Postpartum Neuropathies of the Lower Extremity

Postpartum lower extremity nerve injuries is an important topic that we have previously discussed on the blog. A review article^{(O'Neal 2015)} published in the International Anesthesia Research Society journal discusses maternal neurological complications following childbirth. This article, designed to help anesthesiologists identify the symptoms of a neuropathy, discusses diagnosis, management, and treatment. With the incidence of obstetric neuropathy in the postpartum period estimated at 1%, most of the nerve dysfunction is related to compression injuries. Symptoms may include, but are not limited to, lower extremity pain, weakness, numbness, or bowel and bladder dysfunction. Neuraxial anesthesia can also occur, with issues such as epidural hematoma or an epidural abscess. Risk factors are described in the article as having a prolonged second stage of labor, instrumented delivery, being of short stature and nulliparity (delivering for the first time.)

Clinical pearls listed in the article include the following information that may be helpful in understanding a patient’s condition:

• intramedullary spinal cord syndromes (inside the spinal cord) are usually painless, whereas the peripheral nerve syndromes (involving the spinal nerve roots, plexus, and single nerves) usually cause pain
• bowel and bladder dysfunction often occurs early in the case of conus medullaris and late in the event of cauda equina syndrome
• cauda equina syndrome often causes polyradicular pain, leg weakness, numbness, and deep tendon reflex changes and involves multiple roots
• conus medullaris syndrome is not painful and causes saddle anesthesia and lack of significant sensory and motor symptoms in the lower extremities

In relation to prevention of neuropathies, the authors suggest that women who have diabetes or who have a preexisting neuropathy should be given extra attention. This may include protective padding during labor and delivery as well as frequent repositioning. Pelvic rehabilitation providers are a key player in the arena of birthing. Caring for women and educating them about peripartum issues is critical to helping women both prevent and heal from challenges encountered in relation to pregnancy and childbirth. If you would like to learn more about the topic of peripartum nerve dysfunctions, as well as many other special topics, please join us for the continuing education course Care of the Postpartum Patient. Your next opportunity to take this course will be in Seattle next March!

O’Neal, M. A., Chang, L. Y., & Salajegheh, M. K. (2015). Postpartum Spinal Cord, Root, Plexus and Peripheral Nerve Injuries Involving the Lower Extremities: A Practical Approach. Anesthesia & Analgesia, 120(1), 141-148.