Authors: Tang B et al.
Anesthesiology, February 03, 2026, 10.1097/ALN.0000000000005909
This clinical report highlights the early diagnosis of postpartum obturator neuropathy using magnetic resonance imaging (MRI). Postpartum peripheral nerve injuries are uncommon but clinically important complications that may follow vaginal delivery. Early diagnosis is often difficult because neurologic deficits can resemble other postpartum conditions such as residual epidural anesthesia, nerve root injury, or epidural hematoma. Because anesthesiologists are frequently consulted when neurologic symptoms occur after neuraxial analgesia, they play a critical role in early recognition and evaluation.
The article describes the case of a 35-year-old primiparous woman who experienced difficulty lifting her right leg beginning one day after vaginal delivery. The delivery occurred at 37 weeks and 6 days with epidural labor analgesia and was otherwise uncomplicated. Labor lasted approximately 12 hours in the first stage and 1.5 hours in the second stage, and a mediolateral episiotomy was performed. The infant weighed 2,670 grams.
On postpartum day 1, the patient reported weakness in her right leg. Neurologic examination revealed weakness in hip flexion and hip adduction, both graded at 3/5 strength. The adduction weakness was particularly notable because it impaired the patient’s ability to cross her legs. Reflexes and sensation, including the medial thigh sensory distribution typically associated with the obturator nerve, were normal.
Because postpartum neurologic symptoms can be mistaken for complications related to epidural anesthesia, imaging was obtained to clarify the diagnosis. Pelvic magnetic resonance imaging performed on postpartum day 7 demonstrated increased T2 signal intensity in the right pectineus muscle on fat-suppressed sequences, indicating acute denervation edema. The contralateral muscle showed normal signal.
The pectineus muscle can receive partial innervation from the obturator nerve, and the imaging findings correlated with the clinical deficit in hip adduction. These findings raised suspicion for obturator neuropathy. The diagnosis was later confirmed by needle electromyography performed six weeks later, which demonstrated spontaneous activity in the right adductor magnus muscle consistent with denervation.
The patient was treated conservatively, and neurologic recovery occurred gradually. Hip flexion strength improved to 4/5 within one week and returned to normal by two months. Hip adduction strength improved to 4/5 by one month and achieved full recovery by three months postpartum.
The authors emphasize that electrodiagnostic testing is traditionally used to evaluate peripheral nerve injury but may not be helpful early in the course because denervation changes typically appear only 10 to 28 days after nerve injury. Magnetic resonance imaging, in contrast, can detect muscle denervation as early as 24 hours after injury. MRI also provides the advantage of visualizing surrounding structures and helping exclude compressive causes such as hematoma or structural lesions.
Postpartum obturator neuropathy is rare and usually results from compression of the nerve during labor, often caused by fetal head pressure or prolonged positioning. Because symptoms can mimic complications related to neuraxial anesthesia, anesthesiologists should maintain awareness of obstetric neuropathies when evaluating postpartum neurologic deficits.
The authors recommend that clinicians begin with a detailed peripartum history and focused neurologic examination, with particular attention to hip adduction strength, which is the key motor function of the obturator nerve. Serial examinations help track symptom progression. When deficits persist or worsen, early MRI may facilitate diagnosis and guide timely rehabilitation.
What You Should Know
Postpartum peripheral nerve injuries can mimic complications of neuraxial anesthesia and may be initially misinterpreted.
Obturator neuropathy typically presents with weakness of hip adduction and difficulty crossing the legs.
Electrodiagnostic studies may not detect denervation during the first one to two weeks after nerve injury.
Magnetic resonance imaging can detect muscle denervation within 24 hours and can help identify the affected nerve earlier.
Early diagnosis allows reassurance, monitoring, and appropriate rehabilitation, which generally leads to favorable recovery.
Key Points
Postpartum obturator neuropathy is a rare complication of vaginal delivery, usually due to nerve compression during labor.
The key clinical finding is weakness in hip adduction.
Magnetic resonance imaging can detect early muscle denervation before electromyography becomes diagnostic.
Fat-suppressed T2-weighted MRI may show hyperintensity in affected muscles such as the pectineus.
Most cases improve with conservative management and gradual neurologic recovery.
Anesthesiologists should consider obstetric neuropathies when evaluating postpartum neurologic symptoms after epidural labor analgesia.
Thank you to Anesthesiology for allowing us to summarize this article.