Highlights
- •Postnatal headache may be associated with maternal mortality.
- •The management of obstetric post-dural puncture headache (PDPH) varies considerably.
- •Much of the evidence on obstetric PDPH management is not of high quality.
- •Evidence of obstetric PDPH treatment is reviewed and recommendations made.
- •Women experiencing PDPH should be followed-up after hospital discharge.
Abstract
The 2009–12 MBRRACE-UK report highlighted the deaths of two women in whom dural puncture
had occurred during insertion of a labour epidural catheter. One woman received an
epidural blood patch, the other did not, but both suffered with chronic headaches
following discharge from hospital. Neither woman was adequately followed-up. Death
resulted from a cerebral vein thrombosis in one case and a subdural haematoma in the
other. Surveys of clinical practice in the UK have revealed significant variation
in anaesthetic practice in the management of obstetric post-dural puncture headache.
To help provide guidance on treatment, the Obstetric Anaesthetists’ Association set
up a working group to review the literature and produce evidence-based guidelines
for management of obstetric post-dural puncture headache. These guidelines have been
condensed into two review articles, the first of which covers conservative and pharmacological
treatment.
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Article info
Publication history
Published online: December 21, 2018
Accepted:
December 16,
2018
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
