Postdural puncture headache increases risks of major postpartum neurological complications

  • Guglielminotti J & al.
  • Anesth Analg
  • 17 Jul 2019

  • International Clinical Digest
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Takeaway

  • Obstetric patients who developed postdural puncture headache (PDPH) after childbirth had significantly higher risks of serious postpartum neurological complications, including cerebral venous thrombosis, nontraumatic subdural hematoma, and bacterial meningitis, as well as headache, depression, and lower back pain.

Why this matters

  • PDPH is the most frequent complication following the use of neuraxial anesthetic in obstetric patients.

Study design

  • The study evaluated 1,003,803 women who received neuraxial anesthesia for childbirth in New York State hospitals between January 1, 2005 and September 30, 2014.
  • Funding: None disclosed.

Key results

  • 4808 women developed PDPH (incidence, 4.79 [95% CI, 4.66-4.93] per 1000).
  • Compared with women without PDPH, those with PDPH showed higher incidences of cerebral venous thrombosis and nontraumatic subdural hematoma (3.12 vs 0.16 per 1000; P<.001>
  • Women with PDPH showed higher risks (P<.001 for: style="list-style-type:circle;">
  • cerebral venous thrombosis and nontraumatic subdural hematoma (aOR, 18.98);
  • bacterial meningitis (aOR, 39.70);
  • headache and migraine (aOR, 7.66);
  • depression (aOR, 1.88); and
  • lower back pain (aOR, 4.58).

Limitations

  • Retrospective study.

Coauthored with Chitra Ravi, Mpharm