Childbirth Pain, Labor Epidural Analgesia, and Postpartum Depression: Recent Evidence and Future Directions

Factors influencing the use of epidural labor analgesia: a cross-sectional survey analysis

Introduction

This study aimed to explore the personal and organizational factors influencing the lack of implementation of epidural labor analgesia (ELA).

Methods

This study was conducted at the Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China. A total of 451 women who underwent vaginal delivery without ELA between 8 October 2021 and 30 March 2022, were included. A questionnaire was used to collect the relevant data. We derived and validated the variable, without ELA, by using binary logistic regression analysis.

Results

Of the total 451 included, 355 (78.7%) initially preferred ELA, whereas 96 (21.3%) rejected it directly. Five variables were validated (p < 0.05): multiparas, ELA would lead to back pain, experienced ELA in previous delivery, the inner attitude toward labor pain, and blood routine and coagulation function not being tested within 14 days. The sensitivity and specificity of this model were 96.3 and 69.8%, respectively.

Conclusion

The corresponding training should be provided to the medical staff to identify women at high risk of rejecting ELA during the prenatal examination process using a questionnaire, then provide them with knowledge regarding ELA, so that ELA can benefit more mothers. Additionally, the existing organizational factor should be addressed in order to efficiently provide ELA services to mothers.

Clinical trial registration

This study was registered at the Chinese Clinical Trial Registry (Chi CTR 2000034625) on July 12, 2020.

Maternal intrapartum fever during epidural labour analgesia: Incidence and influencing factors

BACKGROUND

The management and nursing care of women's temperature during delivery is an important part of clinical obstetrics. We aimed to evaluate maternal intrapartum fever during epidural labour analgesia to provide evidence for the management and care of women in labour.

METHODS

This study was conducted and reported according to the STROBE statement. Women in labour undergoing epidural labour analgesia in our hospital from 1 January 2021 to 31 August 2022 were retrospectively selected. The characteristics of women in labour with and without intrapartum fever were compared. Pearson correlation and logistic regression analysis were used to analyse the influencing factors of postpartum fever.

RESULTS

A total of 196 women in labour were included, the incidence of maternal intrapartum fever in women in labour undergoing epidural analgesia was 27.5%. Pearson correlation analyses showed that BMI, oxytocin use, labour duration, number of vaginal examinations, time from rupture of the foetal membranes to the end of labour and duration of epidural analgesia were all correlated with the occurrence of intrapartum fever (all P < 0.05). Logistic regression analyses indicated that body mass index ≥28 kg/m2 (OR = 1.825), oxytocin use (OR = 2.082), labour duration ≥9.2 h (OR = 2.613), number of vaginal examinations ≥8 (OR = 2.044-3.115), the time from rupture of the foetal membranes to the end of labour ≥250 min (OR = 2.766) and duration of epidural analgesia ≥300 min (OR = 3.106) were risk factors for intrapartum fever in women in labour undergoing epidural analgesia (all P < 0.05).

CONCLUSIONS

Maternal intrapartum fever in women in labour undergoing epidural analgesia is common and influenced by many factors. Nurses should take early preventive care measures according to these factors during epidural analgesia in labour.

Persistent Postpartum Pain - A Somatic and Psychologic Perfect Storm

Persistent postpartum pain is common and has a complex etiology. It has both somatic and psychosocial provoking factors and has both functional and psychological ramifications following childbirth. Pain that limits the functional capacity of a person who has the daunting task to take care of all the demands of managing a growing newborn and infant can have debilitating consequences for several people simultaneously. We will review the incidence of persistent postpartum pain, analyze the risk factors, and discuss obstetric, anesthetic, and psychological tools for prevention and management. Based on the current knowledge, early antenatal screening and management is described as the most likely measure to identify patients at risk for persistent postpartum pain. Such antenatal management should be based on the close collaboration between obstetricians, anesthesiologists, and psychologists to tailor peripartum pain management and psychological support-based individual needs.

Effect of single intravenous injection of esketamine on postpartum depression after labor analgesia and potential mechanisms: a randomized, double-blinded controlled trial

BACKGROUND

The study was designed to investigate effects of single intravenous injection of esketamine on the incidence of postpartum depression (PPD) after labor analgesia and explore the potential mechanisms.

METHODS

A total of 120 women who underwent labor analgesia by epidural analgesia pump were enrolled and divided into two groups randomly. Esketamine at a dose of 0.2 mg/kg was intravenously injected after fetal disengagement in the test group and placebo was administered in the control group. The occurrence of PPD and side effects after delivery were recorded. Some indicators related to stress and inflammation were measured before labor analgesia and at 24 h, 1 week, and 6 weeks after delivery in this study. Data were analyzed by independent t-test, repeated measures analysis of variance and Chi-square test in SPSS software (version 25.0). It was considered statistically significant since a p value less than 0.05.

RESULTS

The incidence of PPD was significantly decreased both for one week and six weeks after delivery by using of esketamine (3.4% vs. 15.3%, p = 0.004 and 5.2% vs. 18.6%, p = 0.006, respectively). There were also significant differences between the stress and inflammation-related indicators in different time points in this study, while the side effects for 48 h after delivery were similar between the two groups.

CONCLUSIONS

Single intravenous injection of esketamine after delivery in participants underwent labor analgesia can decrease the occurrence of postpartum depression for one week and six weeks after delivery, while the side effects were not increased. The antidepressant effects of esketamine may be related to the reduction of stress response and inflammation.

TRIAL REGISTRATION

The trial was registered at the Chinese Clinical Trial Registry on 5/30/2022 (CTRI registration number-ChiCTR2200060387). URL of registry: https://www.chictr.org.cn/bin/home .