Authors: Tang B et al.
Source: Anesthesiology, February 03, 2026, 10.1097/ALN.0000000000005909
Summary:
This brief clinical report highlights the value of early magnetic resonance imaging for diagnosing postpartum obturator neuropathy, a rare but clinically significant peripheral nerve injury that can be difficult to distinguish from neuraxial anesthesia–related effects. Postpartum neurologic deficits may mimic residual epidural block, nerve root injury, or epidural hematoma, placing anesthesiologists in a critical position for early evaluation and diagnostic decision-making.
The authors describe a 35-year-old primiparous woman who developed difficulty lifting her right leg one day after vaginal delivery under uneventful epidural labor analgesia. Initial symptoms raised concern for neuraxial-related complications. Focused neurologic examination revealed weakness in right hip flexion and unexpected weakness in hip adduction, while sensation and reflexes remained intact. These findings suggested involvement beyond typical femoral or lumbar root pathology.
Pelvic magnetic resonance imaging performed on postpartum day seven demonstrated focal T2 hyperintensity in the right pectineus muscle, consistent with acute denervation edema. Because the pectineus may receive obturator nerve innervation, the imaging findings aligned anatomically with the clinical deficits and supported early suspicion of obturator neuropathy. Needle electromyography performed at six weeks confirmed the diagnosis by demonstrating denervation in the right adductor magnus.
The case illustrates that electrodiagnostic testing may be nondiagnostic in the early postpartum period because denervation changes take days to weeks to manifest, whereas magnetic resonance imaging can detect muscle denervation within 24 hours of injury. Additionally, MRI provides rapid exclusion of compressive etiologies such as hematoma or abscess. With conservative management, the patient experienced gradual and complete recovery of motor function over three months.
The authors emphasize that postpartum obturator neuropathy is typically caused by mechanical compression from fetal head positioning or prolonged labor and may be overlooked without targeted examination. Careful assessment of hip adduction strength and early imaging are key to accurate localization, reassurance, and timely rehabilitation.
Key Points:
• Postpartum peripheral nerve injuries can mimic residual neuraxial anesthesia effects
• Obturator neuropathy should be suspected when hip adduction weakness is present
• Electrodiagnostic studies are often nondiagnostic in the first 1–2 weeks postpartum
• MRI can detect muscle denervation within 24 hours of nerve injury
• Early imaging helps exclude compressive lesions and guide management
• Anesthesiologists play a central role in early recognition and evaluation
• Conservative management is associated with good functional recovery in most cases
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