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Pelvic haematoma as a cause of unilateral lower limb weakness after spontaneous vaginal delivery
Abstract Number: S 67
Abstract Type: Case Report/Case Series
We describe the case of a 34-year old multiparous woman (gravida 3, para 2) who presented to our institution in spontaneous labour at 40 weeks gestation. First stage of labour lasted 90 minutes, during which time epidural analgesia was administered. The second stage of labour lasted 30 minutes during which time the McRoberts manoeuvre (hyperflexion of hips) was employed to aid delivery. No instrumentation was necessary and a healthy male infant weighing 3.6kg was born by spontaneous vaginal delivery.
Twenty-four hours post-delivery, the patient complained of right hip pain and unilateral lower limb weakness. She was reviewed by our anaesthetic team and was found to have neuropathy in the distribution of the femoral and obturator nerves. She underwent MRI of her lumbosacral spine to outrule direct nerve injury from neuraxial blockade. Images demonstrated extensive muscle abnormality within the sartorius, adductor and gluteal muscle groups consistent with haematoma. Conservative management with analgesia and physiotherapy was unsuccessful and she required haematoma drainage under radiological guidance to relieve nerve compression.
This case of pelvic haematoma causing neurological abnormality has not been described in the literature to date. Maternal neurological complications after labour and delivery are well documented1 and most injuries are the result of maternal obstetric palsies rather than anaesthetic intervention.2 However, given the close correlation between neuraxial blockade and neurological deficit, the anaesthesia team is usually the first port of call when a woman has neurological signs post-delivery.3 This case highlights how patients with epidural analgesia can be placed in extreme delivery positions, which they may not have assumed in the absence of sensory blockade. This extreme maternal positioning may result in mechanical trauma or stretch injury to nerves and vascular structures.
1Holdcroft A, Gibberd FB, Hargrove RL, Hawkins DF, Dellaportas CI. Neurological complications associated with pregnancy. Br J Anaesth 1995;75:522-6
2Loo CC, Dahlgren G, Irestedt L. Neurological complications in obstetric regional anaesthesia. Int J Obstet Anesth 2000;9:99-124
3Wong CA. Neurologic deficits and labor analgesia. Reg Anesth Pain Med 2004;29:341-51