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    Obstetric Palsy

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    Delphy Varghese
    Maternal obstetric palsy, also known as obstetric maternal lumbosacral plexopathy, refers to injury of the lumbosacral plexus that occurs during or after childbirth, presenting with sensory and motor deficits. Risk factors include cephalopelvic disproportion and prolonged labor. The fetal head may compress the lumbosacral plexus nerves as they pass through the pelvis. Most cases resolve within 6 weeks, but exploration is considered if function does not return by 3-9 months. Differential diagnoses include spinal cord injury and Guillain-Barré syndrome.

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    Obstetric Palsy

    Uploaded by

    Delphy Varghese
    661 views4 pages
    Maternal obstetric palsy, also known as obstetric maternal lumbosacral plexopathy, refers to injury of the lumbosacral plexus that occurs during or after childbirth, presenting with sensory and motor deficits. Risk factors include cephalopelvic disproportion and prolonged labor. The fetal head may compress the lumbosacral plexus nerves as they pass through the pelvis. Most cases resolve within 6 weeks, but exploration is considered if function does not return by 3-9 months. Differential diagnoses include spinal cord injury and Guillain-Barré syndrome.

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    Obstetric Palsy

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    Maternal obstetric palsy, also known as obstetric maternal lumbosacral plexopathy, refers to injury of the lumbosacral plexus that occurs during or after childbirth, presenting with sensory and motor deficits. Risk factors include cephalopelvic disproportion and prolonged labor. The fetal head may compress the lumbosacral plexus nerves as they pass through the pelvis. Most cases resolve within 6 weeks, but exploration is considered if function does not return by 3-9 months. Differential diagnoses include spinal cord injury and Guillain-Barré syndrome.

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    661 views4 pages

    Obstetric Palsy

    Uploaded by

    Delphy Varghese
    Maternal obstetric palsy, also known as obstetric maternal lumbosacral plexopathy, refers to injury of the lumbosacral plexus that occurs during or after childbirth, presenting with sensory and motor deficits. Risk factors include cephalopelvic disproportion and prolonged labor. The fetal head may compress the lumbosacral plexus nerves as they pass through the pelvis. Most cases resolve within 6 weeks, but exploration is considered if function does not return by 3-9 months. Differential diagnoses include spinal cord injury and Guillain-Barré syndrome.

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    of 4

    maternal Obstetric Palsy

    Peripheral nerves are occasionally compressed by the fetal head, the application of forceps,
    and improperly positioned leg holders. Craniopelvic disproportion, dystocia, prolonged labor,
    and primigravida status contribute to these injuries. Unilateral lumbosacral (L4, L5, and
    rarely S1) plexus injury is most common. The fetal brow strikes the nerves as they cross the
    posterior brim of the true pelvis. The associated sensory deficit usually involves more
    widespread sensory loss than that due to peroneal neuropathy. Peroneal nerve injuries often
    are caused when the nerve is compressed between a leg holder and the fibular head. Less
    common obstetric palsies include those of the femoral and obturator nerves.

    The fetal brow may strike nerves within the lumbosacral plexus as they cross the posterior
    brim of the true pelvis.

    Most maternal obstetric palsies are neurapraxic and resolve within 6 weeks. In future
    pregnancies, women with recurrent craniopelvic disproportion, dystocia, or axonal
    degeneration with their initial neuropathy are candidates for cesarean delivery. Otherwise, a
    cautious trial of labor may be prudent

    OBSTETRIC PALSY

    Maternal obstetric palsy or obstetric maternal palsy or obstetric maternal lumbosacral


    plexopathy refers to an injury to the lumbosacral plexus whose signs and symptoms become
    evident during labor or after childbirth.

    Epidemiology

    The population of women with maternal obstetrical palsy are relatively small, hence the
    absence of the condition in many textbooks. Feasby et al. reported two cases in 1992 Katirji
    et al. had seven (7) women reported in 2002 And some others had nineteen (19) patients in
    the year 2000.

    Risk factors

     Short stature
     Macrosomia
     Cephalopelvic disproportion
     Delayed/Prolonged labor
     Mid forceps rotation
     Fetal malpositioning

    causes of obstetric palsy


     Obstetric palsy is believed to be due to a traumatic lesion at birth and occurs in
    1:10,000 births. The injury is 175 times more common in breech delivery.

     Two situations may predispose to obstetric palsy. Large infants with cephalic
    presentation and shoulder dystocia are at risk during delivery, as are small infants
    born with a breech presentation.

     Obstetric palsy may occur after a seemingly normal delivery and has been
    documented even after a cesarean section.

    indications and timing for exploration of obstetric palsy


    The absence of any return of biceps or deltoid function by 3 months of age is a strong
    indication for brachial plexus exploration. Other criteria include the absence of elbow
    flexion/extension, wrist extension, or thumb/finger extension by 9 months of age. Most
    surgeons recommend exploration before 6 to 9 months of age.

    Clinically Relevant Anatomy

    The lumbar plexus and sacral plexus, if taken as one entity becomes the lumbosacral plexus,
    the largest spinal nerve plexus. It consists of nerves originating from spinal segments L1 to
    S4, lumbar plexus taking its origin from L1 to L4 and sacral plexus from L5 to S4
    respectively. Nerves arising from the lumbosacral plexus generally course behind the psoas
    major, piercing the abdominal wall antero-laterally, then course antero-medially, upon the
    pelvic rim or iliac crest to enter into the lower limb.

    Mechanism of Injury / Pathological Process


    The position of the lumbocsacral plexus predisposes it to compression during prolonged
    labour, especially in some categories of women e.g. short women. Any trauma, or
    compression or injury to the trunks of the lumbosacral plexus creates clinical signs and
    symptoms in the mother. Katirji et al. (2002) concluded that intrapartum foot drop occurs
    mostly in short women and is caused by lumbosacral trunk compression by the fetal head at
    the pelvic brim primary pathology being predominantly demyelination and recovery is
    complete in up to 5 months.

    The peroneal nerve is frequently affected and "Hunerman in 1892 attributed its frequency to
    its position in the lumbosacral plexus."

    Types

    Presentation of signs and symptoms and electro diagnostic studies have helped in
    differentiating lumbosacral plexopathy into sub-groups

    Types according to research articles reviewed are

    1. Intrapartum maternal lumbosacral plexopathy: it involves the lumbosacral plexopathy


    easily recognized while the woman is in labour

    2. Postpartum maternal lumbosacral plexopathy: this manifests after childbirth

    Electrodiagnostic studies further describes postpartum maternal lumbosacral plexopathy into


    Upper and Lower Lumbosacral Plexopathy. Upper lumbosacral plexopathy involves the
    muscles of the lower limb and affectation to motor and sensory functions, while ,lower
    plexopathy only involves the lower part of the plexus (s2-s4).Lower postpartum lumbosacral
    plexopathy is evoked when perineal sensory disturbances whether or not associated with
    urinary or fecal incontinence persist after a history of a difficult vaginal delivery with no
    associated lower limb sensory or motor deficits noted "The first, second and third sacral roots
    entering into the formation of the sacral plexus lie on the piriformis muscle and are thus
    unprotected against pressure on the bone"

    Clinical Presentation

    For the upper palsy: pain, paraesthesia, weakness of ankle dorsiflexion, eversion, and
    inversion, and sensory loss in the L‐5 dermatome, foot drop.

    For the lower palsy

    Perineal sensori-neuropathy

    Urinary incontinence

    Fecal incontinence

    Sexual dysfunction

    Diagnostic Procedures
    Subjective history taking form the patient. Intrapartum palsy would have been observed
    during parturition.

    Objective diagnostic procedures include the use of Electrodiagnostic devices vis a vis: EMG
    in determining the level of affectation. Compound Muscle Action Potential (CMAP), Sensory
    Nerve Action Potential (SNAP) are recorded to know the exact site of injury.

    Management

    Physiotherapy / Interventions

    Electrical Muscle Stimulation

    Tactile Stimulation

    Proprioceptive Neuromuscular Facilitation

    Prescription of ankle foot orthoses

    Differential Diagnosis

    Spinal Cord Injury

    Guillain-Barre Syndrome

    Injection Neuritis

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