Diagnosing causes of headache within the postpartum period
Notice bibliographique
Résumé
Background: Headache is one of the most common symptoms following delivery and the underlying cause may be benign or life threatening. Identification of the cause of headache in the postpartum period can be challenging and relies on a comprehensive history and thorough examination, with particular focus on the presence or absence of neurological signs, which may suggest a more serious diagnosis (Nelson-Piercy 2010 Nelson-Piercy C. 2010. Handbook of Obstetric Medicine. 4th ed. London: Informa Healthcare [cited 2016 Dec 5]. [Crossref] , [Google Scholar]). However, through clinical experience and research, we have noted that post-partum headache is significantly under-recognised and treated (Goldszmidt et al. 2005 Goldszmidt E, Kern R, Chaput A, Macarthur A. 2005. The incidence and etiology of postpartum headaches: a prospective cohort study. Canadian Journal of Anesthesia/Journal Canadien D’anesthésie 52:971–977. Available from: http://link.springer.com/article/10.1007/BF03022061 [cited 2016 Dec 15].[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]).Aims: To ensure a standardised approach to the management of patients presenting with postpartum headache, we sought to introduce a diagnostic tool for postpartum headache.Methods: This was a literature review combined with a postpartum headache case example that occurred within our institution in 2015. Risk factors and potential clinical failures from the case were noted and compared to the literature.Results: Our case is a 28-year-old woman who developed a postpartum headache following spontaneous vaginal delivery. Of note, the patient had an epidural inserted in labour for analgesia. Initially, systemic and neurological examinations were normal and the patient was discharged home with simple analgesics and a diagnosis of tension-type headache. She represented with worsening headache, pyrexia and signs of meningism. Lumbar puncture confirmed a diagnosis of bacterial meningitis caused by Haemophilus influenzae. She was treated with IV ceftriaxone and discharged home without any long-term sequelae.In an attempt to improve recognition of post-partum headache, especially rare causes such as meningitis, NHS Tayside has chosen to adopt the PARTUM mneumonic (Lim et al. 2014 Lim S, Evangelou N, Jürgens S. 2014. Postpartum headache: diagnostic considerations. Practical Neurology 14:92–99. Available from: http://www.medscape.com/viewarticle/822697_1 [cited 2017 Jan 4].[Crossref], [PubMed] , [Google Scholar]).Pressure (blood pressure for pre-eclampsia/eclampsia)Anaesthetic (post-dural puncture headache)Reversible (vasoconstriction syndrome)Thrombosis (cerebral venous sinus thrombosis, ischaemic stroke)Use your brain (there are so many other causes of headache)Migraine (Lim et al. 2014 Lim S, Evangelou N, Jürgens S. 2014. Postpartum headache: diagnostic considerations. Practical Neurology 14:92–99. Available from: http://www.medscape.com/viewarticle/822697_1 [cited 2017 Jan 4].[Crossref], [PubMed] , [Google Scholar]).PARTUM was first devised in 2014 as part of a research paper published by the Journal Practical Neurology (Lim et al. 2014 Lim S, Evangelou N, Jürgens S. 2014. Postpartum headache: diagnostic considerations. Practical Neurology 14:92–99. Available from: http://www.medscape.com/viewarticle/822697_1 [cited 2017 Jan 4].[Crossref], [PubMed] , [Google Scholar]). The aim of the mnemonic is to allow the treating physician a basic list of postpartum headache causes to use as a working diagnosis (Lim et al. 2014 Lim S, Evangelou N, Jürgens S. 2014. Postpartum headache: diagnostic considerations. Practical Neurology 14:92–99. Available from: http://www.medscape.com/viewarticle/822697_1 [cited 2017 Jan 4].[Crossref], [PubMed] , [Google Scholar]).Conclusions: Research has shown that many postpartum headaches go undiagnosed and as a result are poorly treated, often returning following discharge from secondary care (Nelson-Piercy 2010 Nelson-Piercy C. 2010. Handbook of Obstetric Medicine. 4th ed. London: Informa Healthcare [cited 2016 Dec 5]. [Crossref] , [Google Scholar]). The hope is that the introduction of this adjuvant will allow clinicians to identify the cause of postpartum headaches earlier and will allow life threatening diagnoses to be quickly excluded.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,005 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».