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Functional Lower Extremity Deficits With Sensory Changes and Quadriceps Weakness in a 29-Year-Old Female Postlabor and Delivery: A Case Report and Literature Review of Postpartum Maternal Lower Extremity Peripheral Nerve Injuries

Madson, Timothy James PT, MS, OCS

Journal of Women’s Health Physical Therapy: January/April 2014 - Volume 38 - Issue 1 - p 11–18
doi: 10.1097/JWH.0000000000000006
Case Reports

Background: Maternal peripheral nerve injuries during labor and delivery are rare. Several factors have been associated with their occurrence. These include the effects of regional anesthesia, time in the lithotomy position, and extremes of lower extremity positioning. In 1991, data from the American Society of Anesthesiologists revealed that 16% of obstetric legal claims were for maternal nerve damage. Modern-day incidence of maternal postpartum lower extremity nerve injuries have been estimated at between 0.008% and 2.0%. Many authors believe the incidence is actually much higher.

Study Design: Single-subject case report and literature review.

Case Description: This case report followed a 29-year-old woman with a femoral nerve injury sustained during labor and delivery and her rehabilitation and recovery. Also included is a literature review of lower extremity maternal peripheral nerve injuries.

Outcomes: At 2 months, she extended her knee antigravity with multiple repetitions without fatigue. She had normal quadriceps strength. Her thigh paresthesia had resolved. Stair Climbing Test and Five Times Sit-to-Stand Test scores improved by 68% and 71%, respectively. Her Patient-Specific Functional Scale improved by 4 points or 55% for 2 of her 3 baseline activities. She was able to rise from a chair and toilet seat without using her arms.

At 6 months, she reached her long-term goal and was actively running/jogging 4 days per week. Stair Climbing Test and Five Times Sit-to-Stand Test scores reflected additional improvements of 38% and 10%, respectively, from her 2-month follow-up. At a 1-year phone follow-up, she reported no lower extremity functional strength deficits.

Discussion: Maternal peripheral nerve injuries during labor and delivery have been recognized. Several factors are associated with their occurrence. On the basis of these factors, recommendations include a reduction of time in the lithotomy position and allowing women to be ambulatory throughout labor. Physical therapists practicing in the women's health field should be aware of postpartum peripheral nerve injuries and their prognoses.

Department of Physical Medicine and Rehabilitation, Mayo Foundation College of Medicine, Rochester, Minnesota.

The author declares no funding or conflicts of interest.

Copyright © 2014 by the Section on Women's Health, American Physical Therapy Association.