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Poster Session 2

Category: Labor

Poster Session 2

(564) Accidental Dural Puncture During Labor – The Impact on Perinatal Outcome

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Presenting Author(s)

Lihie Maltz-Yacobi, MD

Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
Tel-Aviv University, Tel Aviv, Israel

Coauthor(s)

SN

Shir Nov, MD

Tel Aviv Sourasky Medical Center
Tel-Aviv University, Tel Aviv, Israel
CG

Chaim Greenberger, MD

Tel Aviv Sourasky Medical Center
Tel-Aviv University, Tel Aviv, Israel
TT

Tomer Talmi, MD

Tel Aviv Sourasky Medical Center
Tel-Aviv University, Tel Aviv, Israel
AL

Anat Lavie, MD

Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
YY

Yariv Yogev, MD

Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center Gray Faculty of Medicine, Tel Aviv University, Israel
Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Liran Hiersch, MD

MFM specialist
Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center Gray Faculty of Medicine, Tel Aviv University, Israel
ISRAEL, Tel Aviv, Israel

Submitting Author(s)

Uri Amikam, MD, MHA (he/him/his)

MFM Specialist
Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
Tel Aviv, Tel Aviv, Israel

Objective:
To examine whether accidental dural puncture (ADP) during epidural analgesia in labor is associated with perinatal outcomes.

Study Design:
A single-center retrospective cohort study including singleton term (≥37 weeks) vertex, live births with epidural analgesia (2018–2024). The study group included women with ADP. Controls were women with an uneventful epidural anesthesia, performed before and immediately after each case in the study group at a 1:2 ratio. Perinatal outcomes were compared between groups. The primary outcome was composite maternal morbidity, including operative vaginal delivery, cesarean delivery, and postpartum hemorrhage. Secondary outcomes included prolonged second stage of labor ( >2 hours for multiparas and >3 hours for nulliparas); urinary retention (need for an indwelling catheter for >24 hours postpartum); hospital readmission within 6 weeks of discharge; and neonatal composite morbidity, including 5-minute Apgar score< 7, arterial pH< 7.1, neonatal intensive care unit admission, need for respiratory support, neonatal sepsis, and hypoxic ischemic encephalopathy. Multivariable logistic regression adjusted for confounders. A sub-analysis was conducted for nulliparas.

Results:

Overall, 429 patients were included: 143 in the study group and 286 controls. Maternal characteristics were similar between groups (Table), except for a higher nulliparity rate in controls (41.9 vs. 52.8,p=0.03,respectively).

The study group had higher rates of urinary retention (4.2% vs. 0.07%,p=0.01) and readmissions (7.7% vs. 1.7%,p< 0.01).

Multivariable logistic regression adjusting for maternal age, pre-pregnancy BMI, labor induction, assisted reproductive technology use, gestational diabetes, and premature rupture of membranes, demonstrated no association between ADP and composite maternal or neonatal outcomes. Sub-analysis including only nulliparas showed similar results (Figure).

Conclusion:
Accidental dural puncture during epidural analgesia in labor was associated with a higher risk of urinary retention and readmission, with similar other maternal and neonatal outcomes.