Prediction of Postdural Puncture Headache

July 10, 2026 updated by: Amasya University

The Effectiveness of Inflammatory Indices in Predicting Postdural Puncture Headache

The primary objective of this study is to evaluate the effectiveness of inflammation index (pan-immune inflammation value, systemic immune inflammation index, and systemic inflammatory response index) values, calculated from routine pre- and post-operative blood test (hemogram) results of pregnant women undergoing cesarean section under spinal anesthesia, in predicting postdural puncture headache. Significant results will allow for the early identification of the population at risk of developing PPH and the implementation of preventive measures. The secondary objectives of the study are to evaluate the effects of factors such as demographic data (age, height, weight, and body mass index) obtained from patient records and the hospital information system, number of births, blood group, infant birth weight, smoking, previous history of postdural puncture headache (PPH), or headache in general, on the development of postdural puncture headache (PPH), to determine the frequency of PPH, and to identify the symptoms accompanying PPH.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Detailed Description

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.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
260

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.
  • Name: Osman O Kılınç, ass prof
  • Phone Number: +905067352859
  • Email: zxgr03@gmail.com

Study Locations

  • Turkey (Türkiye)
      • Amasya, Turkey (Türkiye), 05100
        • Recruiting
        • Amasya University Training and Research Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

Pregnant women undergoing cesarean section under spinal anesthesia

Description

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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort

Group / Cohort

A group or subgroup of participants in an observational study that is assessed for biomedical or health outcomes.
Patients with postdural puncture headache
Patients with postdural puncture headache after cesarean section
Patients without postdural puncture headache
Patients without postdural puncture headache after cesarean section

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
The predictive role of inflammation indices for postdural puncture headache.
Time Frame: 5 days
  • The correlation between the preoperative basal panimmune inflammation value, systemic immune-inflammation index, and systemic inflammatory response index values and the development of PPH will be statistically evaluated.
  • Sensitivity and specificity evaluation will be performed for basal panimmune inflammation value, systemic immune-inflammation index, and systemic inflammatory response index values in those who develop PPH.
5 days

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
PPH incidence
Time Frame: 5 days
The incidence of PPH developing after postdural puncture will be investigated.
5 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Amasya University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
June 15, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
November 15, 2026

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 15, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
July 1, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
July 10, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
July 16, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
July 16, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
July 10, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
July 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • mmk05

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Ethical reasons within the scope of patient privacy

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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