Courses of pregnancy and childbirth
A 24-year-old, G1P0, pregnant woman diagnosed with HAM/TSP presented at our hospital at 12 weeks of gestation.
Her neurological physical findings at the first our visit; bilateral lower limbs; spastic paraparesis, Osame’s motor disability score (OMDS): 11, limb tendon reflex hyperreflexia, Babinski’s reflex positive.
She used a wheelchair in daily life for both lower limbs paraparesis and did self-intermittent catheterization for bladder dysfunction.
There were no obstetric abnormalities and no exacerbation of neurological findings in the first course of pregnancy.
She wore graduated compression stocking in daily life and she conducted physical therapy by her husband (his profession was physical therapists) for prevention of venous thromboembolism (VTE) during pregnancy.
She, with a gestational age of 38 weeks and 5days, was admitted to our hospital because of spontaneous labor with cervical dilation of 5cm. We performed augmentation of labor with the use of intravenous oxytocin for the treatment of prolonged labor in the first stage of labor. The second stage of labor was also prolonged, and she could not push down, we performed vacuum extraction delivery. The birth weight of the neonate was 3,128g with umbilical cord pH 7.25, and the 1-minute and 5-minute Apgar scores were 8/9.
Her labor had lasted 21 hours, and postpartum blood loss was estimated at 686ml.
In postpartum period, she received current standard non-pharmacological VTE prophylaxis recommendations; she also wore graduated compression stocking and conducted physical therapy by he husband. She did not have a VTE during pregnancy, peripartum and postpartum period.
We explained that breastfeeding is at high risk of mother-to-child transmission of HTLV-1, she opted for short-term (3months) breastfeeding and formula-milk nutrition.
Following two consecutive courses of pregnancies after the first pregnancy and childbirth were uneventful. We show the summary of these three courses (Table1). Outcome and follow-up
There was no impairment of neurological findings after the three courses of pregnancy and childbirth.
To prevent an infection of HTLV-1 via breastfeeding, with the patient consent, the first and second babies were fed by short-term (3 months) breastfeeding and formula-milk, the third baby was fed by formula-milk only. We have been monitoring the babies for the infection until they are two-year-old. Three children have not been infected with HTLV-1 until now.