<p>Factors Associated with the Development of Postnatal Depression After Cesarean Delivery: A Prospective Study</p>

Abstract

Pre-operative association factors (pain and psychological vulnerability) could significantly contribute to post-Cesarean pain; however, limited information is available on the development of postnatal depression (PND). We aimed to investigate the development of PND and its association with pain vulnerability and psychological vulnerability factors. Patients and Methods: Women undergoing Cesarean delivery under spinal anesthesia were given pre-operative questionnaires, psychological and pain assessments including pain on local anesthetic injection during spinal anesthesia and mechanical temporal summation. Post-operative assessments were administered at 6 to 10 weeks post-Cesarean delivery via follow-up survey to assess post-Cesarean psychological and pain outcomes. Results: PND occurred in 21.1% (43 of 205) of patients who underwent elective Cesarean delivery. An increased pre-operative pain score with movement (Odds ratio (OR) 1.65, 95% CI 1.12-2.44, p = 0.0110), anxiety about upcoming surgery (OR 1.02, 95% CI 1.00-1.04, p = 0.0429), higher pre-operative Hospital Anxiety and Depression Scale (HADS) subscale on anxiety (OR 1.25, 95% CI 1.07-1.45, p = 0.0041) and higher pre-operative central sensitization inventory (CSI) scores (OR 1.05, 95% CI 1.01-1.09, p = 0.0156) were independently associated with an increased risk of PND. Anticipated pain medication needs were associated with reduced risk of PND (OR 0.48, 95% CI 0.29-0.79, p = 0.0038) (Receiver operating characteristic (ROC) = 0.8177). Conclusion: Higher pre-operative anxiety, pain score, central sensitization and lower anticipated pain medication needs were associated with increased risks of PND. Further work using larger sample size will be needed to validate the model in predicting PND development after Cesarean delivery.

Charité Caesarean Birth Improves Birth Experience in Planned and Unplanned Caesarean Sections While Maintaining Maternal and Neonatal Safety: A Prospective Cohort Study

“…Correspondingly, data have shown that early skin-to-skin contact in the operation room reduces pain [18]. The fear of pain and anxiety regarding upcoming surgery are associated with an increased risk of early postnatal depression after CD [29]. Notably, women reported feeling significantly less exhausted during CCB compared to during CCS.…”

Electroacupuncture Suppresses CCI-Induced Neuropathic Pain through GABAA Receptors

“…e transmission of pain signals from periphery to central sensitization is a dynamic process [31]. Pain signals could be amplified by the transmission of nociceptive information (hyperalgesia), suppressed (analgesia), or relayed unaltered [32]. Pain modulation occurred in the dorsal horn of the spinal cord, where peripheral nerves relay sensory information to the brain through projection neurons [33].…”

Obstetric anesthesia: pearls and pitfalls in anesthesia for cesarean delivery

“…Preoperative factors, for instance pain and anxiety, could significantly contribute to postcesarean delivery pain and other poor outcomes, including postoperative psychological vulnerability and postpartum depression. 15 , 16 It is well-known that up to 20% of new mothers can develop postpartum depression during the first year after giving birth. 17 The resulting increased risks of suicide ideation, infanticide, as well as childhood and adolescent developmental and behavioral problems make this a serious public health issue.…”