Relationships between perineal pain and postpartum depressive symptoms: A prospective cohort study

Chang, Shiow Ru; Chen, Kuang-Ho; Lee, Chien‐Nan; Shyu, Ming‐Kwang; Lin, Ming-I; Lin, Wei-An

doi:10.1016/j.ijnurstu.2016.02.012

Cited by 34 publications

(47 citation statements)

References 52 publications

(72 reference statements)

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“…123 Furthermore, bidirectional predictoreoutcome relationships for some phenotypes, such as depression, are likely where the interaction between predictor and outcome happens over time. 40,124 As such, acquisition of longitudinal data for both predictor and outcome is warranted to allow for identification of specific type and timing of preventive interventions to be tested. Further, studies focused on functional outcome in relation to pain 40 and those focused on women with vaginal delivery are important, as the incidence and severity of persistent pain after vaginal delivery are not as different from Caesarean delivery as one might suspect, 20 and information about functional outcome and the differences in persistent pain outcomes between Caesarean and vaginal delivery is presently scarce.…”

Section: Future Directionsmentioning

confidence: 99%

Factors associated with persistent pain after childbirth: a narrative review

Komatsu

Ando

Flood

2020

British Journal of Anaesthesia

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A systematic literature search was performed to identify studies that reported risk factors for persistent pain after childbirth. Many studies have sought to identify risk factors for post-delivery pain in different populations, using different methodologies and different outcome variables. Studies of several different but interrelated post-partum pain syndromes have been conducted. Factors strongly and specifically associated with persistent incisional scar pain after Caesarean delivery include a coexisting persistent pain problem in another part of the body and severe acute postoperative pain. For persistent vaginal and perineal pain, operative vaginal delivery and the magnitude of perineal trauma have been consistently linked. History of pregnancy-related and pre-pregnancy back pain and heavier body weight are robust risk factors for persistent back pain after pregnancy. Unfortunately, limitations, particularly small samples and lack of a priori sample size calculation designed to detect specific effect sizes for risk of persistent pain outcomes, preclude definitive conclusions about many other predictors and the strength of outcome associations. In future studies, assessments of specific phenotypes using a rigorous analysis with appropriate predetermined sample sizes and validated instruments are needed to allow elucidation of stronger and reliable associations. Interventional studies targeting the most robustly associated, modifiable risk factors, such as acute post-partum pain, may lead to solutions for the prevention and treatment of these common problems that impact a large population.

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Section: Future Directionsmentioning

confidence: 99%

Factors associated with persistent pain after childbirth: a narrative review

Komatsu

Ando

Flood

2020

British Journal of Anaesthesia

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“…An association between persistent perineal pain and symptoms of postpartum depression has been identi ed by several studies [14,15]. An increased risk for depression was showed at 4-6 weeks and 6 months among women who had perineal pain compared to those without perineal pain after adjusting for covariates [16]. In this prospective study, pain at 3-5 days postpartum was a predictor for symptoms of postpartum depression at 3 months [16].…”

Section: Introductionmentioning

confidence: 54%

“…An increased risk for depression was showed at 4-6 weeks and 6 months among women who had perineal pain compared to those without perineal pain after adjusting for covariates [16]. In this prospective study, pain at 3-5 days postpartum was a predictor for symptoms of postpartum depression at 3 months [16]. Moreover, dyspareunia rate around 25% was observed in women who had an episiotomy [17].…”

Section: Introductionmentioning

confidence: 55%

Ropivacaine 75mg versus placebo in perineal infiltration for analgesic efficacy at mid- and long-term for episiotomy repair in postpartum women- The ROPISIO study: a two-center, randomized, double-blind, placebo-controlled trial.

Cardaillac

Ploteau

Thuaut

et al. 2020

Preprint

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Background Perineal pain due to episiotomy is commonly reported and can be severe enough to disturb the mother-infant dyad during the postpartum period. Its incidence at day 7 postpartum varies from 63% to 74%. Recent studies have already investigated the analgesic efficacy of perineal infiltration of ropivacaine after episiotomy, but have only focused on the immediate postpartum period (at 24 and 48 hours after birth). Large, adequately powered, multicenter, randomized controlled trials are required to evaluate the impact of ropivacaine infiltration on perineal pain and mid- and long-term quality of life before the widespread use of ropivacaine to prevent perineal pain after episiotomy can be recommended. Methods The ROPISIO study is a two-center, randomized, double-blind, placebo-controlled trial in La Roche sur Yon and Nantes, France. It will involve 272 women with vaginal singleton delivery and mediolateral episiotomy at term (≥ 37 weeks). Perineal infiltration (ropivacaine 75mg or placebo) will be administrated just after vaginal birth and before episiotomy repair. The primary outcome will be the analgesic efficacy at day 7 postpartum (mid-term), defined by the numerical rating scale of pain (ENS NRS) strictly superior to 3/10 on the perineal repair area. Secondary outcomes will be the analgesic efficacy (ENS NRS), the impact of pain on daily behavior, on the quality of life (36-Item Short Form Health Survey), on the occurrence of symptoms of postpartum depression (Edinburgh Postnatal Depression Scale) and on sexuality (Female Sexual Function Index) at 3 and 6 months (long-term) using validated online questionnaires. This study will have 90% power to show approximately 30% relative risk reduction in the incidence of perineal pain at day 7, from 70.0% to 50.0%. Discussion Ropivacaine is a promising candidate drug, inexpensive, easy to administer, and would be suitable to include in the routine management of deliveries in labor ward. This study will investigate if perineal ropivacaine infiltration just after birth can reduce mid- and long-term postpartum pain and increase quality of life in women with mediolateral episiotomy.

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“…A high VAS level at early pregnancy was not associated with EPDS score at any of the stages. Chang et al [22] reported that pain at 3-5 days postpartum was associated with depression at 3 months postpartum. Other confounding factors may be related to the association of VAS with EPDS score.…”

Section: Discussionmentioning

confidence: 99%

Possible Predictive Factors for Low Back and Pelvic Pain at Three Months Postpartum Assessed in a Prospective Study from Early Pregnancy until the Postpartum Period

Uemura¹,

Horike²,

Maeda³

et al. 2018

OJN

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Background: Low back and pelvic pain (LBPP) is an important issue related to mental health as well as to difficulty for daily life activity during early pregnancy and in the postpartum period. We examined the intensity of LBPP, difficulty for daily life activity and mental health and their associations from early pregnancy until 3 months postpartum in a prospective study. We also examined predictive factors for LBPP at 3 months postpartum. Methods: We recruited 55 pregnant women who responded to questionnaires in the first, second and third trimesters and at one week, one month and 3 months postpartum. We designed a self-administered questionnaire including a visual analog scale (VAS), pregnancy mobility index (PMI) of LBPP and Edinburgh postnatal depression scale (EPDS). Results: There were significant differences in the proportions of women with LBPP in the first trimester (63.6%), second trimester (78.2%) and third trimester (83.6%) and at one week postpartum (80.0%), one month postpartum (69.1%) and 3 months postpartum (56.4%). VAS score at 3 months postpartum was significantly correlated with VAS scores at the first trimester (r = 0.410, p = 0.002), second trimester (r = 0.298, p = 0.027) and one month postpartum (r = 0.476, p < 0.001). VAS score at 3 months postpartum was significantly correlated with PMI scores at the first trimester and one month postpartum.

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Relationships between perineal pain and postpartum depressive symptoms: A prospective cohort study

Cited by 34 publications

References 52 publications

Factors associated with persistent pain after childbirth: a narrative review

Factors associated with persistent pain after childbirth: a narrative review

Ropivacaine 75mg versus placebo in perineal infiltration for analgesic efficacy at mid- and long-term for episiotomy repair in postpartum women- The ROPISIO study: a two-center, randomized, double-blind, placebo-controlled trial.

Possible Predictive Factors for Low Back and Pelvic Pain at Three Months Postpartum Assessed in a Prospective Study from Early Pregnancy until the Postpartum Period

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