Second stage pushing correlates with headache after unintentional dural puncture in parturients

Purpose: To determine the association between bearing down, postdural punct ure headache (PDPH) and epidural blood patch (EBP) following single 17 gaug e unintentional dural puncture (UDP) in parturients. Methods: The charts of 60 parturients identified with UDP in our institutio nal database during epidural placement were independently reviewed. Patient s were divided into categories based on the anesthetic record: well-documen ted single punctures; well-documented multiple punctures; catheter-related puncture; unclear category (not clear a more than one puncture occurred or if dural puncture had occurred at all) and no evidence of dural puncture. P atients with single 17 gauge punctures were divided into those who had push ed (Group I) and those who had not (Group 2), Group 2 patients had undergon e Cesarean section before reaching second stage labour. The incidence of PD PH, EBP: and cumulative duration to delivery after UDP were compared betwee n groups. Results: Thirty-three patients with well-documented single punctures were i dentified: 23 had engaged in active pushing as part of second stage labour( Group I); 10 had not (Group 2). Seventy-four percent of Group I developed P DPH compared with 10% in Group 2 (P < 0.002). Fifty-seven percent of Group I received an EBP compared with 10% in Group 2 (P < 0.002). Increasing the duration of pushing was associated with an increasing incidence of PDPH; th e majority of women who pushed > 30 min developed headache. Conclusions: An increased incidence of PDPH and EBP after UDP occurs in wom en bearing down in 2nd stage labour when compared with those who never push ed. There was also an association between the cumulative duration of bearin g down and the incidence of PDPH.