Prevalence and risk factors for postpartum depression 2 months after a vaginal delivery: a prospective multicenter study

Prevalence and risk factors of maternal dissatisfaction after vaginal delivery: A multicenter prospective study

OBJECTIVE

To evaluate the prevalence and risk factors of maternal dissatisfaction 2 days after a singleton vaginal delivery at or near term.

METHODS

We conducted a planned ancillary cohort study of the TRanexamic Acid for Preventing Postpartum Hemorrhage After Vaginal Delivery (TRAAP) randomized controlled trial. Maternal dissatisfaction, related to the birth and to the subsequent hospital stay, was assessed 2 days postpartum by two self-administered questions: "Are you satisfied with the care you received during your child's birth?" and "Are you satisfied with the care you have received during your hospital stay?". Satisfaction was defined by answers of "extremely satisfied" or "very satisfied," and dissatisfaction by the responses "moderately satisfied," "not very satisfied," or "not at all satisfied". Their association with maternal dissatisfaction was analyzed by random-effects logistic regression.

RESULTS

The prevalence of maternal dissatisfaction with the birth was 2.9%, and with the hospital stay 9.5%. Characteristics associated with a higher risk of maternal dissatisfaction with the birth were labor exceeding 6 h, bad memories of the birth and, only for women without complicated deliveries, manual examination of the uterine cavity. The only characteristic associated with a higher risk of dissatisfaction with the hospital stay was non-French nationality. None of the postpartum hemorrhage, third- or fourth-degree perineal lacerations, operative vaginal delivery, episiotomy and uterine massage were associated with a higher risk of maternal dissatisfaction.

CONCLUSION

Maternal dissatisfaction was low after singleton vaginal deliveries at or near term. Strategies aiming to avoid labor longer than 6 h and manual examination of the uterine cavity may decrease maternal dissatisfaction after delivery.

Impact of oxycodone for the treatment of acute postoperative pain in cesarean section: A review

The review aimed to summarize the recent pharmacological and published clinical trials that used oxycodone for pain management after cesarean section (CS). This narrative review is based on published studies in PubMed, EMbase, Web of science, and EBSCO on oxycodone for pain control after CS. Random studies that used oxycodone only or used oxycodone as a major part of a multimodal analgesia regimen were included. Non-English trials, abstract of conference, letters to the editor, animal studies, or studies with insufficient data were excluded. The initial search terms included a combination of free text words and Medical Subject Headings terms. There are 14 clinical trials included and the total number of participants was 1651. These included documents disputed oral oxycodone and patient-controlled intravenous analgesia (PCIA) morphine, compared oral oxycodone and intravenous morphine, investigated sustained-release oral oxycodone and intrathecal morphine, investigated slow release tapentadol and controlled-release oxycodone, investigated ketoprofen, combination of acetaminophen + oxycodone, acetaminophen, and placebo, evaluated oral oxycodone and epidural ropivacaine + sufentanil, evaluated oral oxycodone and PCIA piritramide, evaluated the combination oxycodone + acetaminophen and separately administered oxycodone/acetaminophen, compared the immediate-release oxycodone and controlled-release oxycodone, compared the oral and intravenous oxycodone, disputed PCIA oxycodone or morphine, compared epidural oxycodone and morphine, evaluated PCIA oxycodone, sufentanil or their combination. Oxycodone showed superior or similar postoperative analgesic efficacy compared with other opioids in various administration and reduced the need for rescue medication and side effects. Oxycodone can be successfully used for postoperative analgesia after CS with comparable side effects.

Risk of suicide and postpartum depression in women who feel they were treated inadequately during childbirth

BACKGROUND

Postpartum depression and suicide are two of the most frequent mental health disorders in the perinatal period and have an increasing trend.. An increasing number of women report receiving inadequate treatment during childbirth care. There are no studies that relate inadequate treatment to any of these mental health disorders; those that exist are very limited and have not used validated instruments. We proposed to determine if there is an association between inadequate treatment and/or abuse during childbirth care with the risk of postpartum depression (PPD) and the risk of suicidality in women during the perinatal stage.

METHODS

An observational study was carried out with postpartum women in Spain. Information was collected on sociodemographic and obstetric variables, among others. Edinburgh Postnatal Depression Scale was used to determine the risk of postpartum depression and item 10 for the risk of suicide, and the Childbirth Abuse and Respect Evaluation-Maternal Questionnaire (CARE-MQ) was used to determine the women's perception of having been treated inadequately during childbirth. Adjusted ORs and their 95 % CI were calculated.

RESULTS

1579 women participated. Women with CARE-MQ scores above the 90th percentile had a higher probability of risk of suicidal ideation (aOR of 2.89; 95 %CI: 1.60-5.04) and postpartum depression (aOR of 3.17; 95 %CI: 1.94-5.18) compared to those who had scores lower than the 50th percentile. On the contrary, factors associated with a lower probability of suicidal ideation and PPD were: higher economic income and attendance at prenatal education.

CONCLUSION

Women who perceived that they experienced a situation of inadequate treatment during childbirth were more likely to be at risk of postpartum depression and risk of suicide.

Mistreatment in healthcare: peripartum experience in a Tunisian maternity

Background

Mistreatment in healthcare is defined by the set of behaviors, acts, and omissions committed by the healthcare providers on patients. Pregnant women can be exposed to this behavior during pregnancy, childbirth, and the postpartum period. It can have several aspects and affects the women's mental health, social and professional life, and also their newborns and families.

Objective

This study was made to estimate the frequency of mistreatment during the peripartum period in a Tunisian maternity unit, determine its impact on the parturient and her entourage, and draw up recommendations for the prevention of this public health problem.

Study Design

We conducted a cross-sectional survey in Department C of the Tunis Maternity and Neonatology Center from July 2022 to September 30, 2022. Our questionnaire encompassed verbal and physical abuse, patient information, consent, unprofessional conduct, poor communication, and discrimination.

Results

This study included 400 patients. The average age was 29.3+-5.65. Single women represented 12.3% of the cases. Seventy-five percent of women reported having been victims of at least one type of violence during childbirth. Verbal abuse was the most frequent type observed. Eighty-two percent of women reported verbal abuse, while 23.25% underwent physical violence. After the delivery, 391 women (97.8%) stated that the delivery was a source of anxiety and that they were not ready to repeat the experience. Six of them were followed up in psychiatry. Mistreatment was expressed by a lack of information and/or respect for consent, unprofessional conduct, or poor communication between the caregiver and the patient.

Conclusion

This study emphasizes the significance of including women in decision-making processes regarding their care. Establishing systematic approaches for providing information and obtaining consent is crucial, ensuring a dynamic approach that promotes women's freedom of choice.

Prevalence and risk factors for postpartum depression 2 months after cesarean delivery: a prospective multicenter study

BACKGROUND

The prevalence and risk factors of postpartum depression after cesarean delivery remain unclear.

OBJECTIVE

To assess the prevalence of postpartum depression and its risk factors 2 months after cesarean delivery.

STUDY DESIGN

Prospective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery trial, conducted in 27 French hospitals in 2018 to 2020 and enrolling women undergoing cesarean delivery before or during labor at 34 or more weeks of gestation. After randomization, characteristics of the cesarean delivery, postpartum blood loss, and immediate postpartum period, including memories of delivery and postoperative pain, were prospectively collected. Women's characteristics, particularly any psychiatric history, were collected from medical records. Two months after childbirth, a postpartum depression provisional diagnosis was defined as a score of 13 or higher on the Edinburgh Postnatal Depression Scale, a validated self-administered questionnaire. The corrected prevalence of postpartum depression was calculated with the inverse probability weighting method to take nonrespondents into account. Multivariate logistic regression analyzed associations between potential risk factors and postpartum depression. A sensitivity analysis used an Edinburgh Postnatal Depression Scale cutoff value of 11 or higher.

RESULTS

The questionnaire was returned by 2793/4431 women (63.0% response rate). The corrected prevalence of postpartum depression provisional diagnosis was 16.4% (95% confidence interval, 14.9%-18.0%) with an Edinburgh Postnatal Depression Scale score of 13 or higher and 23.1% (95% confidence interval, 21.4%-24.9%) with a cutoff value of 11 or higher. Characteristics associated with a higher risk of postpartum depression were prepregnancy characteristics such as young age (adjusted odds ratio 0.83, 95% confidence interval 0.74-0.93 for each 5-year increase in maternal age) and non-European country of birth (adjusted odds ratio 2.58, 95% confidence interval 1.85-3.59 for North Africa; adjusted odds ratio 1.57, 95% confidence interval 1.09-2.26 for Sub-Saharan Africa and adjusted odds ratio 1.99, 95% confidence interval 1.28-3.10 for other country of birth; reference: Europe) and some aspects of the cesarean delivery, notably its timing and context, emergency before labor (adjusted odds ratio 1.70, 95% confidence interval 1.15-2.50; reference: before labor without emergency) and during labor after induction of labor (adjusted odds ratio 1.36, 95% confidence interval 1.03-1.84; reference: before labor without emergency). Also at higher risk were women reporting high intensity pain during the postpartum stay (adjusted odds ratio 1.73, 95% confidence interval 1.32-2.26) and bad memories of delivery on day 2 postpartum (adjusted odds ratio 1.67, 95% confidence interval 1.14-2.45). Conversely, women who had social support in the operating room had a lower risk of postpartum depression (adjusted odds ratio 0.73, 95% confidence interval 0.53-0.97).

CONCLUSION

Around one woman in 6 had postpartum depression symptoms 2 months after cesarean delivery. Some cesarean-related obstetric factors may increase this risk: cesareans before labor for emergency situations or during labor after medically indicated induction of labor, severe postoperative pain, and bad memories of delivery before discharge. Specific subgroups of at-risk women could benefit from early screening or intervention to reduce the onset of postpartum depression. Perinatal professionals should pay particular attention to postoperative pain management.

Comparing the prevalence and influencing factors of postpartum depression in primiparous and multiparous women in China

Background

Few studies have compared the influencing factors of postpartum depression between primiparous and multiparous women. Therefore, this study is aimed to investigate the prevalence and influencing factors of postpartum depression in primiparous and multiparous women, and provide reference suggestions for clinical nursing.

Methods

A total of 429 postpartum women who gave birth at a Maternal and Child Health Hospital in Shandong Province, China, from April to June 2024, were recruited by convenience sampling. A Sociodemographic Questionnaire, Edinburgh Postpartum Depression Scale, Pittsburgh Sleep Quality Index, and Perceived Social Support Scale were used for investigation. SPSS 26.0 was used to analyze the data, and multivariate regression was employed to analyze the influencing factors of postpartum depression between primiparous and multiparous women.

Results

The total prevalence of postpartum depression among 429 postpartum women (191 primiparas and 238 multiparas) was 22.14%. The prevalence of postpartum depression among primiparous and multiparous women were 21.99% and 22.27%, respectively, with no statistically significant difference [OR=1.016, 95% CI (0.642, 1.608)]. Sleep quality is a common protective factor for postpartum depression in both primiparous and multiparous women, while perceived social support is another protective factor for multiparous women. The risk factors are different in both two group, there is no risk factor found in primiparous women, the newborns health and women's expectation on newborns gender are risk factors for postpartum depression in multiparous women.

Conclusions

Both primiparous and multiparous women have a high risk of postpartum depression. In order to promote the mental health of postpartum women, precise nursing measures should be adopted for different parity of postpartum women in clinical practice.

Postpartum depression and autoimmune disease: a bidirectional Mendelian randomization study

Purpose

The rising prevalence of postpartum depression (PPD) is harmful to women and families. While there is a growing body of evidence suggesting an association between PPD and autoimmune diseases (ADs), the direction of causality remains uncertain. Therefore, Mendelian randomization (MR) study was employed to investigate the potential causal relationship between the two.

Methods

This study utilized large-scale genome-wide association study genetic pooled data from two major databases: the IEU OpenGWAS project and the FinnGen databases. The causal analysis methods used inverse variance weighting (IVW). The weighted median, MR-Egger method, MR-PRESSO test, and the leave-one-out sensitivity test have been used to examine the results' robustness, heterogeneity, and horizontal pleiotropy.

Results

A total of 23 ADs were investigated in this study. In the IVW model, the MR study showed that PPD increased the risk of type 1 diabetes (OR , = 1.15 (1.05-1.26),p<0.01),Hashimoto's thyroiditis((OR) = 1.21 (1.09-1.34),p<0.0001),encephalitis((OR) = 1.66 (1.06-2.60),p<0.05). Reverse analysis showed that ADs could not genetically PPD. There was no significant heterogeneity or horizontal pleiotropy bias in this result.

Conclusion

Our study suggests that PPD is a risk factor for type 1 diabetes, Hashimoto's thyroiditis, and encephalitis from a gene perspective, while ADs are not a risk factor for PPD. This finding may provide new insights into prevention and intervention strategies for ADs according to PPD patients.

Digital Training for Nurses and Midwives to Improve Treatment for Women with Postpartum Depression and Protect Neonates: A Dynamic Bibliometric Review Analysis

The high prevalence of postpartum depression makes it necessary for midwives and nurses to implement prenatal interventions for expectant mothers. The current study aims to investigate and highlight the importance of the digital training of nurses in order to help women mitigate the symptoms of postpartum depression and protect infants. To approach this, we conducted a bibliometric analysis to address the study's main objective. Articles were retrieved from the Scopus database for the timeframe 2000-2023. Data analysis was conducted using the statistical programming language R (version R-4.4.) and the bibliometric software VOSviewer (version 1.6.20) and Biblioshiny (version 4.1.4), focused on year, journal, and country. For this investigation, we selected a total of 31 MeSH keywords and sub-headings that exhibited significant frequencies. We consistently used six significant clusters of MeSH keywords. We obtained a total of 585 articles from the Scopus database that were major contributors to the field of PPD, as evidenced by their extensive publication of research articles and their influential role in the domain. The studies included a thorough analysis of depression research, the use of scales for diagnosing and screening PPD, psychological studies related to PPD, and the exploration of causes, mechanisms, outcomes, and genetic factors. Our study's results demonstrate a steady and significant increase in the availability of information on PPD. Importantly, the novelty of the current study lies in highlighting the need for a transition in the ways in which nurses and midwives are trained to mitigate postpartum disease by integrating emerging technologies into their practices. The knowledge provided here has the potential to serve as a foundation for future advancements in obstetric psychology, both presently and in the future.

Parturition at term: induction, second and third stages of labor, and optimal management of life-threatening complications-hemorrhage, infection, and uterine rupture

Childbirth is a defining moment in anyone's life, and it occurs 140 million times per year. Largely a physiologic process, parturition does come with risks; one mother dies every two minutes. These deaths occur mostly among healthy women, and many are considered preventable. For each death, 20 to 30 mothers experience complications that compromise their short- and long-term health. The risk of birth extends to the newborn, and, in 2020, 2.4 million neonates died, 25% in the first day of life. Hence, intrapartum care is an important priority for society. The American Journal of Obstetrics & Gynecology has devoted two special Supplements in 2023 and 2024 to the clinical aspects of labor at term. This article describes the content of the Supplements and highlights new developments in the induction of labor (a comparison of methods, definition of failed induction, new pharmacologic agents), management of the second stage, the value of intrapartum sonography, new concepts on soft tissue dystocia, optimal care during the third stage, and common complications that account for maternal death, such as infection, hemorrhage, and uterine rupture. All articles are available to subscribers and non-subscribers and have supporting video content to enhance dissemination and improve intrapartum care. Our hope is that no mother suffers because of lack of information.

Factors Influencing Duration of Breastfeeding: Insights from a Prospective Study of Maternal Health Literacy and Obstetric Practices

Numerous factors concerning early breastfeeding abandonment have been described, including health literacy (HL). This study's objective was to analyze factors related to early breastfeeding abandonment (<6 months). This prospective multicentric study examined the duration of breastfeeding at 6 months postpartum and was conducted in four different regions of Spain from January 2021 to January 2023. A total of 275 women participated in this study, which focused on maternal HL and obstetric practices. A decrease in the breastfeeding rate was observed from hospital discharge (n = 224, 81.5%) to the sixth month postpartum (n = 117, 42.5%). A Cox regression analysis revealed that inadequate HL levels, lack of mobilization during labour, and induced labour were significantly associated with early breastfeeding cessation (p = 0.022, p = 0.019, and p = 0.010, respectively). The results highlight that women with adequate HL had a 32% lower risk of early breastfeeding abandonment. In comparison, mobilization during labour and induction of labour were linked to a 32.4% reduction and a 53.8% increase in this risk, respectively. These findings emphasize the importance of considering obstetric and HL factors when addressing the breastfeeding duration, indicating opportunities for educational and perinatal care interventions.