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Major Neurologic Complications Associated With Postdural Puncture Headache in Obstetrics

A Retrospective Cohort Study

Guglielminotti, Jean MD, PhD*; Landau, Ruth MD*; Li, Guohua MD, DrPH*,†

doi: 10.1213/ANE.0000000000004336
Obstetric Anesthesiology: PDF Only
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BACKGROUND: Increased risks of cerebral venous thrombosis or subdural hematoma, bacterial meningitis, persistent headache, and persistent low back pain are suggested in obstetric patients with postdural puncture headache (PDPH). Acute postpartum pain such as PDPH may also lead to postpartum depression. This study tested the hypothesis that PDPH in obstetric patients is associated with significantly increased postpartum risks of major neurologic and other maternal complications.

METHODS: This retrospective cohort study consisted of 1,003,803 women who received neuraxial anesthesia for childbirth in New York State hospitals between January 2005 and September 2014. The primary outcome was the composite of cerebral venous thrombosis and subdural hematoma. The 4 secondary outcomes were bacterial meningitis, depression, headache, and low back pain. PDPH and complications were identified during the delivery hospitalization and up to 1 year postdelivery. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using the inverse probability of treatment weighting approach.

RESULTS: Of the women studied, 4808 (0.48%; 95% CI, 0.47–0.49) developed PDPH, including 264 cases (5.2%) identified during a readmission with a median time to readmission of 4 days. The incidence of cerebral venous thrombosis and subdural hematoma was significantly higher in women with PDPH than in women without PDPH (3.12 per 1000 neuraxial or 1:320 vs 0.16 per 1000 or 1:6250, respectively; P < .001). The incidence of the 4 secondary outcomes was also significantly higher in women with PDPH than in women without PDPH. The aORs associated with PDPH were 19.0 (95% CI, 11.2–32.1) for the composite of cerebral venous thrombosis and subdural hematoma, 39.7 (95% CI, 13.6–115.5) for bacterial meningitis, 1.9 (95% CI, 1.4–2.6) for depression, 7.7 (95% CI, 6.5–9.0) for headache, and 4.6 (95% CI, 3.3–6.3) for low back pain. Seventy percent of cerebral venous thrombosis and subdural hematoma were identified during a readmission with a median time to readmission of 5 days.

CONCLUSIONS: PDPH is associated with substantially increased postpartum risks of major neurologic and other maternal complications, underscoring the importance of early recognition and treatment of anesthesia-related complications in obstetrics.

From the *Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York

Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.

Accepted for publication June 12, 2019.

Funding: J.G. is supported by an R03 from the Agency for Healthcare Research and Quality (1 R03 HS025787-01).

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.anesthesia-analgesia.org).

Reprints will not be available from the authors.

Address correspondence to Jean Guglielminotti, MD, PhD, Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 W 168th St, PH5-505, New York, NY 10032. Address e-mail to jg3481@cumc.columbia.edu.

© 2019 International Anesthesia Research Society
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