Incidence, risk factors and severity of post dural puncture headache in patients who underwent caesarean section in three hospitals in RWANDA.

Abstract

Background: PDPH is common in obstetric patients who have undergone spinal anesthesia or epidural anesthesia with an accidental dural puncture. Spinal anesthesia is an inexpensive, safe, rapidly used regional anesthesia technique which can be conducted by anesthesiologists, nonphysician anesthetists and nurse anesthetists for Cesarean section but associated with different complications which include post dural puncture headache. The aim of this study was to identify incidence, risk factors and severity of post dural puncture headache in parturient who underwent elective or emergency Cesarean section under spinal anesthesia in three hospitals in Rwanda. Methods and material: This is a prospective study in three selected hospitals located in Kigali City, Rwanda. Data collected were demographic characteristics, previous surgical history regarding to C-section, presence of PDPH on previous C-section or on current and its characteristics. There after descriptive statistics and inferential statistics were used to display the frequency and to identify risk factors of PDPH. Each independent variable and the dependent variable was analyzed by using binary regression and was considered as significant if their P value is <0.2 and was used in multivariate logistic regression to mitigate the co-founding. On multivariate logistic regression model, the significant risk factors are those with a P value less than 0.05. Results: Thirty three percent of 261 parturient developed PDPH. The severity of PDPH was moderate at 44.8%, mild at 39.1% and the small portion of16.1% was severe. Body Mass Index (BMI) < 25 kg.m-2, PDPH after previous cesarean section were statistically significantly associated with the occurrence of PDPH with the following values 0.000, and 0.036 respectively Conclusion: A high incidence (33.3 %) of post dural puncture headache was found among 261 parturient who were recruited in this study. The severity of this PDPH was usually ranging from mild, moderate, and rarely severe. Significant risk factors were body mass index<25 kg.m-2, prior PDPH after previous C/section.