Post-Spinal Headache & Leg Swelling After Cesarean Delivery

1️⃣ Post-Spinal Headache

• A common complication after spinal anesthesia in cesarean deliveries.
• Incidence: Up to 1–2% of women
• Pathophysiology: Leakage of cerebrospinal fluid (CSF) through the puncture site reduces intracranial pressure.
• Risk factors: Young age, female sex, multiple puncture attempts, larger needle gauge.

Clinical Features:

• Headache worsens when upright, improves when lying flat.
• Associated with neck stiffness, nausea, tinnitus, diplopia.

Guideline-Based Management (RCOA, ACOG):

1. Conservative: Bed rest, hydration, analgesics, oral/IV caffeine.
2. If headache persists >48 hrs or is severe → Epidural Blood Patch (gold standard).
3. Exclude differential diagnoses: meningitis, migraine, preeclampsia.

2️⃣ Postpartum Leg Swelling

• Physiological: Mild, bilateral swelling due to fluid retention and hormonal changes.
• Pathological concern: Deep Vein Thrombosis (DVT).

Risk factors (RCOG – Green-top Guidelines):

• Cesarean section
• Obesity
• Prolonged immobility
• Previous history of thrombosis
• Preeclampsia, infection, dehydration
• Red-Flag Symptoms of DVT:
• Unilateral swelling (≥2 cm difference)
• Pain, warmth, redness in calf or thigh
• Shortness of breath or chest pain (suggesting pulmonary embolism)

Guideline-Based Approach:

• All post-cesarean women should have VTE risk assessment.
• Prophylaxis: Early mobilization, adequate hydration, compression stockings.
• Pharmacological prophylaxis (LMWH) for high-risk patients as per RCOG/ACOG protocols.
• Urgent referral if DVT/PE suspected — diagnostic Doppler and anticoagulation.

✅ Take-home message:

• Post-spinal headache is treatable, but don’t ignore persistent or severe symptoms.
• Leg swelling is often benign but can signal life-threatening VTE.
• Early recognition, patient education, and guideline-based management save lives.

#DrRababCares 

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