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Integrative Review of Lower Extremity Nerve Injury During Vaginal Birth

Published:October 20, 2020DOI:https://doi.org/10.1016/j.jogn.2020.09.155

      Abstract

      Objective

      To describe the incidence, health effects, risk factors, and practice implications of lower extremity nerve injury (LENI) related to vaginal births.

      Data Sources

      We searched MEDLINE, CINAHL, and PubMed from 2000 to 2020 for peer-reviewed published case reports and research studies of LENI related to vaginal births.

      Study Selection

      We identified 188 potential records, and 20 met inclusion criteria (six research studies and 14 case studies).

      Data Extraction

      Three independent reviewers extracted details of injuries and births into an Excel spreadsheet and analyzed data using SPSS.

      Data Synthesis

      Using birth data from each case study and from four of the six research articles, we found the incidence of LENI in vaginal births was 0.3% to 1.8%. The description of health effects includes affected nerves and the location, description, and duration of symptoms. Analyses of risk factors were limited by missing birth data (length of second stage, birth weight, etc). Vaginal births with LENI were 76% spontaneous, 77% with neuraxial anesthesia, and 64% first vaginal birth. Practice implications focused on prevention through specific positioning strategies. Despite nurses being the primary caregivers during labor, LENI was reported most often in anesthesia journals with virtually no reports in nursing journals.

      Conclusion

      LENI is a potential complication of vaginal birth, and little published research is available on prevention and prognosis. While obstetric and anesthesia factors can cause or contribute to nerve injury, LENI is usually caused by positioning and is considered preventable. Care recommendations include the following: avoid prolonged hyperflexion of women’s thighs and knees; minimize time in lithotomy, squatting, or kneeling positions; prevent hand or other deep pressure on lateral knee and posterior thigh areas; avoid motor-blocking neuraxial (epidural) anesthesia; and implement frequent repositioning. The paucity of literature contributes to the lack of awareness of LENI among clinicians.

      Keywords

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      Biography

      Martha Rider Sleutel, PhD, RN, CNS, C-EFM, is a nurse scientist, Nursing Research & Clinical Excellence, Texas Health Resources, Arlington, TX.

      Biography

      Barbara True, MN, CNS, RNC-OB, C-EFM, is a clinical nursing instructor, College of Nursing and Health Innovation, University of Texas Arlington, Arlington, TX.

      Biography

      Jennifer Webb, BSN, RN, CCRN, is a staff nurse, Texas Health Heart and Vascular Hospital Arlington, Arlington, TX.

      Biography

      Ericka Valdez, BSN, RN, RNC-OB, is a staff nurse in labor and delivery, Texas Health Presbyterian Hospital Denton, Denton, TX.

      Biography

      Mary Van Thi Tran, BSN, RNC-OB, C-EFM, is a staff nurse in labor and delivery, Texas Health Arlington Memorial Hospital, Arlington, TX.