Incidence, Onset Time and Predictors of Postdural Puncture Headache Among Mothers Who Underwent Caesarean Section in Hospitals, Ethiopia: A Prospective Cohort Study.

BACKGROUND: Postdural puncture headache (PDPH) is a significant complication of spinal anaesthesia, especially in obstetric patients. It is triggered by the leakage of cerebrospinal fluid (CSF) through the puncture in the Dura mater. Understanding the timing of PDPH onset is crucial for early diagnosis and treatment, but previous studies have not fully explored its timing and associated factors. AIM: To determine the incidence and predictors of PDPH in women who deliver by caesarean section under spinal anaesthesia. METHODS: A prospective follow-up study was conducted from March 7 to May 8, 2025, among 365 mothers who underwent caesarean section under spinal anaesthesia at government hospitals found in Debre Berhan, Ethiopia. Data were collected using a structured interviewer-administered questionnaire. The Kaplan-Meier method was used to estimate the survival time for PDPH, with the log-rank test for curve comparison. Cox regression analysis was conducted to identify predictor variables. RESULTS: The cumulative incidence of PDPH was 33.7% (95% CI: 28.9%, 38.7%), and incidence density was 3.75 (95% CI: 3.11, 4.47) per 1000 person-hours of observation. The mean time to onset of PDPH was 28.9 h (approximately 1.4 days). The restricted mean survival time was 28.98 Hr (95% CI: 25.78, 32.17). Multiple attempts during the procedure AHR 1.69 (95% CI: 1.104, 2.606; p < 0.01), larger needle size AHR 8.22 (95% CI: 4.94, 13.67; p < 0.001) and anaesthetist having less than 3 years of experience AHR 2.7 (95% CI 1.62, 4.51; p < 0.001) were found to be predictors of PDPH. CONCLUSION: This study confirmed that reducing the magnitude of PDPH requires limiting the number of puncture attempts and usage of Quincke spinal needles (22G) or fine-gauge needles (24G-26G).