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NEUROPATHIC COMPLICATIONS ENCOUNTERED IN OBSTETRIC ANAESTHESIA
ESRA Academy. Howle R. Sep 8, 2016; 138470
Topic: Complications in Obstetric Population
Dr. Ryan Howle
Dr. Ryan Howle

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Abstract
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Background and Aims:

Neuropathic complications within obstetric anaesthesia are rare but have significant implications. Despite association with anaesthetic interventions, they are most often caused by patient malpositioning or foetal descent. We sought to review the presentation and management of these complications and correlate it with existing literature.

Methods:

A single centre retrospective case series examining neuropathic obstetric complications was performed over a 4 year period. Data was compiled from anaesthetic follow up, local maternity database systems and electronic patient records. Where no formal diagnosis was made, aetiology was deduced from symptomatic presentation, neurological examination and radiological findings.

Results:

38 neuropathic complications were recorded in 2012-15; 26 maternal obstetric palsies, 6 nerve root radiculopathies and 6 of indeterminate aetiology.

The maternal obstetric palsies are represented in Figure 1. Of these, 14/26 had labour epidurals sited. These were in situ for a mean of 6 hours prior to delivery.

All 6 radiculopathies followed traumatic epidurals where problems were noted on insertion.

Neurological examination was documented in 23/38 cases and 10/38 underwent MRI scanning. Follow-up letters were available for 4 patients, all of whom reported residual symptoms between 2 weeks and 6 months post-delivery; 3 patients were offered follow-up they did not attend.


Conclusions:

Due to their sparse presentation, the assessment and management of neuropathic complications were highly variable. No serious sequelae were reported although in some cases symptoms were persistent. The extent of this is unknown due to a poor follow-up rate. National guidance in the area is lacking; accordingly introduction of local guidelines may help improve future management.

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