First reported case of a parturient with aggressive lymphoma resulting in pelvic lymphadenopathy that obstructed vaginal delivery, requiring urgent cesarean despite acute lower extremity neurologic deficits, active DVTs, and no comparable cases in the literature to guide anesthesia decision making.

 

With the goal of urgent delivery, input from Neurology, Hematology-Oncology, Obstetrics, and Anesthesiology helped to guide a time sensitive work-up

Lumbar and pelvic MRI was crucial for OB surgical planning and determining the feasibility of neuraxial; completion spine and brain MRI for staging was deferred as the patient could not tolerate lying flat for extended periods - further oncology and neurology work-up would wait until after delivery

 

No published framework exists for neuraxial for urgent delivery in a parturient with acute neurologic deficits from suspected tumor compression. This novel case demonstrates a replicable decision pathway:

→ Neurology consult to characterize mechanism of neurologic deficits and aid in thorough documentation of deficits prior to and after neuraxial

→ Targeted lumbar MRI to exclude cord involvement at levels used for neuraxial

→ Multidisciplinary risk-benefit and goal consensus at every key decision point

 

Pre-existing neurologic deficits are not an absolute contraindication to neuraxial - clear documentation and multidisciplinary consensus are critical for time sensitive care in the absence of evidence-based guidance.