Richards A, McLaren T, Paech M J, Nathan E A, Beattie E, McDonnell N
The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
Department of Anesthesia and Pain Medicine, King Edward Memorial Hospital, Perth, Western Australia, Australia; School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia.
Int J Obstet Anesth. 2017 May;31:5-12. doi: 10.1016/j.ijoa.2017.04.002. Epub 2017 Apr 8.
Neurological deficits noted immediately after childbirth are usually various obstetric neuropathies, but prospective studies are limited. The main study aim was to quantify and describe immediate postpartum neurological deficits of the lower extremity, including the buttocks.
A prospective observational study of postpartum women delivering in a single maternity hospital during three months of 2016. Among 1147 eligible women, 1019 were screened for symptoms of lower extremity numbness or weakness within eight to 32hours of delivery. Consent to undergo a detailed neurological evaluation was sought from those reporting symptoms. Risk factors were identified using logistic regression.
Thirty five women (3.4%) reported symptoms, 27 entered the study and 23 (2.0%) had objective signs of a neurological deficit. The most common injuries were mild lumbosacral plexopathies and cluneal nerve compression. Most deficits were sensory, half of these also having a motor deficit that did not impact functionally. Based on analysis of 22 cases involving a likely intrapartum deficit, no association was found with parity, body weight, duration of labour, mode of delivery or neuraxial block. A past history of a neurological condition or a back injury was associated with odds ratios of 7.98 and 4.82 respectively. There were no neurological deficits that were clinically concerning or that were likely a complication of a neuraxial block.
Transient neurological complications after labour and delivery are infrequent, mainly sensory involving multiple lumbosacral nerve roots or specific sacral cutaneous nerves, and they typically resolve within a short time.
分娩后立即出现的神经功能缺损通常是各种产科神经病，但前瞻性研究有限。主要研究目的是量化和描述产后即刻下肢（包括臀部）的神经功能缺损情况。
对2016年三个月内在一家妇产医院分娩的产后妇女进行前瞻性观察研究。在1147名符合条件的妇女中，1019名在分娩后8至32小时内接受了下肢麻木或无力症状筛查。对报告有症状的妇女寻求其同意进行详细的神经学评估。使用逻辑回归确定危险因素。
35名妇女（3.4%）报告有症状，27名进入研究，23名（2.0%）有神经功能缺损的客观体征。最常见的损伤是轻度腰骶丛神经病和臀上皮神经受压。大多数缺损是感觉性的，其中一半也有运动缺损，但对功能无影响。基于对22例可能在分娩期出现缺损病例的分析，未发现与产次、体重、产程、分娩方式或椎管内阻滞有关。既往有神经疾病史或背部损伤史的比值比分别为7.98和4.82。没有临床上令人担忧的神经功能缺损，也没有可能是椎管内阻滞并发症的情况。
分娩后短暂的神经并发症很少见，主要是感觉性的，累及多个腰骶神经根或特定的骶部皮神经，通常在短时间内缓解。
