The management of accidental dural puncture in pregnant women: what does an obstetrician need to know?

Arch Gynecol Obstet. 2007 Feb;275(2):125-31. doi: 10.1007/s00404-006-0146-y. Epub 2006 Mar 11.


Post-dural puncture headache (PDPH) also known as spinal (or post-spinal) headache still remains a disabling complication of needle insertion into the subarachnoid space. Pregnant women are at particular risk of dural puncture, and the subsequent headache, because of sex, young age, and the widespread application of regional anesthesia. Accidental dural puncture complicating epidural anesthesia varies in incidence from 0.19 to 4.4%. The incidence of epidural needle-induced PDPH headache in pregnant women has been reported to range 76-85%. The classic symptoms of PDPH consist of photophobia, nausea, vomiting, neck stiffness, tinnitus, diplopia, and dizziness in addition to the often, severe cephalgia. This article reviews the current literature on the pathophysiology, incidence, prevention, and treatment of PDPH in pregnant women.

Publication types

  • Review

MeSH terms

  • Anesthesia, Obstetrical / adverse effects*
  • Anesthesia, Obstetrical / instrumentation
  • Anesthesia, Spinal / adverse effects*
  • Anesthesia, Spinal / instrumentation
  • Diagnosis, Differential
  • Female
  • Humans
  • Post-Dural Puncture Headache / diagnosis
  • Post-Dural Puncture Headache / physiopathology
  • Post-Dural Puncture Headache / prevention & control*
  • Pregnancy