Obstetric Neurological Injuries TOG 2020

Question 1

Incidence of neurological injury postpartum?

Answer 1

2%

Question 2

Which type or peripheral nerve injury is common in obstetrics?

Answer 2

Compression

Question 3

What is the most commonly effected nerve?

Answer 3

Lateral cutaneous nerve of the thigh

Question 4

Sensory roots of lateral cutaneous nerve of thigh

Answer 4

L2/L3

Question 5

Where does lateral cutaneous nerve of thigh supply

Answer 5

Sensory to lateral thigh

Question 6

Treatment injury to lateral cutaneous nerve of thigh?

Answer 6

Relieve nerve compression - lose excess weight, loose clothing.
Late gestation/labour - delivery baby, simple analgesia

Rarely LA, neuropathic pain meds.

Question 7

Nerve roots of lumbosacral trunk?

Answer 7

L4/L5

Question 8

How is the lumbroscaral truck injured?

Answer 8

Compressed between sacral and fetal head/foceps

Question 9

Symptoms injury to lumbrosacral trunk

Answer 9

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.

Question 10

Prognosis and treatment of lumbosacral injury?

Answer 10

Dx. nerve conduction study
Prognosis - good as compression
Tx physio & neuropathic pain meds

Question 11

Nerve roots femoral nerve

Answer 11

L2/L3/L4

Question 12

What does the femoral nerve supply? How does injury present

Answer 12

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.

Question 13

How does injury to the femoral nerve occur

Answer 13

Stretching/comression at the inguindla ligament between fetal head and pelvis

Question 14

What % of femoral nerve injuries are bilateral?

Answer 14

25%
Alway perform MRI to rule our central lesion

Question 15

Treatment femoral nerve injury

Answer 15

Simple analgesia
Neuropathic pain medication
Femoral nerve block
Physio, knee brace

Question 16

Nerve roots obturator nerve

Answer 16

L2/L3/L4

Question 17

Where does the obturator run and how is it injured?

Answer 17

Medial boarder of psoas major, to obtrurator canal.
Can be compressed by fetal head, lithotomy poison stretches nerve as exits obturator foramen

Question 18

What does the obturator nerve suppply?

Answer 18

Hip adductors
Sensory to medial portion of thigh

• isolated weakness of hip adduction and loss of sensation medial thigh

Question 19

What % of obturator nerve injuries are bilateral?

Answer 19

25%

Question 20

Treatment obtrurator nerve injury

Answer 20

Phyiotherapy

Question 21

Where does the common peroneal nerve run and how does it become injured?

Answer 21

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

Question 22

What does common peroneal nerve supply?

Answer 22

Motor to anterior and lateral compartments of leg and sensory to anterior and lateral leg and foot.

Question 23

How does injury to common peroneal nerve present

Answer 23

Foot drop
Impaired sensation over lateral and anterior calf and food

Need to distinguish from lumbosacral injury

Question 24

How to manage common peroneal nerve injury

Answer 24

High stepping gait, risk trips and falls
Ankle foot orthosis, supplied by physio

Question 25

If new lower limb neurological symptoms and had regional?

Answer 25

Consider anaesthetic complication - discuss with anaesthetics and consider MRI spine