///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Case-control study to investigate the relationship between postdural puncture headache and postpartum psychological and physical morbidities

Abstract Number: O1-05
Abstract Type: Original Research

Sharon Orbach-Zinger MD1 ; Olya Matkovski MD2; Carolyn F Weiniger MB ChB 3; Michal Y Livne MD4; Eitan Mangobi MD5; Leonid A Eidelman MD6

Background: Accidental dural puncture (ADP) occurs in 0.4-6% of labor epidurals (LE), leading to postdural puncture headache (PDPH) that may cause chronic headache and backache (1). Information regarding psychological sequelae after PDPH is lacking. The primary study aim was to investigate the incidence of postpartum depression (PPD) after PDPH. Secondary aims were to investigate postpartum stress disorder (PTSD), chronic postpartum headache, backache, and breastfeeding after PDPH. Methods: Case-control study of women who received LE. Cases were women who developed documented PDPH after ADP, identified from medical records (Jan 2012-18) and controls were women with a normal LE in that 24hr period. Women from 2 hospitals gave verbal consent by telephone (study period Jul-Dec 2018) to answer questions about PPD, PTSD, headache, backache (prior to LE and current), and breastfeeding using questionnaires (Table 1). Cases and controls were compared using appropriate comparison statistics, significance was p<0.01. A multivariable regression analysis was performed to evaluate factors (ADP, epidural blood patch (EBP), current headache, current backache and breastfeeding) associated with PPD. A sub-group analysis of PDPH women with vs without EBP investigated the same outcomes. Results: PDPH women (n=132) and case-controls (n=276) had similar age, parity, BMI and questionnaire time-interval since ADP (median 48 months). Table 2 presents questionnaire findings. Among PDPH women the incidence of PPD was 67(52.3%) vs 31(11.2%) for controls, p<0.0001. Current headache and backache and possible PTSD were also significantly higher among PDPH women, and they were less likely to breastfeed. Multivariable regression analysis showed that ADP significantly increased the likelihood of PPD, Odds Ratio 7.81 (95% CI 3.55-14.9). EBP was performed for 60(45.5%) PDPH women. PDPH women with vs without EBP had similar rates of PPD (56.5 vs 48.3% p=0.35); possible PTSD (15.0 vs 11.3% p=0.53); headache (32.2 vs 33.4% p=0.89); and backache (40.7 vs 43.5% p=0.75). Discussion: In our case-control study, we found increased incidence of PPD and possible PTSD after PDPH, and decreased breastfeeding. We confirmed that PDPH was associated with chronic headache and backache (1). Our results suggest that EBP does not protect against PDPH-related postpartum complications. Given the increased likelihood of PPD after PDPH, these women require postpartum follow-up. 1. Webb CA, Anesth Analg. 2012.

SOAP 2019