Acute Peripheral Facial Nerve Palsy (Bell's Palsy) in Pregnancy

Clinical Presentation and Diagnosis

The American Academy of Neurology recommends that a diagnosis of Bell's palsy be considered in patients with acute onset of unilateral facial weakness, including inability to close the eye, in the absence of other neurological deficits 1
The presence of isolated facial symptoms with eye closure weakness indicates peripheral facial nerve involvement at or distal to the facial nucleus 1
The absence of other neurological deficits, such as limb weakness or speech difficulties, argues strongly against a central stroke 1, 2, 3

The American College of Obstetricians and Gynecologists recommends initiating oral prednisone 60-80 mg daily for 7 days within 72 hours of symptom onset for best outcomes 1
Pregnancy is not a contraindication to corticosteroids for Bell's palsy, as the benefits of preventing permanent facial paralysis outweigh theoretical fetal risks 4
The American Academy of Ophthalmology recommends implementing aggressive corneal protection immediately to prevent exposure keratopathy, which can cause permanent vision loss 1

70-85% of patients recover completely within 3-6 months with corticosteroid treatment 1
The American Academy of Neurology recommends scheduling neurology follow-up in 2-4 weeks to assess recovery trajectory 1
If no improvement by 3-4 weeks, an MRI should be obtained to exclude alternative diagnoses 1

Bell's palsy is 3 times more common in pregnancy, particularly in the third trimester and early postpartum period 4
The prognosis is similar to non-pregnant patients with appropriate treatment 4
Antiviral agents should be avoided unless herpes zoster is confirmed, as routine antivirals for Bell's palsy have limited evidence and pregnancy safety data 4