What is compression and stretch neuropathy in pregnancy and how are they treated?

Updated: Nov 08, 2018
  • Author: Carmel Armon, MD, MSc, MHS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

Compression or stretch neuropathies occur rarely as postdelivery complications. These conditions are disconcerting to the patient because they introduce unanticipated and unwelcome intrusions into the joyful setting of an expectant family. Dealing with the disappointment of the patient and her family becomes an important focus of therapeutic interventions. The overall prognosis for recovery is excellent, though no immediate guarantee can be given to any individual patient at presentation.

The most common locations at which compression or stretch neuropathies occur are the sciatic nerve (presumably because of positioning during natural delivery) and the femoral nerve (presumably because of retraction during cesarean delivery).

Emergence or worsening of carpal tunnel syndrome may occur during pregnancy. The presumed mechanism is pressure on the median nerve within the carpal compartment at the wrist as a result of tissue swelling, secondary to the fluid retention that occurs during pregnancy.

The use of spinal or epidural analgesia or anesthesia raises the possibility of a local complication (eg, bleeding) related to the anesthesia. When adequate localization cannot be achieved by means of the neurologic examination, lumbar spinal magnetic resonance imaging (MRI) may help. MRI may be indicated if the findings suggest a diagnosis or etiology other than compression neuropathy (eg, a central cause). [10]

A rehabilitation medicine specialist (physiatrist) or physical therapist should be consulted to assist in developing a plan to help the patient ambulate, to choose appropriate assistive devices, and to select appropriate range-of-motion and strengthening exercises for the different stages of recovery. Follow-up with a neurologist, physiatrist, physical therapist, or primary physician must be individualized.


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