title: The effect of second-stage pushing and body mass index on postdural puncture headache.
abstract: 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.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Obstetric ward and operating rooms at a university-affiliated hospital.
  
  
  METHODS
  One hundred ninety parturients who had witnessed dural puncture with 17 or 18 gauge Tuohy needles from 1999-2014.
  
  
  METHODS
  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.
  
  
  METHODS
  Headache, number of days of headache, maximum headache score, and epidural blood patch placement.
  
  
  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/m2were 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.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE MB.11.500, Seattle, WA 98105, USA. Electronic address: amber.franz@seattlechildrens.org.
authors.forename: Amber M
authors.initials: AM
authors.lastname: Franz
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, 3094, Durham, NC 27710, USA. Electronic address: shawn.jia@dm.duke.edu.
authors.forename: Shawn Y
authors.initials: SY
authors.lastname: Jia
authors.affiliation: Benaroya Research Institute, 1201 Ninth Avenue, Seattle, WA 98101, USA. Electronic address: tbahnson@benaroyaresearch.org.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Bahnson
authors.affiliation: Department of Anesthesia, University of Toronto, 12th Floor, 123 Edward St, Toronto, Ontario M5G 1E2, Canada. Electronic address: akash.goel@medportal.ca.
authors.forename: Akash
authors.initials: A
authors.lastname: Goel
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, 3094, Durham, NC 27710, USA. Electronic address: ashraf.habib@dm.duke.edu.
authors.forename: Ashraf S
authors.initials: AS
authors.lastname: Habib
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D017217:Blood Patch, Epidural / Q000706:statistics & numerical data; D015992:Body Mass Index; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D009767:Obesity, Morbid / Q000150:complications*; D010147:Pain Measurement; D051299:Post-Dural Puncture Headache / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D013129:Spinal Puncture / Q000009:adverse effects*; D055815:Young Adult
keywords: Delivery; Labor; Obesity; Parturient; Postdural puncture headache; Pushing