Postpartum post-traumatic stress disorder (PP-PTSD) is a severe mental disorder worldwide. In recent years, some studies have reported that PP-PTSD stems from birth trauma. The present study was dedicated in finding ways to predict the occurrence of emergency caesarean section (ECS), trying to analyze the methods to reduce incidence of PP-PTSD on this basis, further exploring the neuroimaging changes in PP-PTSD. A total of 245 primiparas with intention of vaginal delivery were recruited. The internal tocodynamometry measurement was performed during labor for all mothers, and respectively taken at 3–5 cm, 5–8 cm, and 8–10 cm of cervical dilation. The receiver operating characteristic (ROC) curve and Binary logistic regression analyses were also performed to identify fetal head descending thrust that might help in the prediction of ECS. Resting-state magnetic resonance imaging (MRI) was performed on 26 patients diagnosed with PP-PTSD of 245 mothers, the amplitude of low-frequency fluctuations (ALFF) technology was used to observe the spontaneous neural activity of all PP-PTSD patients and correlation analyses were performed. We found that the natural delivery rate of mothers with fetal head descending thrust <16.29 N (5–8 cm), 26.36 N (8–10 cm) were respectively lower than other mothers with fetal head descending thrust ≥16.29 N (5–8 cm), 26.36 N (8–10 cm) (P < 0.05). The ROC curve analysis showed that the area under the receiver operating characteristic curve (AUC) value of thrust (5–8 cm) was 0.896 (95% CI: 0.854–0.938, p < 0.001), AUC of thrust(8–10 cm) was 0.786 (95% CI: 0.714–0.858, p < 0.001), which showed strong potential for predicting ECS. In addition, the Binary logistic regression analysis showed thrust (5-8 cm) and thrust (8–10 cm) were independent correlates of ECS. The resting-state functional magnetic resonance imaging (rs-fMRI) results indicated that PP-PTSD group showed decreased ALFF in the bilateral insula cortex (IC), right anterior cingulate cortex (ACC), and left midcingulate cortex (MCC) compared with healthy postpartum women (HPW) (false discovery rate (FDR) correction q-value < 0.05). The ALFF value of the right ACC was positively correlated with the Perinatal Post-traumatic stress disorder Questionnaire (PPQ) score (r = 0.4046 p = 0.0403) and Posttraumatic Stress Disorder Checklist–Civilian Version (PCL–C) score (r = 0.3909 p = 0.0483). The internal tocodynamometry measurement can serve as a predictive tool for ECS, on this basis, the implementation of effective emotional support may help to reduce the incidence of PP-PTSD. Besides, this study has verified the presence of altered ALFF in the brain regions of PP-PTSD patients, mainly involving the bilateral IC, right ACC, and left MCC, that might be associated with emotion, cognition, and memory disorders functions in PP-PTSD patients.
