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

Abstract

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/m²): 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/m² 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.

Keywords: Delivery; Labor; Obesity; Parturient; Postdural puncture headache; Pushing.