Neurological complications associated with pregnancy

Abstract

Prospective multidisciplinary audit from both hospital and community has identified neurological complications persisting for more than 6 weeks in association with pregnancy and delivery. They occurred at a frequency of 1 in 2530 deliveries in the North West Thames Region. Extradural analgesia was considered contributory to a neurological disorder in one of 13,007 patients. The woman had prolonged paraesthesiae along a nerve root. The types of sensory, motor and sympathetic neurological problems presented ranged from transient problems to more serious disorders resulting in death in one case. Seven of 19 patients had a continuing neurological disability for more than 1 yr. Although obstetrics may be associated with lumbar and sacral neurological disorders, problems occurred with the same frequency in the upper as in the lower half of the body. Significant morbidity is not being recognized in hospitals where women are being delivered and it is within the community that these disorders are recognized. This has implications for training, audit and risk assessment.

Sciatica in the female patient: anatomical considerations, aetiology and review of the literature

“…The incidence of obstetric neuropathy during vaginal labour has been evaluated between 1 for 2,530 and 1 for 6,400 pregnancies [29,84]. Neuropathy of the sciatic nerve can be caused by continuous pressure of the presenting part on the lumbosacral trunk as it crosses the pelvic brim during a prolonged labour [134].…”

“…The neurotoxic effect of the local anaesthetic may involve rootlets of all anaesthetised nerves and is thus bilateral [21]. In a survey in the North West Thames Region of 48,066 women delivering including 13,636 regional blocks, a single case of paraesthesia of nerve root distribution without any neurological signs could be attributed to epidural analgesia [84]. Another survey of 11,701 women who delivered in Birmingham showed that 26 women had numbness or tingling in the lower back, buttocks and leg, of whom 23 had epidural anaesthesia [112].…”

Informed consent for epidural analgesia in labour

“…7 However, neurological complications also arise from pregnancy itself. 8 Transient paresthesia and motor weakness after delivery has an incidence of 1.9 per 1000 deliveries.…”

“…7 Toutefois, les complications neurologiques peuvent originer de la grossesse elle-même. 8 La paresthésie transitoire et la faiblesse musculaire qui suivent l'accouchement présentent une incidence de 1,9 sur 1 000 naissances.…”

Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review

“…Central neuraxial anaesthesia and adhesive arachnoiditis Spinal and epidural anaesthesia are safe, well established, widely utilised anaesthetic techniques that facilitate many hundreds of thousands of obstetric, orthopaedic, urological, general and other surgeries per year [18][19][20]. Neurological complications are uncommon and almost invariably temporary [17,18,21].…”