Long-term psychological and physical outcomes of women after postdural puncture headache

Abstract

BACKGROUND Postdural puncture headache after accidental dural puncture during labour may lead to chronic sequalae. OBJECTIVES We aimed to measure the incidence of postpartum depression, posttraumatic stress disorder, chronic headache, backache and breastfeeding rates after a postdural puncture headache. DESIGN A retrospective, case-matched cohort study. SETTING A review of documented cases of dural puncture and matched case controls occurring at Rabin Medical Center and Shamir Medical Center from 01 January 2012 to 30 September 2018. PATIENTS The study cohort consisted of women with a documented postdural puncture headache and the controls were women with uneventful labour epidurals in the same 24-h period. Women were interviewed by telephone. PRIMARY OUTCOMES MEASURE The primary outcome measure was the incidence of postpartum depression after a postdural puncture headache. RESULTS Women with postdural puncture headache (n = 132) and controls (n = 276) had similar demographic data. The incidence of postpartum depression was 67/128 (52.3%) versus 31/276 (11.2%) for controls, P < 0.0001, 95% confidence intervals of the difference 31.5 to 50.2. Posttraumatic stress disorder was more frequent among women with postdural puncture headache, 17/132 (12.8%) versus controls 1/276 (0.4%), P < 0.0001, 95% confidence intervals of the difference 7.6 to 19.5. Women with postdural puncture headache breastfed less, 74/126 (54.5%) versus controls 212/276 (76.8%), P < 0.0001, 95% confidence intervals of the difference 33.1 to 55.2. Current headache and backache were significantly more frequent among women with postdural puncture headache [current headache 42/129 (32.6%) versus controls 42/276 (15.2%) P < 0.00001, 95% confidence intervals 0.085 to 0.266; current backache 58/129 (43.9%) versus controls 58/275 (21%) P < 0.0001, 95% confidence intervals 14.1 to 33.5]. CONCLUSION We report an increased incidence of postpartum depression, posttraumatic stress disorder, chronic headache and backache and decreased breastfeeding following a postdural puncture headache. Our findings emphasise the need for postpartum follow-up for women with postdural puncture headache. TRIAL REGISTRY NUMBER Clinical trial registry number: NCT03550586.

Chronic pain in parturients with an accidental dural puncture: A case‐controlled prospective observational study

“…and chronic backache 17.9%-23.9% in women with accidental dural puncture without or with an epidural blood patch. This confirms previous reports 8,9,18 which found chronic headache rates from 17.6% to 34.8% and chronic backache rates of 28 to 43.9%. Our study is the first study that excluded any women who had a history of chronic headaches or history of backaches.…”

“…While EBP is considered the gold standard for the treatment of PDPH, 6,19 there is not much information on its long‐term effects. Like the study by Webb et al 9 and Orbach‐Zinger et al, 18 we found no difference in rates of chronic headache and backache in women who received an EBP as opposed to those who did not. It is unclear, however, how the severity of the PDPH headache impacted the development of headache.…”

“…However, during the study period due to new and more current data being published on the incidence of chronic headache in women with PDPH—that better represented our patient population—, we already reached a margin of error of 25% when we include 55 parturients. We based this interim sample size calculation on the incidence rates reported in a recent study by Orbach‐Zinger et al 18 …”

Efficacy and Safety of Prophylactic Intrathecal Normal Saline for Prevention of Post Dural Puncture Headache among Women Undergoing Cesarean Section under Spinal Anesthesia: A Randomized Controlled Trial

“…Post Dural Puncture Headache is the most common complication of neuraxial anesthesia which has been postulated that it is resulting from intracranial hypotension due to continuous loss of CSF through the dural tear that is mainly related to needle size, shape, type, and less likely risk factor including female gender, young age, pregnancy, low BMI, previous history of PDPH, and history of migraine headache (4,12,20,24,38,42,43). In turn, these causes prolonged bedridden and thrombosis, decrease early breastfeeding and mother-to-child bonding, length of hospital stay, increased psychological distress, and dissatisfaction to the mother and her family (13,16,(43)(44)(45).…”

Anesthesiologists’ perspectives on why dural punctures occur: a multicenter international survey

“…Accidental dural puncture (ADP) is a serious complication of obstetric anesthesia 1 2. Although several studies have identified specific risk factors, there remains a need for modifiable etiologies3 4 There has been growing interest in root cause analysis, an exploration of key system-level factors as contributors to the occurrence of accidents 3.…”