The effect of second-stage pushing and body mass index on postdural puncture headache.

STUDY OBJECTIVE

To explore how pushing during labor and body mass index affect the development of postdural puncture headache in parturients who experienced dural puncture with Tuohy needles.

DESIGN

Retrospective cohort.

SETTING

Obstetric ward and operating rooms at a university-affiliated hospital.

PATIENTS

One hundred ninety parturients who had witnessed dural puncture with 17 or 18 gauge Tuohy needles from 1999-2014.

INTERVENTIONS

Patients were categorized by pushing status and body mass index (kg/m): nonobese <30, obese 30-39.99, morbidly obese 40-49.99, and super obese ≥50.

MEASUREMENTS

Headache, number of days of headache, maximum headache score, and epidural blood patch placement.

MAIN RESULTS

Compared with women who did not push, women who pushed during labor had increased risk of postdural puncture headache (odds ratio [OR], 2.1 [1.1-4.0]; P=.02), more days of headache (P=.02), and increased epidural blood patch placement (P=.02). Super obese patients were less likely to develop headache compared with nonobese (OR, 0.33 [0.13-0.85]; P=.02), obese (OR, 0.37 [0.14-0.98]; P=.045], and morbidly obese patients (OR, 0.20 [0.05-0.68]; P<.01). In a multivariate logistic regression model, lack of pushing (OR, 0.57 [0.29-1.10]; P=.096) and super obesity (OR, 0.41 [0.16-1.02]; P=.056] were no longer significantly associated with reduced risk of postdural puncture headache.

CONCLUSIONS

Parturients who did not push before delivery and parturients with body mass index ≥50kg/m were less likely to develop postdural puncture headache in a univariate analysis. Similar trends were demonstrated in a multivariate model, but were no longer statistically significant.