Lesions of peripheral nerves in obstetrics and gynecology. A review


Authors: E. Ehler 1;  M. Košťál 2
Authors‘ workplace: Neurologická klinika PKN, a. s., a FZS UPa, přednosta doc. MUDr. E. Ehler, CSc. 1;  Porodnicko-gynekologická klinika PKN, a. s., a FZS UPa, přednosta doc. MUDr. M. Košťál, CSc. 2
Published in: Čes. Gynek.2010, 75, č. 5 s. 423-428

Overview

Peripheral nerves in obstetrics and gynecology are damaged with moderate frequency. Mostly there are iatrogenic lesions, that most often develope during delivery, operations and also in course of smaller invasive procedures. In genitofemoral nerve lesions neuralgic pain in groin and vulva is the most striking symptom, in cutaneus femoris lateralis nerve damage there are unpleasant paresthesias of lateral thigh. In case of femoral or obturator nerve lesion a weakness of thigh muscles with difficulties of standing and walking is the most typical. In pudendal nerve damage the autonomic disturbances (incontinence of feaces and urine) and pain in perineum are in the foreground of the patient’s complains. After a knowledgeable history taking and detailed clinical examination the next step of diagnostics are neurophysiological investigations (neurography and needle electomyography). In special cases there is racional to use imaging methods (ultrasonography, MRI, CT). In majority of these iatrogennic nerve lesions the conservative approach is successful (rehabilitation, medicaments against neuropathic pain) and only in a small proportion of patients the neurosurgeon consultation is necessary.

Key words:
delivery, gynecological operations, iatrogenic lesions, peripheral nerves, electromyography.


Sources

1. Balasubramanian, S., Morley-Forster, P. Chronic pelvic pain due to peripheral neuropathy: a case report. J Obstet Gynaecol Can, 2006, 28, 7, p. 603-607.

2. Bischoff, C., Schonle, PW. Obturator nerve injuries during intraabdominal surgery. Gynecol Oncol, 1994, 53, 2, p. 152-155.

3. Bohrer, JC., Walters, MD., Park, A., et al. Pelvic nerve injury following gynecologic surgery: a prospective cohort study. Am J Obstet Gynecol, 2009, 201, 5, p. 531-538.

4. Cardosi, RJ., Cox, CS., Hoffmann, MS. Postoperative neuropathies after major pelvic surgery. Obstet Gynecol, 2002, 100, 2, p. 240-244.

5. Ciaramitaro, P., Mondelli, M., Logullo, F., et al. Traumatic peripheral nerve injuries: epidemiological findings, neuropathic pain and quality of life of 158 patients. J Periph Nerv Syst, 2010, 15, 2, p. 120-127.

6. Corona, R., De Cicco, C., Schonman, R., et al. Tension-free vaginal tapes and pelvic nerve neuropathy. J Minim Invasive Gynecol, 2008, 15, 3, p. 262-267.

7. Dellas, A., Almendral, AC. Surgical treatment of vaginal prolapse after hysterectomy. Geburtshilfe Frauenheilkd, 1995, 55, 5, p. 244-246.

8. Donato, DM., Waller-Smith, S. The vaginal-psoas suspension repair of uterovaginal prolaps. J Am Coll Surg, 2002, 195, 1, p. 51-54.

9. Dunnihoo, DR., Huddleston, HT., North, SC. Femoral nerve palsy as a complication of vaginal hypesterectomy: review of the world literature. J Gynec Surg, 1994, 10, 1, p. 1-6.

10. Ehler, E., Ambler, Z. Mononeuropatie. Praha: Galén, 2002, 176 s.

11. Fitzpatrick, M., O’Brien, C., O’Connel, PR., O’Herlihy, C. Patterns of abnormal pudendal nerve function that are associated with postpartum fecal incontinence. Am J Ostet Gynecol, 2003, 189, 3, p. 730-735.

12. Hibner, M., Desai, N., Robertson, LJ., Nour, M. Pudendal neuralgia. J Minim Invasive Gynecol, 2010, 17, 2, p. 148-153.

13. Holub Z. Obturator neuropathy after laparoscopic retroperitoneal surgery. Int J Gynaecol Obstet, 2006, 95(2), p.165-166.

14. Hur, M., Kim, JH., Moon, JS., et al. Laparoscopically assisted vaginal hypesterectomy. J Repr Med Obstet Gyn, 1995, 40, 12, p. 829-833.

15. Irvin, W., Andersen, W., Taylor, P., Rice, L. Minimizing the risk of neurologic injury in gynecologic surgery. Obstet Gynec, 2004, 103, 2, p. 374-382.

16. Kitagawa, R., Kim, D., Reid, N., Kline, D. Surgical management of obturator nerve lesions. Neurosurgery, 2009, 65, p. A24-A28.

17. Lacima, G., Pera, M., Valls-Solé, J., et al. Electrophysiologic studies and clinical findins in females with combined fecal and urinary incontinence: a prospective study. Dis Colon Rectum, 2006, 49, 3, p. 353-359.

18. Lindner, A., Schulte-Mattler, W., Zierz, S. Postpartales nervus obturatorius syndrom: Fallberich und Übersicht über die Nervenkompressionsyndrome während Schwangerschaft und Geburt Zbl f Gynäkologie, 1997, 119, 3, S. 93-99.

19. Murovic, JA., Kim, DH., Tiel, RL., Kline, DG. Surgical management of 10 genitofemoral neuralgias at the Louisiana State University Health Sciences Center. Neurosurgery, 2005, 56, 2, p. 296-303.

20. Peirce, C., O’Brien, C., O’Herlihy, C. Postpartum femoral neuropathy following spontaneous vaginal delivery. J Obstet Gynaecol, 2010, 30, 2, p. 203-204.

21. Peters, G., Larner, AJ. Meralgia paresthetica following gynecologic and obstetric surgery. Ing J Gynaecol Obstet, 2006, 95, 1, p. 41-43.

22. Porzionato, A., Macchi, V., Fenato, F., et al. Femoral nerve injury after gynecologic laparoscopy. J Minim Invasive Gynecol, 2008, 15, 1, p. 105-107.

23. Quinn, M. Obstetric denervation – gynaecological reinnervation: Disruption of the inferior hypogastricus plexus in a childbirth as a source of gynaecological symptoms. Med Hypotheses, 2004, 63, 3, p. 390-393.

24. Rieger, N., Wattchow, D. The effect of vaginal delivery on anal function. Aust N Z J Surg, 1999, 69, 3, p. 172-177.

25. Saidha, S., Spillane, J., Mullins, G., McNamara, B. Spectrum of peripheral neuropathies associated with surgical interventions; A neurophysiological assessment. J Brachial Plex Peripher Nerve Inj, 2010, 19, p. 5-9.

26. Sorenson, EJ., Chen, JJ., Daube, JR. Obturator neuropathy: causes and outcome. Muscle Nerve, 2002, 25, p. 605-607.

27. Spinner, RJ., Winfree, CJ. Peripheral nerves: injuries. Neurosurg Clin North Amer, 2009, 20. 1, p. 1-136.

28. Vasilev, SA. Obturator nerve injuries: a review of management options. Gynecol Oncol, 1994, 53, 2, p. 152-155.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account