lumbosacral plexopathy following childbirth

Last edited 06/2020

Lumbosacral plexopathy is a disorder affecting a network of nerves, blood vessels, or lymph vessels of the lumbosacral plexus.

Neuropathy during vaginal delivery can be caused by a mother’s preexisting neurologic impairment, manipulation of instruments during the delivery process, lithotomy position, compression by the head of the fetus, anesthetic procedures and a combination of other causes, but occasionally the cause can be idiopathic

• lumbosacral plexopathy associated with childbirth often involves the upper plexus (L2–S1) causing obturator, femoral, or sciatic nerve palsies.
• symptoms in the lower limbs often are unilateral involving more than one nerve, sensory and motor
• autonomic involvement is rare
• urinary, anorectal, or sexual dysfunctions due to autonomic involvement are always reported to be associated with motor or sensory disorders in the lower limbs (2)

Epidural and lumbosacral plexopathy:

• neurological complications for those that receive an epidural block or anesthesia occur at a low rate of 1 out of 13,007 patients, while those caused by the obstetric procedure itself or other causes can occur at rates of 4-6 times that (3)
• nerve damage can be caused by the Tuohy needle, the catheter, spinal cord ischemia, accidental injection of neurotoxic agents, infection or injection of local anesthetics into the epidural space
• neurological complications from an epidural hematoma can occur, but such cases are rare at a rate of 1 : 150,000 (4)

Vaginal delivery and lumbosacral plexopathy:

• various factors can lead to nerve damage such as improper vacuum or forceps operation, inappropriate position of the mother, and pressure from the fetal head

Prognosis of the lumbosacral plexopathy is reported to be excellent and recovery usually occurs within 4 to 6 months (2).

Reference:

• Wong CA, Scavone BM, Dugan S, Smith JC, Prather H, Ganchiff JN, et al. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol 2003; 101: 279-88.
• Ismael SS et al. Postpartum lumbosacral plexopathy limited to autonomic and perineal manifestations: clinical and electrophysiological study of 19 patients.J Neurol Neurosurg Psychiatry 2000;68:771–773
• Park S et al. Lumbosacral plexus injury following vaginal delivery with epidural analgesia -A case report.Korean J Anesthesiol 2013 February 64(2): 175-179.
• Horlocker TT, Wedel DJ. Anticoagulation and neuraxial block: historical perspective, anesthetic implications, and risk management. Reg Anesth Pain Med 1998; 23(6 Suppl 2): 129-34