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#35960 Accidental dural puncture in a morbidly obese pregnant woman: what now? – case report
  1. Susana Maia,
  2. Beatriz Xavier,
  3. Miguel Sá,
  4. Eva Antunes,
  5. Alexandra Carneiro,
  6. Susana Caramelo and
  7. Catarina Sampaio Martins
  1. Anesthesiology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal


Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims Spinal-epidural anesthesia is a well-established technique for performing cesarian-section. Accidental dural puncture during this procedure is a possible complication, especially in obese obstetric patients.

Methods A morbidly obese 30-year-old with a body mass index of 59 was proposed for elective cesarian-section and myomectomy. We performed a spinal- epidural technique, and there was an accidental dural puncture with a Tuohy needle 18G. Given her phenotype, we had previously discussed the possibility of introducing the catheter in the intrathecal space if this complication took place. We followed up with our plan B, which allowed the administration of continuous spinal anesthesia. At the end of surgery, we administered intrathecal morphine, and the catheter was removed.

Results The surgery lasted one and half hours, and the patient was always hemodynamically stable. The newborn had an Apgar score of 9/10/10. We explained the potential complications to the patient, and she was evaluated daily during her hospital stay, without developing headache or other symptoms. There was no record of her visiting urgent care in the following days.

Conclusions We need to be alert for the higher possibility of accidental dural puncture in obese pregnant women, the complications that might arise, and, as such, always have a plan B. In this case, we were able to provide optimal surgical conditions and effective post operative analgesia.

  • Epidural
  • Dural Puncture
  • Pregnancy
  • Morbid Obesity

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