The association between epidural labour analgesia and postpartum depression: a randomised controlled trial

Depressive Symptoms during Pregnancy and the Postpartum Period: A Tertiary Hospital Experience

Background and Objectives: The prevalence of depressive symptoms during pregnancy is about 20%, and 10-15% in the postpartum period. Suicide is a worrying cause of death among women in these periods. Although ICD-10 lacks specific definitions for perinatal depression (it is planned in ICD-11), the DSM-5 defines it. Various etiological factors and treatment options are being investigated. This study aimed to examine potential etiological factors in order to contribute to potential preventive and therapeutic approaches. Material and Methods: A prospective study at the Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, from October 2023 to January 2024 was conducted. Two hundred and five healthy women were surveyed before giving birth (37+ gestational weeks) and 2 weeks and 2 months after childbirth. The following factors were examined: sociodemographic, psychological, and obstetric (using a specially designed questionnaire); relationship quality (DAS-32); and depression, anxiety, and stress symptoms (EPDS; DASS-21). Results: Depression frequency was 26.3% before childbirth, 20% in the second week, and 21.9% in the second month after delivery. DASS-21 test results showed a statistically significant correlation before delivery and two weeks postpartum (p = 0.02). Factors that are significantly associated with the presence of depressive symptoms include the following: before childbirth-miscarriages (p < 0.01); in the second week after childbirth-personal experiences of a difficult birth (p < 0.01), cesarean delivery instead of planned vaginal delivery (p = 0.03), and application of epidural anesthesia (p = 0.04); and in the second month after childbirth-satisfaction with financial status (p = 0.035). Relationship quality is significantly correlated with DASS-21 test results before childbirth, in the second week, and in the second month after childbirth (p < 0.01), and it is significantly different in women with and without depressive symptoms (before childbirth, in the second week, and in the second month after childbirth, p < 0.01). Conclusions: There are risk factors that can be addressed preventively and therapeutically during pregnancy and in labor. This could be achieved through psychotherapy, partner support, and appropriate management of labor.

Long-term effects of neuraxial analgesia

PURPOSE OF REVIEW

This review article explores the potential longer-term implications of neuraxial analgesia in labour for both the mother and her child.

RECENT FINDINGS

Neuraxial techniques for labour analgesia are well tolerated and effective, and long-term adverse sequelae are rare. Labour epidural analgesia is not independently associated with long-term headache, backache, postnatal depression or anal sphincter injury, and evidence supports that epidurals may offer protection against severe maternal morbidity, particularly in women at a higher risk of complications. However, there is an increasing awareness that postdural puncture headache may be associated with chronic headache, back pain and postnatal depression, emphasizing the need for adequate follow-up until symptoms resolve.For the neonate, a growing body of evidence refutes any association between epidural analgesia in labour and the later development of autism spectrum disorder. The clinical significance of epidural related maternal fever remains uncertain and is a research priority.

SUMMARY

Women should continue to access the significant benefits of neuraxial analgesia in labour without undue concern about adverse sequelae for themselves or their offspring. Measures to prevent, appropriately manage and adequately follow-up women who have suffered complications of neuraxial analgesia, such as postdural puncture headache, are good practice and can mitigate the development of long-term sequelae.

Sub-acute pain after childbirth during COVID-19 pandemic: A secondary analysis of A prospective clinical trial

Background

COVID-19 pandemic could bring great impact upon the psychological statuses of post-partum women, but no clear evidence was provided yet as to COVID-19 would also affect their pain profile during post-partum period. We determined if pain and psychological vulnerabilities, obstetric factors, and labor analgesia were associated with sub-acute pain after childbirth (SAPC; ongoing pain related to delivery at post-partum 4 weeks or more) during COVID-19 pandemic.

Methods

We included women having a singleton pregnancy of ≥36 gestational weeks. The recruited women were given pre-delivery questionnaires to measure their pain and psychological vulnerabilities. At post-partum 6-10 weeks, an online survey was conducted to collect data on post-partum pain information.

Results

Of the 880 recruited women, 816 completed the post-partum pain survey, with 99 (12.1%) having developed SAPC. Giving birth during COVID-19 pandemic (adjusted odds ratio (aOR) 1.64, 95%CI 1.04 to 2.57), greater pre-delivery central sensitization (aOR 1.02, 95%CI 1.00 to 1.04), greater number of pain relief administered (aOR 1.49, 95%CI 1.18 to 1.89), having had artificial rupture of membrane and oxytocic during labor onset (aOR 3.00, 95%CI 1.66 to 5.40), greater volume of blood loss during delivery (every 100 ml; aOR 1.27, 95%CI 1.11 to 1.44), having had third-degree tear during delivery (aOR 4.40, 95%CI 1.33 to 14.51), and greater infant height (aOR 1.14, 95%CI 1.01 to 1.30) were independently associated with greater risk of SAPC. Having greater general health score was protective against the risk of SAPC (aOR 0.99, 95% CI 0.97 to 0.999) (Area under the curve (AUC) = 0.74).

Conclusions

The generated multivariable association model may help us better understand the shift in pain and psychological aspects of women during COVID-19 pandemic.