HS Yoo, et al / Pregnancy in Woman with Spinal Cord Stimulator 267 used more frequently in parturient care. We report a rare case of pregnancy in a woman with a spinal cord stim- ulator and review the literature on pregnancy in women with SCS. CASE REPORT A 32-year-old woman with SCS presented for con- sultation in court regarding documentation concerning her injuries related to a traffic accident she had experienced. She had received SCS implantation at another hospital several months earlier as treatment for CRPS I of the left lower extremity. Her chronic pain syndrome stemmed from the unfortunate complications of a previous pedestrian traffic accident in which she was struck on the backside by a car. Lumbar spine X-rays and MRI were within nor- mal limits, but she suffered from allodynia, hyperalgesia, motor weakness and temperature fluctuations at that time. Despite extensive physical therapy, anxiolytic therapy, several local anesthetic blocks, four sympathetic blocks, transcutaneous electric stimulation and adjunctive phar- macological management, her condition failed to improve. During the early period of SCS implantation, her pain was reduced to an acceptable level, but when she presented for consultation at our hospital, she clearly required pain relief. The electrodes entered the L3-4 interspace, and the end of the electrode was located in the epidural space at the T9-10. The generator was then implanted in the ante- rior abdominal wall. At the time of her visit to our pain clin- ic, she was receiving propranolol HCl 20 mg, mirtazapine 30 mg and tramadol HCl 50 mg twice a day, along with buspirone HCl 15 mg, solifenacin succinate 5 mg, mefe- namic acid 250 mg, ethyl loflazepate 1 mg and sodium tia- neptine 12.5 mg daily. During various checkup tests, we found that her urine beta-hCG was positive, which is the case in women of childbearing age. Thus, her serum be- ta-hCG was checked, revealing that it was 150.19 mIU/ml. Immediately, we consulted the obstetric department, and eventually pregnancy was diagnosed, but ultrasonographic visualization did not rule out the possibility of ectopic pregnancy, a tubal abortion state or, less likely, early pregnancy. She was informed about this and further tests were recommended. However, she quit her therapy at our hospital and transferred to a hospital closer to her home for the management required. Upon her discharge, we in- formed her that there were no animal or human studies regarding possible teratogenic effects or fetal/maternal risk of using SCS at the time of conception, pregnancy, or labor. We also explained that despite all the risks, preg- nancy is possible if she desired and recommended that a good outcome requires a multidisciplinary team approach, including obstetrics, neonatology, pain medicine and anes- thesia, as was used in an early pregnancy. Unfortunately, she had a missed abortion after 6 weeks. DISCUSSION Management of patients with chronic pain syndromes during pregnancy can be challenging, particularly in the presence of SCS. SCS is an accepted cost-effective ther- apy for many chronic pain syndromes. The safety and ef- fects of SCS during pregnancy have not been established, and pregnancy is a relative contraindication according to the FDA and the manufacturers of the related devices [4]. Various meta-analysis and reviews of the effects of SCS have not included this group of patients [2,5,6]. However, SCS is increasingly used to manage chronic pain in a fe- male in her reproductive years may present. Child-bearing women who had SCS become or choose to become preg- nant despite these policies. Reviewing the literature in English, we found four case reports of SCS in pregnancy. In the first case, a 31- year-old woman with cervical SCS of CRPS II allowed po- tentially teratogenic painkillers to be discontinued before conception. The cervical SCS electrode end was in the epi- dural space at the C2-3 interspace, and the generator was implanted in the upper gluteal region instead of the abdo- men owing to the patient’s concern of discomfort during pregnancy and the risk of damage if a caesarean section was necessary. This patient had a full-term safe vaginal delivery despite the SCS being turned off the time of labor and delivery. The disadvantages of using teratogenic an- algesics were overcome by SCS [7]. In the second case, a 37-year-old woman with cervical SCS of CRPS I pre- sented for epidural analgesia for labor. She was taking no medication. The electrodes entered the C7-T1 interspace and the ends of electrodes were located in epidural space at the C3 level. The generator was implanted in the left lower buttock. The spinal cord stimulator continued to function well throughout the entire process. A year and a half later, particularly interesting, the same patient pre- sented again to their labor and delivery unit for another