Pocket ObGyn – Neuropathies in Pregnancy
See Abbreviations
Bell’s Palsy (Otolaryngol Head Neck Surg 2007;137:858)
- Definition: Paralysis of the facial nerve – involving V1,V2,V3
- PE: Asym facial expression & unilateral weakness of eye closure
- Epidemiology: 2–4-fold during Preg, esp 3rd trimester or in 1st-w PP
- Pathophysiology: Increased perineural edema, hypercoagulability (thrombus of vasa-nervorum), relative immunosuppression in Preg
- Association w/ preeclampsia (QJM 2002;95:359)
- rx: Cort taper; w/ exception of 1st 9 w of Preg
Meralgia Paresthetica
- Definition: Sensory neuropathy that occurs w/ compression of the lateral femoral cutaneous nerve as it penetrates the tensor fascia lata at the inguinal ligament
- Pathophysiology: Expanding abdominal wall & increased lumbar lordosis
- Rx rarely req
Postpartum Compression Neuropathies (Obstet Gynecol 2003;101:279)
- Epidemiology: Reported in 1–8/10000 deliveries
- Femoral neuropathy: Motor loss involving the quadriceps, w/ sparing of adduction; sensory loss involving the anter thigh & most of the medial thigh
- Lateral femoral cutaneous neuropathy: No motor fibers; lateral hip pain w/ paresthesias or hypesthesias over upper outer thigh
- Peroneal neuropathy: Foot drop caused by prolonged squatting sustained knee flexion, pres on the fibular head from stirrups or palmar pres during pushing
- Obturator neuropathies: Uncommon complication of deliv; pt p/w medial thigh pain & adductor weakness
- risk factors: Fetal macrosomia, malpresentation, sensory blockade, prolonged lithotomy position, prolonged 2nd stage, improper use of leg stirrups & retractors