Background and Goal of Study
The prevalence of Inadvertent Dural Puncture (IDP) in the obstetric population is 1.5% , 60%  of whom will go on to develop  a post dural  puncture (PDPH)  Due to the relatively high probability of developing  a PDPH, we conducted a national survey,  to evaluate various aspects surrounding PDPH, and to examine effective treatment options.
Materials and Methods: 
A national survey was undertaken, in which representatives of obstetrical anesthesia units throughout Israel were contacted to obtain information which included: hospital data, intern training, management of IDP, PDPH and Epidural Blood Patch (EBP) outcomes.
Results and Discussion
A total of 23 hospitals participated in the survey. 87% of hospitals did not perform prophylactic EBP. Most hospitals (78.3%) did not utilize saline injection into the epidural space; however, 4 hospitals (17.4%) did routinely perform such procedures when  an inadvertent dural puncture occurred and one hospital (4.3%) had no consistent pattern of use. In 95.7% of hospitals, in this study cohort, conservative treatment was initiated within 24-48 hours. Conservative treatment included IV Fluids (91.3%), bedrest (73.9%) and caffeine (60.9%). Consent form specifically for EBP was obtained in 39.1% of hospitals, 34.8% utilized the surgical consent form, in the reminder (26.1%) used the epidural consent form.
Conclusions
In this national survey, we noted there is no consensus or clear guidelines in the management and treatment of PDPH. While EBP is the Gold Standard of treatment, prophylactic EBP is known to be ineffective. The majority of obstetric units initiate conservative measures within 24-48 hours after which, they performed an EBP which was shown to increases efficacy. In light of results, we hope this survey may provide guidance and lead to improved treatment outcomes.


03 / Israeli national survey on treatment and management for parturients suffering from a post dural puncture headache.