Takeaway
- Women who developed a postdural puncture headache after neuraxial anesthesia (epidural or spinal) for childbirth had a small, significant increase in the absolute risk for intracranial subdural haematoma during the first few months postpartum.
Why this matters
- Headache may develop after hospital discharge.
- Association with subdural haematoma has not been well studied.
- Subdural haematoma carries risks for permanent disability and death.
Key results
- Subdural haematoma rate:
- 1.5 per 100,000 deliveries in entire cohort.
- 147 per 100,000 deliveries in subgroup with postdural puncture headache.
- Postdural puncture headache conferred elevated risk for subdural haematoma:
- Unadjusted absolute risk increase of 145 cases per 100,000 deliveries (crude OR, 134; P<.001).
- Adjusted absolute risk increase of 130 per 100,000 deliveries (aOR, 199; P<.001).
Study design
- Retrospective cohort study using US hospital discharge records from the National Readmission Database for 22,130,815 women and deliveries in 2010-2016.
- Main outcome: intracranial subdural haematoma in 2-month postpartum period.
- Funding: McGill University Health Center Department of Anesthesia.
Limitations
- Causality is unknown.
- Possible surveillance bias, rare event bias.
- Potential misclassification of exposure, outcome.
- Database limitations.
References
References