Canadian Journal of Anesthesia

, Volume 46, Issue 9, pp 861–866 | Cite as

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

  • Pamela Angle
  • Dorothy Thompson
  • Stephen Halpern
  • Donna B. Wilson
Reports of Investigation



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.


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 durai puncture. Patients with single 17 gauge punctures were divided into those who had pushed (Group 1) 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.


Thirty-three patients with well-documented single punctures were identified: 23 had engaged in active pushing as part of second stage labour(Group 1); 10 had not (Group 2). Seventy-four percent of Group 1 developed PDPH compared with 10% in Group 2 (P < 0.002). Fifty-seven percent of Group 1 received an EBP compared with 0% in Group 2 (P < 0.002). Increasing the duration of pushing was associated with an increasing incidence of PDPH; the majority of women who pushed > 30 min developed headache.


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.


Dural Puncture Epidural Blood Patch Cumulative Duration Anesthetic Record Post Dural Puncture Headache 
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Déterminer l’association qui existe entre les efforts expulsifs, les céphalées postponction durale (CPPD) et le colmatage sanguin épidural (CSE) à la suite d’une seule brèche durale accidentelle (BDA) au moyen d’un aiguille de calibre 17 chez des parturientes.


On a révisé séparément 60 dossiers qui présentaient des BDA pendant la mise en place de l’aiguille épidurale. On a réparti les parturientes selon le protocole anesthésique: des ponctions uniques vérifiées; des ponctions multiples vérifiées; des ponctions avec cathéters; une catégorie imprécise, si plus d’une ponction a été réalisée ou si la ponction durale s’est produite à chaque essai; aucune preuve de ponction durale. Les patientes qui n’ont eu qu’une ponction avec une aiguille de calibre 17 ont été réparties en deux groupes: celles qui ont poussé (Groupe 1) et celles qui n’ont pas poussé (Groupe 2), ayant subi une césarienne avant que le travail n’en soit à la période d’expulsion. L’incidence de CPPD et de CSE et le temps entre la naissance et la BDA ont fait l’objet de comparaisons intergroupes.


Trente-trois patientes n’avaient reçu qu’une seule ponction: 23 s’étaient engagées à pousser activement pendant la phase d’expulsion du travail (Groupe 1); 10 ne poussaient pas (Groupe 2). Soixante-quatorze pour cent des patientes du Groupe 1 et 10 % du Groupe 2 ont souffert de CPPD (P < 0,002). Cinquante-sept pour cent des patientes du Groupe 1 et 0 % du Groupe 2 ont reçu un CSE (P < 0,002). L’incidence de CPPD a augmenté avec le temps des efforts expulsifs; la majorité des femmes qui ont poussé > 30 min ont eu des céphalées.


Une plus grande incidence de CPPD et de CSE a suivi la survenue d’une BDA chez des parturientes qui ont poussé à la période d’expulsion du travail comparées aux femmes qui ont subi une césarienne. L’incidence des CPPD est aussi liée au temps des efforts expulsifs.


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Copyright information

© Canadian Anesthesiologists 1999

Authors and Affiliations

  • Pamela Angle
    • 1
  • Dorothy Thompson
    • 1
  • Stephen Halpern
    • 1
  • Donna B. Wilson
    • 1
  1. 1.Sunnybrook and Women’s College Health Sciences Center (Women’s College Hospital Campus)University of TorontoTorontoCanada

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