Postdural puncture headache in obstetric patients

INTRODUCTION

Headache in the early postpartum period is a common symptom, with up to 39% of women reporting it in the first week after giving birth.¹ Although the majority will have self-limiting aetiologies,² a subset of patients will suffer with a postdural puncture headache (PDPH), a recognised complication of neuraxial anaesthetic techniques, with potentially life-threatening neurological consequences and a profound impact on the postnatal period. The report on Confidential Enquiries into Maternal Deaths (2009–2012) highlights two maternal mortalities that were attributed to a delay in diagnosis of subdural haematoma and cerebral venous sinus thrombosis that were associated with PDPH.³ Subsequent recommendations underscore the need for follow-up of patients with PDPH and communication of events to the GP, who plays a pivotal role in providing care for the mother in the puerperium.³ Current guidance from the Obstetric Anaesthetists’ Association and the Association of Anaesthetists of Great Britain and Ireland⁴ recommends the routine follow-up of parturients who have received neuraxial anaesthesia, in order to seek feedback and identify complications. Expedited discharge of the mother or a delayed onset of PDPH in some women may mean, however, that not all cases will be captured prior to hospital discharge, and it may be within the sphere of primary care that these symptoms are …