title: Risk factors of post-dural puncture headache receiving a blood patch in obstetric patients.
abstract: Post-dural puncture headache (PDPH) is one of the most frequent complications of neuraxial anesthesia and analgesia. The objective is to determine risk factors of PDPH receiving a blood patch in the obstetric population.
  
  
  
  Between November 2009 and January 2013, 10914 women delivered in Port Royal maternity unit (Paris, France). The incidence of PDPH receiving a blood patch was calculated among those who received neuraxial analgesia or anesthesia for delivery. Then we performed a case-control study to identify risk factors for PDPH receiving a blood patch by comparing women who experienced PDPH receiving a blood patch with some women randomly selected by computer among those who delivered during the study period (4 controls for 1 case, univariate and multivariate analysis).
  
  
  
  Among the 10685 women who had neuraxial analgesia or anesthesia, 0.4% had a PDPH receiving a blood patch. In the univariate analysis, cervix dilatation ≥7 cm, lateral decubitus position during the neuraxial procedure and multiple punctures were significantly associated with PDPH receiving a blood patch, whereas maternal Body Mass Index, age, mode of delivery, performance at night and level of needle insertion were not. In the multivariate analysis, cervix dilatation ≥7 cm and multiple punctures significantly increased the risk of PDPH receiving a blood patch (odd ratios 6.5 [95% CI: 1.5-29.3] and 5.6 [95% CI: 2.2-14.0], respectively). Experience of the anesthesiologist was not associated with PDPH in both univariate and multivariate analysis.
  
  
  
  In the obstetric population, a cervix dilation ≥7 cm during labor and multiple punctures are independent risk factors for PDPH receiving a blood patch.
authors.affiliation: Department of Anesthesiology and Critical Care, Centre Hospitalier Universitaire Cochin Broca Hôtel Dieu, Hôpitaux Universitaires Paris Centre, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France - je.bardon@gmail.com.
authors.forename: Jean
authors.initials: J
authors.lastname: Bardon
authors.forename: Camille
authors.initials: C
authors.lastname: LE Ray
authors.forename: Charles M
authors.initials: CM
authors.lastname: Samama
authors.forename: Marie P
authors.initials: MP
authors.lastname: Bonnet
mesh_terms: D000704:Analysis of Variance; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D017217:Blood Patch, Epidural; D016022:Case-Control Studies; D005260:Female; D005602:France; D006801:Humans; D051299:Post-Dural Puncture Headache / Q000209:etiology* / Q000628:therapy*; D011247:Pregnancy; D012307:Risk Factors