key: cord-0077679-2myjl0zi
authors: Miglani, A.; Kavanagh, G.; Murphy, B.; Loughrey, J.
title: P.68 An audit of compliance with post-dural puncture headache guidelines of Obstetric Anaesthetists’ Association on patient follow-up
date: 2022-05-03
journal: Int J Obstet Anesth
DOI: 10.1016/j.ijoa.2022.103364
sha: bced91634dd532fb2ef226e4f998713564a629fa
doc_id: 77679
cord_uid: 2myjl0zi

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Results: COVID-19 survey responses were received from 105 ObsQoR study centres (response rate 98%), representing 54% of 194 obstetric units in the UK. 99/103 (94.3%) sites had guidelines for how to manage parturients with COVID-19 infection including 61/105 (58.1%) with specific guidance on venous thromboembolism prophylaxis. 37/104 (35.6%) of centres had routine restrictions on parturients' birthing plans (e.g., birthing location or changes to labour and delivery preferences) if a positive diagnosis of COVID-19 was made. A vaccination referral pathway was present in 63/103 centres (61.2%) encouraging full vaccination for all pregnant women. Isolation precautions were present in 101/105 (96.2%) centres, with COVID-19 positive parturients isolated on labour and delivery, recovery and postnatal wards throughout their admission. Nearly all centres (103/ 105 (98.1%)) allowed birth partners to be present during delivery if the parturient was COVID-19 negative, however only 79/104 (76%) allowed birthing partners to be present if the parturient was COVID-19 positive. If birthing partners were COVID-19 positive but asymptomatic, 29/105 (27.6%) of centres allowed them to be present. Requirements for parturients to wear personal protective equipment during their labour and delivery was reported by 42/104 (40.4%) centres, irrespective of COVID-19 status. Discussion: This survey demonstrates that the majority of maternity units in the UK adhere to the recommended alterations produced by the RCOG [1] , relating to COVID-19 practices. However, there remains variation in the provision of care, with scope to improve access and pathways to immunisations, birth plans and VTE prophylaxis. [1] . Recently released guidelines from the Obstetric Committee of the American Society of Anesthesiology (ASA) suggest follow-up until the patient is symptom-free [2] . Methods: We initiated a structured telephone follow-up of all patients diagnosed with PDPH at our institution from January 2020. An electronic patient record ensures a diagnosis of PDPH is sent to the GP on discharge when this is documented correctly in the record. We included appropriate hospital contact information for patients on an adapted version of the OAA-approved patient information sheet on PDPH available on labourpains.com. Following local audit committee approval we audited our practice over a two-year period.

Results: A total of 89 patients were identified with headache with 42 following an epidural needle puncture. 50 patients received an epidural blood patch. Only 66% had their PDPH diagnosis communicated via their hospital discharge letter but this improved over the second year of the audit. All 89 patients were phoned by a consultant anaesthetist between 6 weeks and 3 months postpartum. 74% of patients answered the telephone call. Few reported long-term sequelae with 5 reporting backache, one with auditory sequelae and one with headaches. Discussion: Our institution delivers 8500 mothers annually with an epidural rate of 67% and a caesarean section rate of 38%. We have an unremarkable incidence of PDPH for a teaching hospital. Follow-up revealed a low incidence of chronic symptoms. While the 2018 OAA recommendation is to consider long-term follow-up, our data suggest that following patients until they are asymptomatic is also a reasonable service goal. Good patient and GP information on PDPH and local lines of communication are essential given the potential for the more serious but rare neurological complications of dural puncture.

Chronic disabling postpartum headache after unintentional dural puncture during epidural anaesthesia: a prospective cohort study

Statement on Post-Dural Puncture Headache Management

UK Introduction: Peripartum hyponatremia is not uncommon; however, it is underestimated and can have deleterious effects on mother and infant [1]. Dilutional hyponatremia is common in labour caused by excessive hypotonic fluids intake [2]. Accepted blood sodium level in pregnancy is 130-140 mmol/L compared to 135-145 mmol/L in the non-pregnant population [2]. Our hospital implemented new hyponatremia guidelines in November 2020, and we conducted this project to assess the efficiency and implementation of these guidelines in our labour ward