P Pu ur rp po os se e: : This retrospective cohort study examined hospital length of stay (LOS) and emergency room (ER) visits in parturients diagnosed with postdural puncture headache (PDPH) following recognized dural puncture (DP). All cases were managed expectantly. Outcomes were compared with matched controls with uneventful labour epidurals.M Me et th ho od ds s: : After Ethics Committee approval, the hospital perinatal database was used to identify healthy parturients with recognized DP during labour epidural placement from 1996-2001. Women developing PDPH after expectant management were matched with women with uneventful epidurals and no evidence of PDPH, as well as by parity, delivery mode and admission date. All women delivered term singletons. The primary outcome was LOS (hours) from delivery to discharge. Secondary outcomes included: number (#) nights in hospital, #ER visits for PDPH, epidural blood patch (EBP) timing (pre vs post discharge), EBP location (ward vs ER) and blood volumes used. R Re es su ul lt ts s: : 26 cases and 26 controls were identified. Precise discharge times were found for 23 cases and 23 controls. In cases, the LOS was increased by a mean of 17 ± 23.8 (SD) hours; [95% conficence interval (CI) = 8, 26; P = 0.0012] and # nights in hospital was increased by a mean of 0.62 ± 0.94 nights (95% CI, 0.26, 0.98, P = 0.0027). Nineteen cases (73% 19/26) received at least one EBP. Sixteen cases received at least one EBP prior to discharge with 38% (6/16) returning to ER for re-assessment/repeat EBP. Forty-four percent (4/9) of cases without an EBP prior to discharge returned to ER for further assessment/EBP. C Co on nc cl lu us si io on n: : PDPH leads to a significant increase in hospital LOS and ER visits. Studies of preventive therapy are warranted.

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Cerebrospinal fluid leak after puncture was influenced most by epidural needle gauge. Leak rate was significantly less for the 20-gauge Tuohy needle.

Purpose: To determine the association between bearing down, postdural puncture headache (PDPH) and epidural blood patch (EBP) following single 17 gauge unintentional dural puncture (UDP) in parturients. Methods: The charts of 60 parturients identified with UDP in our institutional database during epidural placement were independently reviewed. Patients were divided into categories based on the anesthetic record: well-documented single punctures; well-documented multiple punctures; catheter-related puncture; unclear category (not clear if more than one puncture occurred or if dural puncture had occurred at all) and no evidence of dural puncture. Patients with single 17 gauge punctures were divided into those who had pushed (Group I) and those who had not (Group 2). Group 2 patients had undergone Cesarean section before reaching second stage labour. The incidence of PDPH, EBP, and cumulative duration to delivery after UDP were compared between groups. Results: Thirty-three patients with well-documented single punctures were identified: 23 had engaged in active pushing as part of second stage labour(Group I); I 0 had not (Group 2). Seventy-four percent of Group I developed PDPH compared with 10% in Group 2 ~P < 0.002). Fifty-seven percent of Group I received an EBP compared with 0% in Group 2 (P < 0.002). Increasing the duration of pushing was associated with an increasing incidence of PDPI-I; the majority of women who pushed > 30 rain developed headache. Conclusious: An increased incidence of PDPH and EBP after UDP occurs in women bearing down in 2nd stage labour when compared with those who never pushed. There was also an association between the cumulative duration of bearing down and the incidence of PDPH.Objectif : D&erminer l'association qui existe entre les efforts expulsifs, les c~phal~es postponction durale (CPPD) et le colmatage sanguin Epidural (CSE) ~ la suite d'une seule brEche durale accidentelle (BDA) au moyen d'un aiguille de calibre 17 chez des parturientes. M&hode : On a r~vis~ sEpar~ment 60 dossiers qui pr&entaient des BDA pendant la raise en place de l'aiguille Epidurale. On a r~parti les parturientes selon le protocole anesth&ique : des ponctions uniques v&ifi&s; des ponctions multiples v&ifi~es; des ponctions avec cath&ers; une cat~gorie impr&ise, si plus d'une ponction a ~t~ r~alis~e ou si la ponction durale s'est produite ~ chaque essai; aucune preuve de ponction durale. Les patientes qui n'ont eu qu'une ponction avec une aiguille de calibre 17 ont Et~ r~parties en deux groupes : celles qui ont poussE (Groupe I) et celles qui front pas poussE (Groupe 2), ayant subi une c~sarienne avant que le travail n'en soit ~ la p&iode d'expulsion, l'incidence de CPPD et de CSE et le temps entre la naissance et la BDA ont fait robjet de comparaisons intergroupes. Ba~sultats : Trente-trois patientes n'avaient re~su qu'une seule ponction : 23 s'~taient engag~es ~ pousser activement pendant la phase d'expulsion du travail (Groupe I); I0 ne poussaient pas (Groupe 2). Soixante-quatorze pour cent des patientes d...