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INTRODUCTION

Most nerve injury after childbirth can be attributed to delivery of the neonate. These are referred to as intrinsic obstetric palsies, and are often due to stretching or compression of the lumbosacral plexus and lower extremity peripheral nerves. Fortunately, obstetric palsies are usually transient with expected full recovery. Rarely, potentially catastrophic neurological complications occur after neuraxial procedures. Prompt recognition and treatment are essential to avoid permanent injury.1-3 Diagnosis and differential diagnosis of peripartum neurological injury are summarized in Fig. 62-1.

FIGURE 62-1

Diagnosis of peripartum neurological injury. EBP, epidural blood patch; IV, intravenous; PDPH, postdural puncture headache; Stat MRI, emergent magnetic resonance imaging.

MILD COMPLICATIONS—MUSCULAR STRAIN

Myofascial pain syndrome: may occur in any region (common in neck, shoulders, lower extremities):

  • Muscle hypertonicity/edema with marked tenderness at specific anatomic points

  • Cervical myofascial pain, base of occiput, and neck pain without positional changes

  • Management: Acetaminophen/Nonsteroidal anti-inflammatory drugs (NSAIDs), ice/heat, physical therapy (PT) consult

MODERATE COMPLICATIONS—PERIPHERAL NERVE INJURIES (TABLE 62-1)

  • Associated with prolonged first or second stage of labor, difficult instrumental delivery, nulliparity, extremes of stature, and prolonged use of the lithotomy position

  • Unilateral, with weakness/paralysis in single muscle or group of muscles

  • Unilateral sensory deficits in nerve distribution

  • May be bilateral, especially with plexus injuries

  • Management: Conservative, consult PT with presence of muscle weakness

TABLE 62-1Characteristics of Peripheral Nerve Injury

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