Post-dural Puncture Headache in Obstetrical Patients in the Tertiary Care Centre, PUMHS Nawabshah

Iqra Arif; Sadaf Wahid; Anam Mumtaz; Rabail Malik; Samina Gaffar; Sania Ali; Raishem

doi:10.70749/ijbr.v3i3.2471

Authors

Iqra Arif Department of Obstetrics and Gynaecology, Peoples University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, Pakistan
Sadaf Wahid Department of Obstetrics and Gynaecology, Peoples University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, Pakistan
Anam Mumtaz Gambat Institute of Medical Sciences, Gambat, Pakistan
Rabail Malik Department of Obstetrics and Gynaecology, Peoples University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, Pakistan
Samina Gaffar Department of Obstetrics and Gynaecology, Peoples University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, Pakistan
Sania Ali Department of Obstetrics and Gynaecology, Peoples University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, Pakistan
Raishem Department of Obstetrics and Gynaecology, Peoples University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, Pakistan

DOI:

https://doi.org/10.70749/ijbr.v3i3.2471

Keywords:

Post-Dural Puncture Headache; Obstetric Anesthesia; Cesarean Section; Neuraxial Block; Pakistan

Abstract

Background: Post-dural puncture headache (PDPH) remains a frequent iatrogenic complication of neuraxial anesthesia in obstetric patients. Although usually self-limiting, it can delay mobilization, impair mother-infant bonding, and affect quality of life. Understanding its frequency and contributing factors is crucial to improving safety and preventing chronic morbidity. Objective: To determine the incidence, severity, and associated risk factors of post-dural puncture headache among obstetric patients undergoing spinal or epidural anesthesia at Peoples University of Medical & Health Sciences for Women (PUMHS), Shaheed Benazirabad. Methods: A descriptive cross-sectional study was conducted at the Department of Obstetrics and Gynecology, PUMHS, from 21 May 2024 to 20 November 2024. A total of 207 obstetric patients receiving neuraxial anesthesia for delivery were included. Data on age, body-mass index, gestational age, anesthesia type, needle gauge and design, number of puncture attempts, provider level, and accidental dural puncture were collected. PDPH was diagnosed according to International Headache Society criteria. Statistical analysis was performed using SPSS v26, applying descriptive statistics and χ² / t-tests, with p < 0.05 considered significant. Results: PDPH occurred in 2.4 % (5 / 207) patients. The mean VAS pain score among PDPH cases was 6.4 ± 1.1, and mean headache duration 2.8 ± 1.1 days. Significant associations were found with multiple puncture attempts (p = 0.0017) and accidental dural puncture (p = 0.0478). No PDPH occurred in epidural-only blocks. Most patients responded to conservative measures; 40 % required an epidural blood patch. The mean hospital stay was longer in PDPH cases (3.7 ± 1.1 days) compared with non-PDPH (2.9 ± 0.9 days). Conclusion: The low PDPH incidence observed highlights improved procedural safety; however, operator experience and atraumatic needle use remain key preventive strategies. Establishing standardized post-anesthesia surveillance and management protocols can further reduce maternal morbidity in obstetric units.

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References

1. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91(5):718-29.

https://doi.org/10.1093/bja/aeg231

2. Bezov D, Lipton RB, Ashina S. Post-dural puncture headache: Part I—pathophysiology, prevention, and treatment. Headache. 2010;50(7):1144-52.

https://doi.org/10.1111/j.1526-4610.2010.01678.x.

3. Halpern S, Preston R. Post-dural puncture headache and spinal needle design. Meta-analysis. Anesthesiology. 1994;81(6):1376-83.

https://doi.org/10.1097/00000542-199412000-00020.

4. Safa-Tisseront V, Thormann F, Malassiné P, et al. Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anesthesiology. 2001;95(2):334-9.

https://doi.org/10.1097/00000542-200108000-00010.

5. Siddiqi FA, de Silva A, Alanazy W, et al. Trends and determinants of caesarean section in Pakistan: secondary analysis of DHS 1990–2018. BMC Pregnancy Childbirth. 2020;20:

https://doi.org/10.1186/s12884-020-03457-y.

6. Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226-32.

https://doi.org/10.1097/01.AOG.0000219750.79480.84.

7. Jauniaux E, Ayres-de-Campos D; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on PAS: epidemiology and risk factors. Int J Gynaecol Obstet. 2018;140(3):265-73.

https://doi.org/10.1002/ijgo.12406.

8. Cahill AG, Beigi R, Heine RP, Silver RM. Placenta accreta spectrum: epidemiology, risk factors, and maternal morbidity. Clin Obstet Gynecol. 2018;61(4):733-42.

https://doi.org/10.1097/GRF.0000000000000372.

9. Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound. Ultrasound Obstet Gynecol. 2018;52(2):157-68.

https://doi.org/10.1002/uog.19020.

10. Apfel CC, Saxena A, Cakmakkaya OS, et al. Prevention of post-dural puncture headache after accidental dural puncture: a quantitative systematic review. Br J Anaesth. 2010;105(3):255-63.

https://doi.org/10.1093/bja/aeq191.

11. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91(5):718-29.

https://doi.org/10.1093/bja/aeg231

12. Bezov D, Lipton RB, Ashina S. Post-dural puncture headache: Part I—diagnosis, epidemiology, etiology, and pathophysiology. Headache. 2010;50(7):1144-52.

https://doi.org/10.1111/j.1526-4610.2010.01699.x

13. Halpern S, Preston R. Post-dural puncture headache and spinal needle design. Anesthesiology. 1994;81(6):1376-83.

https://doi.org/10.1097/00000542-199412000-00012

14. Safa-Tisseront V, Thormann F, Malassiné P, et al. Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anesthesiology. 2001;95(2):334-9.

https://doi.org/10.1097/00000542-200108000-00012

15. Apfel CC, Saxena A, Cakmakkaya OS, Gaiser R, George E, Radke O. Prevention of post-dural puncture headache after accidental dural puncture: a quantitative systematic review. Br J Anaesth. 2010;105(3):255-63.

https://doi.org/10.1093/bja/aeq191

16. Boonmak P, Boonmak S. Epidural blood patching for preventing and treating post-dural puncture headache. Cochrane Database Syst Rev. 2010;(1):CD001791.

https://doi.org/10.1002/14651858.CD001791.pub3

17. Amorim JA, Valença MM. Post-dural puncture headache is a risk factor for new headache types. Cephalalgia. 2008;28(1):5-8.

https://doi.org/10.1111/j.1468-2982.2007.01461.x

18. Amjad A, Amjad U, Zakar R, Zakar MZ, Fischer F. Trends of caesarean-section deliveries in Pakistan: secondary data analysis from Demographic and Health Surveys 1990-2018. BMC Pregnancy Childbirth. 2020;20:753.

https://doi.org/10.1186/s12884-020-03457-y

19. Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226-32.

https://doi.org/10.1097/01.AOG.0000219750.79480.84

20. Jauniaux E, Ayres-de-Campos D; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: epidemiology. Int J Gynaecol Obstet. 2018;140(3):265-73.

https://doi.org/10.1002/ijgo.12407

21. Cahill AG, Beigi R, Heine RP, Silver RM; ACOG; SMFM. Placenta accreta spectrum. Am J Obstet Gynecol. 2018;219(6):B2-B16.

https://doi.org/10.1016/j.ajog.2018.09.042