Maternal obstetric paralysis

Summary 1. Seven cases of maternal obstetric paralysis occurring in a series of approximately 45,000 deliveries at the Woman's Clinic of the New York Hospital are reported. All seven cases were personally observed by the author. 2. The majority of cases of obstetric paralysis will exhibit a combination of the following characteristics: primipara, prolonged labor, difficult forceps delivery, cephalopelvic disproportion. In addition, x-ray studies show that the pelvis will present certain characteristic features: a short posterior ileum, a sacral ala with shallow anterior concavity, and a promontory which does not encroach on the posterior pelvic capacity. 3. The patient who develops pain, paresthesias, and paralysis of either or both of the lower extremities during labor and/or the puerperium should have an immediate neurological examination. 4. A historical review of maternal obstetric paralysis is presented in an effort to demonstrate the development of the modern teaching. 5. The various theories as to etiology are discussed. The pressure theory, originally advanced by Hunermann, appears to be the most common cause of paralysis. 6. The prognosis as to degree and speed of recovery must be guarded. 7. The prevention of obstetric paralysis depends on recognition of the signs of lumbosacral cord compression, careful evaluation of the patient, and a correct decision as to the method of delivery. 8. Treatment consists of : support of the injured extremity, active and passive motion, galvanic stimulation, vitamin therapy, and the use of a walking brace.