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EXPECTANT MANAGEMENT, PDPH AND LENGTH OF HOSPITAL STAY

Women's College Campus, Sunnybrook and Women's College Health Sciences Ctr, 76 Grenville Street, Toronto, Ontario M5S 1B2 University of Toronto

INTRODUCTION

Prophylactic extradural patching to prevent postdural puncture headache (PDPH) has been advocated after large gauge dural puncture (DP).¹ In many institutions, however, management is expectant. This matched case-control study examined the impact of expectant management on length of hospital stay (LOS) in parturients who developed PDPH vs women with uncomplicated epidurals.

METHODS

After REB approval, our perinatal database was used to identify ASA I-II parturients with recognized unintentional DPs during epidural placement (1996-2001) and otherwise uncomplicated deliveries. Women with recognized DPs who developed PDPH were matched by parity, mode of delivery (vaginal /instrumental) and admission date(<l yr) with women who had uneventful epidural placement/delivery. Exclusion criteria included prematurity, multiple gestation, significant maternal/neonatal illness, NICU admission or post-delivery complications. All charts were independently reviewed by 2 authors to identify cases with PDPH, to exclude PDPH in controls and to confirm study eligibility. Outcomes were assessed only after patients were entered into the study. Primary outcome was LOS (hrs) from birth to patient discharge (or last recorded time). Secondary outcomes included # nights in hospital, # of EW visits related to PDPH, time of EBP (pre vs post-discharge), and blood volume used. LOS and # of nights in hospital were assessed using a 2-tailed paired t-test.

RESULTS

106 charts were reviewed to find 26 cases and 26 controls with firm discharge times found for 23 cases/controls. Demographics did not differ significantly between groups. LOS in hospital in PDPH cases was increased by a mean of 17 ± 23 (SD) hours (95%CI,8,26; p=0.0012) and # of nights in hospital was increased by a mean of 0.62 nights (95%CI,0.26,0.98,p=0.0027). 73% (19/26) of cases received at least l EBP (mean blood volume of 18.7ml). 68%(13/19) of cases had EBPs done on the ward. 11 cases visited the EW 14 times for evaluation of PDPH with 54% receiving at least 1 EBP.

DISCUSSION

Women developing PDPH after recognized large gauge DP and expectant management have a significant increase in hospital LOS compared with women with uncomplicated epidurals as well as a large number of EW visits for evaluation/treatment. Prophylactic therapy warrants further investigation.

REFERENCES

1 Anesth Analg 1989;69;522-3.[Free Full Text]

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