Prediction of Postdural Puncture Headache

This study is a prospective observational clinical research aiming to evaluate the effectiveness of inflammation index values, calculated from routine blood tests (hemogram) performed before and after surgery in pregnant women undergoing cesarean section under spinal anesthesia, in predicting postdural puncture headache. Spinal anesthesia (SA) is the most commonly preferred regional anesthesia method in cesarean sections due to its rapid onset and effective sensory-motor blockade, but it can lead to complications that restrict maternal comfort in the postoperative period. The most frequently observed of these complications is postdural puncture headache (PPH), which is characteristically worsened in the upright position, relieved in the supine position, and develops within 5 days. PPH, usually located in the frontal or occipital region, is a clinical condition that may be accompanied by symptoms such as nausea, vomiting, weakness, tinnitus, photophobia, and neck pain. Incidence; The type of needle used varies depending on age, gender, and technical factors . The fundamental mechanism in the pathophysiology of PPH is intracranial hypotension resulting from cerebrospinal fluid (CSF) leakage and the subsequent traction in the brain tissue. Cerebral vasodilation and systemic neuroinflammatory response are also thought to contribute to this process . The physiological systemic inflammatory response observed during pregnancy plays a critical role in the maternal immune system's development of immune tolerance against the fetus and the sustainability of the pregnancy. During this process, neutrophilia, relative lymphopenia, and increased monocyte activation are particularly observed, and these immunological changes are characterized by pro-inflammatory and anti-inflammatory phases that differ according to the trimesters of pregnancy .Systemic inflammatory response has been shown to have significant effects not only on infectious processes but also on nociceptive mechanisms and tissue healing. Immune system components such as macrophages, T-lymphocytes, and mast cells, along with pro-inflammatory mediators like tumor necrosis factor (TNF), interleukin-1 (IL-1), IL-6, and IL-8, are reported to directly contribute to pain pathogenesis . In recent years, pan-immune inflammation value, systemic immune-inflammation index, and systemic inflammatory response index have emerged as cost-effective and easily accessible next-generation biomarkers enabling holistic assessment of inflammation. These indices, calculated from complete blood count (hemogram) parameters using the formulas (neutrophil count x monocyte count x platelet count / lymphocyte count), (platelet count x neutrophil count / lymphocyte count), and (neutrophil count x monocyte count / lymphocyte count), respectively, have been proven to have high prognostic value in predicting various pathophysiological processes in extensive cohort studies . The main objective of this study, planned with the prediction that the physiological inflammatory shift during pregnancy may increase susceptibility to PPH by raising the pan-immune inflammation value, systemic immune-inflammation index, and systemic inflammatory response index values above basal levels, is; The aim of this study is to investigate the predictive value of the aforementioned inflammatory index levels in predicting PPH in pregnant women undergoing cesarean section under spinal anesthesia. Finding significant results will allow for the identification of pregnant women at high risk and the development of early treatment strategies for those predicted to be at high risk.

Inclusion criteria

• . Pregnant women who are of a cognitive level capable of giving informed consent
• Pregnant women aged 18-45 who have undergone elective cesarean section
• Term (37 weeks and above) pregnant women
• Patients with an American Society of Anesthesiologists (ASA) physical status score of 2 (ASA II)

Exclusion criteria

• History of active infection or chronic inflammatory disease
• History of steroid or immunomodulatory drug use
• Presence of coagulopathy or hematological disorder
• Presence of preeclampsia/HELLP syndrome
• Those who received blood transfusions during and after surgery