (SSEH) are rare yet severe conditions. In pregnancy this condition is challenging to diagnose and treat due to the risks to the mother and foetus. This study reviews the literature on SSEH in pregnancy. MATERIAL AND METHODS We performed a systematic review of the English literature on SSEH from 1990 until 2018. Outcome measures were mode of presentation, risk factors, initial neurological findings, diagnostic investigations, site and size of the SSEH, treatment, neurological recovery and survival. RESULTS Fourteen publications (16 patients) were included. Two patients presented in the second trimester, the remainder in the third trimester. All patients presented with back pain, 15 subsequently developed spinal cord dysfunction. An MRI was performed in all cases. The cervico-thoracic region was the most commonly affected and the average haematoma size extended across 3.9 vertebral levels. All patients with neurologic dysfunction underwent surgical decompression. In women under 32 weeks gestation, caesarean section was not routinely performed. In contrast, women of gestational age of 32 weeks or more underwent a caesarean section prior to spinal decompression. Women without neurological dysfunction underwent a caesarean section and neurological monitoring without decompression. All patients with abnormal neurology improved following surgery, except one patient. No patients died. DISCUSSION In pregnancy SSEHs typically present in the second or third trimesters with back pain, predominantly in the cervico-thoracic region, followed by progressive neurological dysfunction. MRI is diagnostic and the treatment depends on the patients neurological dysfunction and gestational age.