Palsy In Pregnancy Research Articles

Association between hypertensive disorders and Bell’s palsy in pregnancy: protocol for a systematic review and meta-analysis

BackgroundBell’s palsy is an idiopathic peripheral nerve palsy involving the facial nerve. Pregnancy, diabetes mellitus and hypertension are the risk factors for Bell’s palsy. However, the association between hypertensive disorders...

Bell's palsy in pregnancy: A scoping review of risk factors, treatment and outcomes.

There are limited studies reporting on Bell's palsy and pregnancy. Our study aimed to evaluate risk factors, current treatment options and facial function outcomes in women who developed Bell's palsy in pregnancy. To our knowledge this is the first review analyzing these factors. A search of PubMed/MEDLINE, Embase, Web of Sciences and Scopus was carried out. Studies describing risk factors, treatment and/or facial function outcomes of Bell's palsy in pregnancy were included. PRISMA-Scr guidelines were followed. The search yielded 392 abstracts, of which 15 studies were included for analysis. It was not possible to perform a meta-analysis due to small numbers and quality of studies. There were 559 patients included from the 15 studies. The third trimester was the most common time for Bell's palsy to occur (n = 364, 65%). Pre-eclampsia was the most common co-morbidity reported. The most common treatment was corticosteroids and the majority of patients had a complete recovery of their palsy (58%, n = 192). This analysis has evaluated all available data concerning risk factors, treatment and facial function outcomes of BP in pregnancy. The third trimester is the most common time for Bell's palsy to occur in pregnancy. There is currently a lack of high quality evidence into this condition in pregnancy. 1.

Central dural venous thrombosis presenting with lateral rectus palsy in pregnancy

Central dural venous thrombosis presenting with lateral rectus palsy in pregnancy

Bell's Palsy in Pregnancy and Postpartum: A Retrospective Case-Control Study of 182 Patients.

To assess the incidence of Bell's palsy in pregnant and postpartum women. Additionally, to compare facial outcomes in terms of Sunnybrook score following Bell's palsy with regard to corticosteroid treatment and other confounding factors. Retrospective case-control study. University Hospital, Stockholm, Sweden. All women with Bell's palsy in pregnancy or postpartum (6 weeks after birth) with a computerized medical chart in the Stockholm Region 2005 to 2015 were included. The total number of births in the region during this period was retrieved from the Swedish Medical Birth Register. Nonpregnant age-matched women with Bell's palsy served as controls. Characteristics, medication, and Sunnybrook scores were collected. Risk factors for incomplete recovery (Sunnybrook score <96) at 3 months were calculated by logistic regression. In total, 182 pregnant and postpartum women with Bell's palsy were identified. The estimated incidence among pregnant and postpartum women was 60.5/100,000 person-years. The mean Sunnybrook score at 3 months was 74 among pregnant and postpartum women and 83 for controls (p = .002). At 12 months, Sunnybrook score was 81 and 89, respectively (p = .017). Only one-third of the pregnant women received corticosteroid treatment. The incidence of Bell's palsy in pregnancy and postpartum was 60.5 per 100,000 women and year in the Stockholm Region. Sunnybrook score was poorer in pregnant women compared with postpartum and nonpregnant women throughout. Corticosteroid treatment had little effect on any patients, however, only one-third of the pregnant women received this treatment.

Incidence of Facial Nerve Palsy in Pregnancy.

The facial nerve is cranial nerve number seven. A facial nerve palsy is a form of severe weakness of muscles of the face or paralysis due to swelling or any other kind of injury to the seventh nerve. Bell's palsy is the most common reason for facial nerve palsy in both pregnant and non-pregnant women, as well as in men and children. Palsy of the facial nerve is increased in conditions like pregnancy, diabetes, myasthenia gravis, Lyme disease, and multiple sclerosis, among others. The frequency of Bell's palsy in pregnant women is about three times that of an average person. There are several theories that have not been proven as to why this is the case. They are elevation of clotting factors in the blood, total body water causing compression and swelling of the facial nerve, increased level of female hormones like estrogen and progesterone, and the weakening of immune system in the third trimester of pregnancy, leading to reactivation of many viruses. Also, Bell's palsy during pregnancy has been linked to pre-eclampsia, which is also referred to as pregnancy-induced high blood pressure. Other associated factors are hemolysis, low platelets, which is a variant of pre-eclampsia, and elevated liver enzymes. Women are also susceptible to paralysis after childbirth. Most of the women who develop Bell's palsy after pregnancy start showing signs and symptoms seven to 10 days after the date of delivery.

An Interesting Case of Bell’s Palsy in Pregnancy Associated with COVID-19 Infection

Recent studies have reported that Coronavirus Disease 2019 (COVID-19) can be the cause of peripheral facial paralysis and neurological symptoms may be the only manifestation of the disease. Hereby, the authors report an interesting case of a pregnant COVID-19 positive female with Bell's palsy, in third trimester of pregnancy. A 33-year-old female, G3P0L0A2, presented with left-side deviation of angle of mouth, excessive lacrimation and redness of right eye for the past three days. She had involuntary drooling on right and left side labial commissural deviation, absence of forehead frowning, inability to close her right eye (positive Bell’s phenomena), and ipsilateral lagophthalmos. No lesions were seen on the external ear and otoscopy was normal. She was confirmed to have right-sided facial nerve palsy. She had an uneventful course of pregnancy till term and underwent caesarean section at 40 weeks, in view of foetal distress. Pregnancy and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, both are immunocompromised state, and hence could be a risk factor for Bell’s palsy. But larger studies with more cases are required to prove the causal association.

Bell's Palsy in Pregnancy and Pre-eclampsia: Is There An Association?

While the diagnosis of Bell’s Palsy (BP) in the general population is rare, previous research has demonstrated a higher rate of diagnosis in the third trimester of pregnancy. Prior retrospective studies and case reports have been published noting a relationship between BP and pre-eclampsia, however studies have been limited by small sample sizes due to the rare nature of BP. The objective of this study was to determine if women with BP and live births were diagnosed with pre-eclampsia more frequently when compared to women with a live birth without BP.

Bell's Palsy in Pregnancy.

The incidence and severity of Bell's palsy are increased in pregnancy, with most cases arising in the third trimester or postpartum period. It has been indicated that pregnancy-related Bell's palsy has worse long-term outcomes, such as complete facial paralysis, compared with nonpregnant women and males. This article outlines the existing literature diagnosis, treatment, and prognosis of Bell's palsy, specifically looking at the implications during pregnancy. The aim is to provide a reference for physicians treating Bell's palsy in pregnant patients. Existing literature on neuropathies during pregnancy, clinical presentation, and treatment of Bell's palsy was reviewed through a MEDLINE and PubMed search. Referenced articles were reviewed and used as primary source materials as appropriate. Multiple clinical tests of motor function are used to establish the diagnosis of Bell's palsy including Wartenberg's lid vibration test, an abnormal eyelash occlusion test, and asymmetry with voluntary and spontaneous smiling. Optimal treatment for Bell's palsy remains controversial. While early treatment with corticosteroids for 10 days is highly recommended, the simultaneous use of antiviral therapy is frequently performed but has less supporting evidence. Pregnancy itself and delay in treatment initiation are associated with persistent nerve palsy, whereas treatment started within 3 days of symptom onset is usually associated with full recovery. Recurrence of Bell's palsy in pregnancy is rare. To date, there is limited literature in the diagnosis and treatment of Bell's palsy during pregnancy. The prognosis of Bell's palsy in pregnancy is worse than in nonpregnant individuals. Early treatment with steroids is recommended, but not without risk.

Bell's Palsy in Pregnancy

A 26 years old mother was doing well in her 3rd trimester. Pregnancy was going good. Her expected due date was at the end of July month. (prevalence rate is high during autumn season)1. One morning at 36th week of pregnancy while returning from routine morning walk, she felt pain below her right ear and headache. She concluded it as lack of sleep, so she slept back. When she got up, bels palsy was showing its peak on her face along with knuckle rigidity. There was generalized edema over face and no sensation at the right side of face. Immediately she approached to neurologist where immunoglobulin and methylprednisolone were advised for initial two days. Investigation such as CBC, LFT, RFT were advised and reports came with elevated levels of-alkaline phosphatase, total leukocyte count, erythrocyte sedimentation rate, differential leukocyte count Controversy was in prescribing higher doses of corticosteroids and antiviral due to adverse effect on baby. Team of gynecologists and neurophysicians concluded to take the baby out by L.S.C.S. Abnormal delivery may have exerted pressure over nerves. A healthy baby was delivered. Oedema over the face released to some extent as fluid pressure was relieved. One aspect to be monitored was suture site as corticosteroids may delay wound healing. On 10th post-operative day sutures were removed and wound healing was good, she discharged from hospital with follow up advice. After one month she was advised for physiotherapy. There was no improvement till 4th month. At mothers aspect in spite of family support and expert counselling she was feeling very low. She started avoiding going out, interacting with people, sometimes she feel lack of interest in baby care. 5th month she started improving, regaining lip moments, drooling of tears also improved. Muscle over fore head and blowing balloon, sealing of mouth were yet to improve. After one month pause to physiotherapy again session was started this time she experienced twitching of lips, pain while electric stimulation, over stimulation of sebaceous glands. In medication folic acid tablets were still continuing. As there was no improvement in next 2 months of therapy, so it was stopped. At 10th month of getting affected review had been taken from senior neuro physician who stated that 70 percent recovery has taken place. Complete recovery will not take place. After 2 years period of Bell's palsy, it can only be noticed while smiling, blowing balloon, and tightly sealing the mouth.

Idiopatic facial nerve palsy in pregnancy – facts and myths

Idiopathic facial nerve palsy, called also Bell palsy, can be a challenge for clinicians if a pregnant woman reports symptoms of facial paresis. The incidence of Bell's paralysis in pregnant women is almost three times higher than in the non-pregnant women's age group. The problem is the lack of guidelines for the treatment of idiopatic facial nerve palsy in this group of patients. In randomized studies, but without participation of pregnant women, greater efficacy was found in the return of nerve function after early treatment with corticosteroids than with other methods. The dilemma concerning therapy is intensified by the fact that the prognosis regarding the return of facial nerve function in pregnant women is significantly worse than in the remaining population and the weakness of facial muscles is yet diagnosed in a young woman. In the article we present the example of a patient consulted in our department and the review of current literature. We introduce recommendations for the treatment of pregnant women with facial nerve palsy. There are discussed benefits, advised medicines, doses, necessary precautions and potential side effects of corticosteroids, which are the only ones that have proven efficacy in the treatment of Bell's paralysis in pregnant women.

Isolated Sixth Cranial Nerve Palsy in Pregnancy (P2.136)

Isolated Sixth Cranial Nerve Palsy in Pregnancy (P2.136)

Warm needling moxibustion at Xià guān ( ST 7) plus shallow Puncture for Bell's palsy in pregnancy

ObjectiveTo observe the effects of a protocol consisting of warm needling with moxibustion at Xiàguān (▪ ST 7) plus shallow puncture on Bell's palsy (BP) in pregnancy. MethodsThirteen patients with BP received an intervention of warm needling moxibustion at ST 7 plus shallow puncture, and were evaluated using the House–Brackmann facial nerve grading system (HB) before and after intervention. ResultAfter intervention, the HB grade improved significantly (P<0.05). ConclusionWarm needling moxibustion plus shallow puncture is a safe and effective therapy for pregnant BP patients. BP in pregnancy appears to be more frequent in the last trimester. The severity of nerve injury and the timing for the first visit to the doctor after the onset of facial paralysis are essential factors for the recovery and prognosis of pregnant with BP.

Two cases of fourth nerve palsy in pregnancy

Aim: To present two cases of recent-onset fourth nerve palsies during pregnancy.Methods: Two pregnant patients presented to A&amp;E with recent-onset diplopia due to isolated right superior oblique palsy. Patient 1, aged 42, complained of a 5-day history of intermittent vertical diplopia at 38 weeks gestation. Patient 2, aged 34, presented with constant horizontal and vertical diplopia at 34 weeks gestation.Results: Two months after giving birth, patient 1 attended the eye clinic reporting her symptoms had completely resolved within 5 days from onset. Patient 2 reported her symptoms resolved within 3 months. Both patients fully recovered, therefore no further management or investigation was required. They both gave birth at term without complication. Patient 1 presented with a slight hyperphoria in primary position, demonstrating binocular single vision (BSV). Ocular motility and Hess chart showed a very slight right superior oblique under-action. Her blood pressure, fundus and media were normal and no underlying pathology was found. No further investigations were undertaken. Patient 2 presented with a slight exotropia and right hypertropia in primary position, with diplopia and no BSV demonstrable. Further orthoptic testing showed right superior oblique under-action. No pathology was found.Conclusions: Cranial nerve palsies developing in pregnancy are rare but have been reported. No pathology was found in our cases; however, the literature does suggest that serious cases could be apparent and should therefore be considered.

LMN Facial Palsy in Pregnancy: An Opportunity to Predict Preeclampsia-Report and Review.

Facial paralysis is the most frequent unilateral cranial nerve pathology affecting pregnant population 2 to 4 times more often than the nonpregnant population. There exists an association with preeclampsia but this has largely been overlooked. Clinicians often dismiss it for idiopathic palsy as seen in the present case. A 30-year-old woman, Gravida 4, Para 3, presented at 26 weeks pregnancy with complaints of facial weakness, blurring of vision, altered taste sensation, increased noise sensitivity for 1 month, headache since 18 days, and vomiting since 2­3 days. Her pulse was 90/min, BP was 170/120, and RR was 18/min. Uterus was 18 weeks size and proteinuria++ was present. Ultrasonography revealed a 26 weeks fetus, severe bradycardia, and absent liquor. HELLP syndrome was diagnosed after investigations. Six units of fresh frozen plasma were transfused. An informed decision for termination of pregnancy was made. She delivered a 450 gram stillborn. The third stage was complicated with postpartum hemorrhage but it was managed successfully. Women with Bell's palsy during pregnancy should be evaluated critically as in some it may precede preeclampsia which has serious maternal and fetal implications. Therefore, these women should be in regular followup of the obstetrician.

Bell's palsy in pregnancy: underlying HELLP syndrome or pre-eclampsia?

Bell's palsy is not uncommon during pregnancy. An association with pre-eclampsia (PE) has been reported previously. Furthermore, it has even been suggested that Bell's palsy could be a predictor of PE. We report three cases illustrating various possible aspects of this association, one of them including the features of HELLP (haemolysis, elevated liver enzymes, and low platelets) syndrome.

Bilateral abductor vocal cord palsy and pregnancy: a case report

Introduction/backgroundBilateral abductor vocal cord palsy in pregnancy is a rareclinical problem. Due to the rarity of this condition, there isno definite guideline on obstetric management.CaseA 23-year-old primigravida was referred to our tertiaryhospital at 23 weeks gestation. Her prior antenatal care hadbeen with a primary health care clinic. She was diagnosedwith papillary carcinoma of the thyroid when she was17 years old, and had undergone a total thyroidectomy. Shehad since been in remission, and had been on thyroxine200 lg daily. She reported hoarseness of voice since herthyroidectomy, but did not have respiratory compromise.On presentation, she complained of stridor, snoring andworsening episodes of sleep apnoea since early in thesecond trimester. On examination, her pulse rate was88 bpm, her blood pressure was 120/80. Her respiratoryrate was 20/min. Stridor was audible even without aus-cultation. Auscultation of her lungs was unremarkable. Heruterus size corresponded to her dates and ultrasonographyrevealed a structurally normal foetus with normal growthparameters. She was then referred to an otorhinolaryngol-ogist for assessment. A flexible laryngoscopy showedbilateral abductor vocal cord palsy in paramedian position(Fig. 1).Her condition remained stable until 32 weeks when herstridor worsened and she was having more difficultybreathing. A decision was made to electively insert a tra-cheostomy at 36 weeks, and to perform a lower segmentcaesarean section at 38 weeks. However, ultrasonographyat 36 weeks showed evidence of intrauterine growthrestriction (IUGR) and an amniotic fluid index of 6.0.Under general anaesthesia, a size 7.5 tracheostomy tubewas inserted. At the same sitting, lower segment caesareansection was performed uneventfully. A baby girl weighing2,600 g was delivered with an Apgar score of 8 at 1 minand 9 at 5 min. Estimated blood loss was 400 ml. Twoweeks later, left laser cordectomy was performed followedby removal of the tracheostomy. On follow-up 2 weekslater, her voice was still hoarse but she no longer hadstridor.DiscussionAbductor vocal cord palsy is caused by damage to one orboth recurrent laryngeal nerves (RLN). RLN palsy is acommon complication following neck/thyroid surgery witha reported frequency of 6.6–13.2 % [1, 2]. The incidencefollowing thyroidectomy for thyroid carcinoma is 10.1 %[3]. In bilateral RLN palsy, the vocal cords remain in theparamedian position. It commonly presents as stridor andhoarseness of voice. It may occur due to direct or indirectsurgical denervation of the RLN, or it can happen due to

Periphere Fazialisparese in der Schwangerschaft

Idiopathic facial (Bell's) palsy occurring during pregnancy or post partum is a rare disease. Reports regarding incidence, prognosis and associated risk factors are still inconsistent. We performed a retrospective analysis of patients presenting with idiopathic facial palsy who had been treated in cooperation between obstetric and otorhinolaryngological departments (tertiary referral centers). The time of onset of paralysis, grading according to House and Brackman, treatment modalities and results were analyzed for the years 1999-2010. The incidence of Bell's palsy in pregnancy was 56 in 100,000 live births. Preeclampsia was reported in one case only. Therapy included prednisolone, methylprednisolone and/or pentoxifylline (up to 2005). All results were favorable (House-Brackman 1-2). The incidence of Bell's palsy in pregnancy within our cohort is not increased with regard to the international reports. Early treatment with corticosteroids in consultation with the treating obstetrician is indicated in both pregnant and post-partum patients to achieve optimal results.

Association of Nonreassuring Fetal Heart Rate Patterns and Subsequent Cerebral Palsy in Pregnancies with Intrauterine Bacterial Infection

We evaluated an association of nonreassuring fetal heart rate (FHR) patterns and subsequent cerebral palsy (CP) in pregnancies with intrauterine bacterial infection. Among 10,030 infants born during 1995 to 2000, 139 were complicated with acute intrauterine bacterial infection in labor. The FHR patterns 2 hours immediately before delivery were interpreted according to the guidelines of the National Institute of Child Health and Human Development. The correlations between the FHR patterns and umbilical blood gases, as well as FHR patterns and CP were studied. Statistics included unpaired t test, contingency table with chi (2) and Fisher test, and one-way analysis of variance with Bonferroni/Dunn test. Fifteen infants (11%) developed CP at 2 years or older. Nonreassuring FHR patterns including recurrent late deceleration, severe variable deceleration, and prolonged deceleration occurred in 24% of pregnancies with intrauterine infection. Incidence of CP was not different according to the FHR deceleration patterns or umbilical pH values. Multiple logistic regression analysis revealed that fetal tachycardia (OR, 11; 95% CI, 1.8 to 67) and lower gestational age (< 34 weeks; OR, 9.4; 95% CI, 0.96 to 93) was associated with CP in intrauterine infection. Nonreassuring FHR patterns were increased in intrauterine infection. CP occurred more frequently and was associated with tachycardia and lower gestational age, but not with FHR deceleration patterns or acidemia, suggesting different pathophysiology from acute hypoxia-ischemia.

Association between Bell's palsy in pregnancy and pre-eclampsia.

Previous published case series have suggested an association between the onset of Bell's palsy in pregnancy and the risk of pre-eclampsia and gestational hypertension. To evaluate the period of onset of Bell's palsy in pregnancy and the associated risk of adverse maternal and perinatal events, including the hypertensive disorders of pregnancy. Case series study of consecutive female patients. Women presenting with Bell's palsy during pregnancy or the puerperium were identified by a hospital record review at five Canadian centres over 11 years. Information was abstracted about each woman's medical and obstetrical history, period of onset of Bell's palsy, and associated maternal complications, including pre-eclampsia and gestational hypertension as well as preterm delivery and low infant birth weight (<2500 g). These rates were compared to those previously described for the province of Ontario or for Canada. Forty-one patients were identified. Mean onset of Bell's palsy was 35.4 weeks gestation (SD 3.9). Nine (22.0%, 95%CI 10.8-35.7) were also diagnosed with pre-eclampsia and three (7.3%, 95%CI 1.4-17.1) with gestational hypertension, together (29.3%, 95%CI 16.5-43.9) representing nearly a five-fold increase over the expected provincial/national average. There were three twin births. The observed rates of Caesarean (43.6%) and preterm (25.6%) delivery, as well as low infant birth weight (22.7%), were also higher than expected, although the rate of congenital anomalies (4.5%) was not. The onset of Bell's palsy during pregnancy or the puerperium is probably associated with the development of the hypertensive disorders of pregnancy. Pregnant women who develop Bell's palsy should be closely monitored for hypertension or pre-eclampsia, and managed accordingly.

Bell's palsy in pregnancy: A study of recovery outcomes

Objective: To study facial nerve recovery in patients with Bell's palsy of pregnancy compared with that of the nonpregnant population. Methods: A retrospective chart analysis was conducted of all patients seen within 6 weeks of the onset of Bell's palsy of pregnancy, with a minimum of 1-year follow-up. Recovery outcomes were compared with similarly chosen randomly selected groups of nonpregnant females 15 to 40 years old (group 1), nonpregnant females of all ages (group 2), males 15 to 40 years old (group 3), and males of all ages (group 4), all of whom were also seen within 6 weeks of onset. Recovery was categorized as satisfactory (House-Brackmann grade I to II) or unsatisfactory (House-Brackmann grade III or IV). The 2-tailed Fisher exact test was used to statistically analyze differences between groups. Results: Fifty-two percent of women with Bell's palsy of pregnancy whose facial palsy progressed to complete paralysis within 10 days of onset recovered to a satisfactory level compared with 77% to 88% of comparison patients. These differences were statistically significant in all cases. Recovery for those with an incomplete palsy was satisfactory in virtually 100% of all patients studied. Conclusion: The prognosis for a satisfactory recovery for women who develop a complete facial paralysis with Bell's palsy while pregnant is significantly worse than for that for the general population. This information should be taken into consideration by all physicians involved in the counseling of these patients. (Otolaryngol Head Neck Surg 2002;126:26-30.)