Abstract Details

Multiple neuropathies are common in the postpartum period, including lumbosacral plexopathy, lateral femoral cutaneous neuropathy, and femoral neuropathy. Common risk factors include cesarean section, regional anesthesia, nulliparity, prolonged labor, large infant, short maternal stature, and lateral tilt position.

We present a rare case of sciatic mononeuropathy after an uncomplicated vaginal delivery.

Not applicable 

Not applicable 

This is a 25-year-old G5P2 woman who was evaluated for left lower extremity weakness and paresthesia of less than one day duration after a normal vaginal delivery. She had an uncomplicated pregnancy with a gestational age of 39 + 5 weeks and received epidural anesthesia for labor lasting approximately six hours in supine lithotomy position.

There was no history of perinatal complications or dystocia. Neurologic examination revealed left lower extremity flail foot, 4-/5 knee flexion with intact hip abduction, as well as sensory impairment in lateral aspect of the knee to the leg, dorsal aspect of the leg and dorsal/plantar aspect of the foot with trace Achilles reflex.

MRI of lumbar spine did not show evidence of lumbar central canal stenosis, nerve root impingement or significant epidural thickening/hematoma. NCS/EMG two months later showed evidence of a sciatic mononeuropathy proximal to the short head of biceps femoris on the left. This is supported by small peroneal and tibial CMAPs, sural and superficial peroneal SNAPs, absent H reflexes on the left compared to the right and EMG evidence of active neurogenic changes in the tibial and peroneal innervated muscles.

Nerve entrapment can occur during normal vaginal delivery in the setting of prolonged labor with an inappropriate position that is not felt under epidural anesthesia. This case highlights that sciatic mononeuropathy can occur not only after cesarean section delivery, but also after an uncomplicated vaginal delivery and should raise awareness of this risk to clinicians.