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Treatment of obstetric post-dural puncture headache. Part 2: epidural blood patch

Published:December 21, 2018DOI:https://doi.org/10.1016/j.ijoa.2018.12.005

      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.
      • Recommendations for treatment with an epidural blood patch are 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. Despite suffering long-term headaches, neither woman was adequately followed-up after discharge from hospital. Death resulted from a cerebral vein thrombosis in one case and a subdural haematoma in the other. Due to significant variation in the treatment of obstetric post-dural puncture headache, an Obstetric Anaesthetists’ Association working group was set up to produce evidence-based guidelines to guide clinicians. These guidelines have been condensed into two review articles. In this second review, the role of an epidural blood patch is discussed using a question and answer format.
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