Obstetric Neurological Injuries TOG 2020 Flashcards
Incidence of neurological injury postpartum?
2%
Which type or peripheral nerve injury is common in obstetrics?
Compression
What is the most commonly effected nerve?
Lateral cutaneous nerve of the thigh
Sensory roots of lateral cutaneous nerve of thigh
L2/L3
Where does lateral cutaneous nerve of thigh supply
Sensory to lateral thigh
Treatment injury to lateral cutaneous nerve of thigh?
Relieve nerve compression - lose excess weight, loose clothing.
Late gestation/labour - delivery baby, simple analgesia
Rarely LA, neuropathic pain meds.
Nerve roots of lumbosacral trunk?
L4/L5
How is the lumbroscaral truck injured?
Compressed between sacral and fetal head/foceps
Symptoms injury to lumbrosacral trunk
Contribute to common peroneal nerve - foot drop/paraesthesia
Loss of sensation along lateral calf/foot, unilateral
Maybe mild weakness in knee flexion, hip abdcution, extension or internal rotation.
Prognosis and treatment of lumbosacral injury?
Dx. nerve conduction study
Prognosis - good as compression
Tx physio & neuropathic pain meds
Nerve roots femoral nerve
L2/L3/L4
What does the femoral nerve supply? How does injury present
Motor: Anterior thigh muscles, sensory to anterior thigh and medial calf.
Weakness in knee extension +/- hip flexion, pain/parasthesia or loss of sensation in the anterior calf/medial calf. Knee ‘gives way’, difficultt climbing stairs, knee reflexes impaired.
How does injury to the femoral nerve occur
Stretching/comression at the inguindla ligament between fetal head and pelvis
What % of femoral nerve injuries are bilateral?
25%
Alway perform MRI to rule our central lesion
Treatment femoral nerve injury
Simple analgesia
Neuropathic pain medication
Femoral nerve block
Physio, knee brace
Nerve roots obturator nerve
L2/L3/L4
Where does the obturator run and how is it injured?
Medial boarder of psoas major, to obtrurator canal.
Can be compressed by fetal head, lithotomy poison stretches nerve as exits obturator foramen
What does the obturator nerve suppply?
Hip adductors
Sensory to medial portion of thigh
- isolated weakness of hip adduction and loss of sensation medial thigh
What % of obturator nerve injuries are bilateral?
25%
Treatment obtrurator nerve injury
Phyiotherapy
Where does the common peroneal nerve run and how does it become injured?
Arises from sciatic nerve in posterior thigh, vulnerable to compression (from lithotomy supports) or traumatic injuries when it runs around head off fibula to anterior calf
What does common peroneal nerve supply?
Motor to anterior and lateral compartments of leg and sensory to anterior and lateral leg and foot.
How does injury to common peroneal nerve present
Foot drop
Impaired sensation over lateral and anterior calf and food
Need to distinguish from lumbosacral injury
How to manage common peroneal nerve injury
High stepping gait, risk trips and falls
Ankle foot orthosis, supplied by physio
If new lower limb neurological symptoms and had regional?
Consider anaesthetic complication - discuss with anaesthetics and consider MRI spine
