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Treatment of obstetric post-dural puncture headache. Part 1: conservative and pharmacological management

Published:December 21, 2018DOI:https://doi.org/10.1016/j.ijoa.2018.12.006

      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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