1
|
Osório FL, Borges MM. Posttraumatic stress disorder prevalence and childbirth: update meta-analysis after the introduction of the DSM-5 and COVID-19 pandemic. Arch Womens Ment Health 2024; 27:337-357. [PMID: 38265513 DOI: 10.1007/s00737-024-01423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Meta-analyses were previously performed to estimate PTSD prevalence in the postpartum period. Significant events that could impact this outcome occurred in the last decade, such as the publication of the DSM-5 in 2013 and the COVID-19 pandemic in 2020. This systematic literature review with a meta-analysis addressed studies published after 2014 to estimate PTSD prevalence after childbirth. METHOD The methodological guidelines recommended by PRISMA were followed. The meta-analysis estimate was the proportion of PTSD cases. The restricted maximum likelihood (REML) was the method adopted for estimation in addition to multilevel random effect models. Subgroup analyses were performed to assess the impact of interest variables. RESULTS The estimated prevalence was 0.10 (95%CI: 0.8-0.13; I2 = 98.5%). No significant differences were found regarding the introduction of the DSM-5 (p = 0.73) or COVID-19 (p = 0.97), but instead, between low- and middle-income countries, e.g., the Middle East presents a higher prevalence (p < 0.01) than European countries. CONCLUSIONS There is a potential increase in PTSD prevalence rates after childbirth in the last decade not associated with the pandemic or the current diagnostic classification. Most studies showed a methodological fragility that must be overcome to understand this phenomenon better and support preventive actions and treatment for puerperal women.
Collapse
Affiliation(s)
- Flávia L Osório
- Medical School of Ribeirão Preto. São Paulo University, Avenida Dos Bandeirantes, 3900, Ribeirão Preto, SP, 14048-900, Brazil.
- National Institute of Science and Technology (INCT-TM, CNPq), Brasília, Brazil.
| | - Maira Morena Borges
- Medical School of Ribeirão Preto. São Paulo University, Avenida Dos Bandeirantes, 3900, Ribeirão Preto, SP, 14048-900, Brazil
| |
Collapse
|
2
|
Hüner B, Friedl T, Schütze S, Polasik A, Janni W, Reister F. Post-traumatic stress syndromes following childbirth influenced by birth mode-is an emergency cesarean section worst? Arch Gynecol Obstet 2024; 309:2439-2446. [PMID: 37391646 DOI: 10.1007/s00404-023-07114-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/19/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE The experience of birth is an emotional challenge for women. Traumatic birth experiences can cause psychological stress symptoms up to post-traumatic stress disorders (PTSD), with impact on women's wellbeing. Primarily unplanned interventions can trigger birth-mode-related traumatization. The aim of the study was to evaluate whether an emergency cesarean section (ECS) is the most traumatizing. METHODS A retrospective case-control study was undertaken. Therefore, data were collected by standardized questionnaires (Impact of Event Scale-Revised and City Birth Trauma Scale) that were sent to women with singleton pregnancies > 34 weeks of gestation who either give birth by ECS (case group, n = 139), unplanned cesarean section (UCS), operative vaginal birth (OVB), or natural birth (NB) (three control groups, n = 139 each). The investigation period was 5 years. RESULTS Overall, 126 of 556 (22%) sent questionnaires were returned and could be analyzed (32 ECS, 38 UCS, 36 OVB, and 20 NB). In comparison to other birth modes, women with ECS were associated with a higher degree of traumatization as revealed by statistically significant differences regarding the DSM-5 criteria intrusion and stressor. In addition, women who underwent ECS declared more frequently a demand for professional debriefing compared to other birth modes. DISCUSSION ECS is associated with more post-traumatic stress symptoms compared to other birth modes. Therefore, early interventions are recommended to reduce long-term psychological stress reactions. In addition, outpatient follow-ups by midwives or emotional support programs should be implemented as an integral component of postpartum debriefings.
Collapse
Affiliation(s)
- Beate Hüner
- Department for Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstraße 43, 89075, Ulm, Germany.
| | - Thomas Friedl
- Department for Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Sabine Schütze
- Department for Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Arkadius Polasik
- Department for Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Wolfgang Janni
- Department for Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Frank Reister
- Department for Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| |
Collapse
|
3
|
Froeliger A, Deneux-Tharaux C, Loussert L, Madar H, Sentilhes L. Posttraumatic stress disorder 2 months after cesarean delivery: a multicenter prospective study. Am J Obstet Gynecol 2024:S0002-9378(24)00440-X. [PMID: 38494069 DOI: 10.1016/j.ajog.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND The prevalence and risk factors of posttraumatic stress disorder after cesarean delivery, outside high-risk contexts, remain unclear. OBJECTIVE This study aimed to assess posttraumatic stress disorder prevalence and risk factors at 2 months postpartum among a general population of women with cesarean delivery. STUDY DESIGN This was a prospective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, conducted in 27 French hospitals from 2018 to 2020, enrolling women expected to undergo cesarean delivery before or during labor at ≥34 weeks of gestation. After randomization, characteristics of the cesarean delivery and postpartum blood loss were prospectively collected. Two months after childbirth, posttraumatic stress disorder profile (presence of posttraumatic stress disorder symptoms) and provisional diagnosis (positive screening for diagnosis consistent with a posttraumatic stress disorder) were assessed by 2 self-administered questionnaires (Impact of Event Scale - Revised and Traumatic Event Scale). The corrected posttraumatic stress disorder prevalence was estimated with inverse probability weighting to take nonresponse into account. Associations between potential risk factors and posttraumatic stress disorder were analyzed by multivariate logistic or linear regression modeling according to the type of dependent variable. RESULTS In total, 2785 of 4431 women returned the Impact of Event Scale - Revised questionnaire and 2792 the Traumatic Event Scale (response rates of 62.9% and 63.0%). The prevalence of posttraumatic stress disorder profile was 9.0% (95% confidence interval, 7.8%-10.3%) and of provisional diagnosis 1.7% (95% confidence interval, 1.2%-2.4%). Characteristics associated with a higher risk of posttraumatic stress disorder profile were prepregnancy vulnerability factors (young age, high body mass index, and African-born migrant) and cesarean delivery-related obstetrical factors (cesarean delivery after induced labor [adjusted odds ratio, 1.81; 95% confidence interval, 1.14-2.87], postpartum hemorrhage [adjusted odds ratio, 1.61; 95% confidence interval, 1.04-2.46] and high-intensity pain during the postpartum stay [adjusted odds ratio, 1.90; 95% confidence interval, 1.17-3.11]). Women who had immediate skin-to-skin contact with their newborn were at lower risk of posttraumatic stress disorder (adjusted odds ratio, 0.66; 95% confidence interval, 0.46-0.98), and women with bad memories of delivery on day 2 postpartum were at higher risk (adjusted odds ratio, 3.20; 95% confidence interval, 1.97-5.12). The Impact of Event Scale - Revised and the Traumatic Event Scale yielded consistent results. CONCLUSION Approximately 1 in 11 women with cesarean deliveries had posttraumatic stress disorder symptoms at 2 months postpartum. Some obstetrical interventions and components of cesarean delivery management may influence this risk.
Collapse
Affiliation(s)
- Alizée Froeliger
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France; Université Paris Cité, Women's Health, Institut Hors-Murs, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Research on Epidemiology and Statistics (CRESS) U1153, Inserm, Paris, France.
| | - Catherine Deneux-Tharaux
- Université Paris Cité, Women's Health, Institut Hors-Murs, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Research on Epidemiology and Statistics (CRESS) U1153, Inserm, Paris, France
| | - Lola Loussert
- Université Paris Cité, Women's Health, Institut Hors-Murs, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Research on Epidemiology and Statistics (CRESS) U1153, Inserm, Paris, France; Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse, France
| | - Hugo Madar
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France; Université Paris Cité, Women's Health, Institut Hors-Murs, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Research on Epidemiology and Statistics (CRESS) U1153, Inserm, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| |
Collapse
|
4
|
Du F, Zha J, Li Y, Fang L, Xia S, Yu Y. Risk factors for postpartum posttraumatic stress disorder after emergency admission. World J Emerg Med 2024; 15:121-125. [PMID: 38476530 PMCID: PMC10925529 DOI: 10.5847/wjem.j.1920-8642.2024.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/03/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Postpartum posttraumatic stress disorder (PTSD) can occur in women who give birth after emergency admission. The identification of risk factors for this condition is crucial for developing effective preventive measures. This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission. METHODS Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023. The patients' general conditions and perinatal clinical indicators were recorded. The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum. Multivariate logistic regression analysis was performed to identify risk factors. RESULTS A total of 276 puerperae were included, with a PTSD incidence of 20.3% at six weeks postpartum. Multivariate logistic regression analysis identified emergency cesarean section (odds ratio [OR]=2.102; 95% confidence interval [CI]: 1.114-3.966, P=0.022), admission to the emergency department after midnight (12:00 AM) (OR=2.245; 95%CI: 1.170-4.305, P<0.001), and cervical dilation (OR=3.203; 95%CI: 1.670-6.141, P=0.039) as independent risk factors for postpartum PTSD. Analgesia pump use (OR= 0.500; 95%CI: 0.259-0.966, P=0.015) was found to be a protective factor against postpartum PTSD. CONCLUSION Emergency cesarean section, admission to the emergency department after midnight, and cervical dilation were identified as independent risk factors for postpartum PTSD, while analgesic pump use was a protective factor. These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.
Collapse
Affiliation(s)
- Fengxia Du
- Department of Obstetrics, Suzhou Xiangcheng People’s Hospital, Suzhou 215131, China
| | - Jun Zha
- Department of Anesthesiology, the Second Affiliated Hospital of Wannan Medical College, Wuhu 241000, China
| | - Yan Li
- Department of Anesthesiology, Suzhou Xiangcheng People’s Hospital, Suzhou 215131, China
| | - Lichao Fang
- Department of Emergency and Intensive Care Unit, Suzhou Xiangcheng People’s Hospital, Suzhou 215131, China
| | - Shuyu Xia
- Department of Obstetrics, Suzhou Xiangcheng People’s Hospital, Suzhou 215131, China
| | - Youjia Yu
- Department of Anesthesiology, Suzhou Xiangcheng People’s Hospital, Suzhou 215131, China
| |
Collapse
|
5
|
Orovou E, Iliadou M, Chatzopoulou MT, Dagla M, Eskitzis P, Rigas N, Antoniou E. The Relation between Birth with Cesarean Section and Posttraumatic Stress in Postpartum Women. MAEDICA 2023; 18:615-622. [PMID: 38348064 PMCID: PMC10859197 DOI: 10.26574/maedica.2023.18.4.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Objective: The aim of this study was to investigate the relation between cesarean section and postpartum posttraumatic stress disorder as well as the factors that contribute to the development of posttraumatic symptoms in mothers. Materials and methods: A sample of 538 women who gave birth with emergency and elective cesarean section in a University Hospital of Thessaly, Greece, have consented to participate in a two-phase prospective study. A socio-demographic questionnaire, the stressor Criterion A, the Life Events Checklist and the Posttraumatic Checklist of the fifth edition of the Diagnostic and Statistical Manual (DSM-5) were used to diagnose posttraumatic symptoms in Greek postpartum mothers. Results:Out of 538 mothers, 37.2% had an emergency cesarean section and the remaining 62.8% an elective one. Posttraumatic stress was seen in 26 (26%) of women with emergency surgery and three (3%) of those with elective surgery. The present study also found that the inclusion of a neonate to the NICU, complications during pregnancy and delivery, lack of breastfeeding and lack of support from the partner were strongly associated with the development of posttraumatic symptoms. Conclusions:The results of the current study indicate the need to take measures to reduce cesarean section rates and promote vaginal delivery. The high posttraumatic stress rates make it imperative to take additional measures for the mental health of women after cesarean section, especially in those with a traumatic birth experience.
Collapse
Affiliation(s)
- Eirini Orovou
- aDepartment of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | | | - Maria Dagla
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Panagiotis Eskitzis
- aDepartment of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | - Nikolaos Rigas
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Evangelia Antoniou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| |
Collapse
|
6
|
Chassard D, Langlois-Jacques C, Naaim M, Galetti S, Bouvet L, Coz E, Ecochard R, Portefaix A, Kassai-Koupai B. Anesthesia practices for management of labor pain and cesarean delivery in France (EPIDOL): A cross-sectional survey. Anaesth Crit Care Pain Med 2023; 42:101302. [PMID: 37709198 DOI: 10.1016/j.accpm.2023.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND This study aimed to collect obstetric anesthesia practice and patient-reported outcomes as an update to the last French Obstetric Anesthesia survey from 1996. METHODS Maternity units were randomly selected across France and surveyed for 7 consecutive days from February, 2016, to January, 2017. Data was gathered prospectively by questionnaires filled out by patients and anesthesia providers. RESULTS There were 1885 questionnaires received from 56 units, with 379 cesarean delivery (CD) and 1506 vaginal delivery (VD) cases analyzed. The overall neuraxial labor analgesia (NLA) rate was 82.5% (95% CI [82.4-82.6]), with 70.3% (95% CI [71.4-71.6]) receiving automated administration (PCEA/PIEB). NLA was effective throughout labor in 68.2% of cases, however, severe pain was reported by 29.4% of patients. The overall rate of alternative approaches for labor analgesia was 19.5% (95%CI [19.2-19.7]). Obesity (OR 2.8; 95% CI [1.0-7.5], p < 0.04) and delivery in level I units (OR 0.6; 95% CI [0.5-0.9], p < 0.01) were associated with severe pain during VD. Satisfaction was found to be similar in patients delivering with or without NLA. The incidence of pain during CD was similar in scheduled versus non-scheduled CD. Failure of NLA during CD was associated with severe pain (OR 10.0; 95% CI [3.1-31.9], p < 0.01) and dissatisfaction (OR 26.2; 95% CI [3.0-225.1], p < 0.01). CONCLUSION Despite the high NLA rate in France, a significant proportion of women experience severe pain during labor and delivery. This study emphasizes the need for further practice guidelines in obstetric anesthesia to ensure optimal pain management and improve patients' experience during childbirth. CLINICALTRIALS govNCT02853890.
Collapse
Affiliation(s)
- Dominique Chassard
- Service d'Anesthésie-Réanimation, Hôpital Femme Mère Enfant 59, Boulevard Pinel, F-69677 Bron Cedex, France.
| | - Carole Langlois-Jacques
- Service de Biostatistique des Hospices Civils de Lyon 165, Chemin du Grand Revoyet, Bât 4D, F-69495 Pierre-Bénite, France
| | - Marie Naaim
- Service d'Anesthésie-Réanimation, Hôpital Femme Mère Enfant 59, Boulevard Pinel, F-69677 Bron Cedex, France
| | - Sonia Galetti
- INSERM, CIC1407, Hospices Civils de Lyon, Groupement Hospitalier Est, 59 Bvd Pinel, F-69500 Bron, France
| | - Lionel Bouvet
- Service d'Anesthésie-Réanimation, Hôpital Femme Mère Enfant 59, Boulevard Pinel, F-69677 Bron Cedex, France
| | - Elsa Coz
- Service de Biostatistique des Hospices Civils de Lyon 165, Chemin du Grand Revoyet, Bât 4D, F-69495 Pierre-Bénite, France
| | - René Ecochard
- Service de Biostatistique des Hospices Civils de Lyon 165, Chemin du Grand Revoyet, Bât 4D, F-69495 Pierre-Bénite, France
| | - Aurélie Portefaix
- INSERM, CIC1407, Hospices Civils de Lyon, Groupement Hospitalier Est, 59 Bvd Pinel, F-69500 Bron, France; UMR 5558, Université Claude Bernard Lyon 1, F-69100, France
| | - Behrouz Kassai-Koupai
- INSERM, CIC1407, Hospices Civils de Lyon, Groupement Hospitalier Est, 59 Bvd Pinel, F-69500 Bron, France
| |
Collapse
|
7
|
Meili X, Sasa H, Ying H, Lijuan Z, Guanxiu T, Jun L. Prevalence of postpartum post-traumatic stress disorder and its determinants in Mainland China: A systematic review and meta-analysis. Arch Psychiatr Nurs 2023; 44:76-85. [PMID: 37197866 DOI: 10.1016/j.apnu.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/18/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND The prevalence and risk factors of postpartum posttraumatic stress disorder reported by population-based studies have significantly varied and the data are all collected from regional populations in Mainland China. AIMS To utilize published data to estimate the overall prevalence of postpartum posttraumatic stress disorder and its determinants in Mainland China. METHODS Comprehensively electronic searches were performed across six English databases and three Chinese databases. Random effects of the meta-analysis were performed to evaluate the pooled prevalence of postpartum posttraumatic stress disorder. Meta-regression was performed with the variable of study design, sample size, setting, measures, region, time points, and publication year. RESULTS Totaling of nineteen studies was included, with a sample size of 13,231 postpartum women. The pooled prevalence of postpartum posttraumatic stress disorder was 11.2 % in Mainland China, with a higher prevalence at the timepoint within 1 month postpartum (18.1 %). Significant publication bias and heterogeneity were found (I2 = 97.1 %). Sample size and measurements were conditional on the prevalence of postpartum posttraumatic stress disorder. Postpartum depressive symptoms, sleep problems, cesarean section, and low levels of social support were the major risk factors for postpartum posttraumatic stress disorder. While being the one child in the family was the protective factor. CONCLUSION An increasing prevalence of posttraumatic stress disorder within one month postpartum significantly arises awareness to provide screening and more mental health services during this period. Screening programs for postpartum posttraumatic stress disorder are still needed in Mainland China.
Collapse
Affiliation(s)
- Xiao Meili
- Department of Nursing, the Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan Province, 410013, China; Xiang Ya School of Nursing, Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan Province, 410013, China
| | - Huang Sasa
- Department of Nursing, the Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan Province, 410013, China; Xiang Ya School of Nursing, Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan Province, 410013, China
| | - Hu Ying
- Department of Nursing, the Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan Province, 410013, China; Xiang Ya School of Nursing, Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan Province, 410013, China
| | - Zhang Lijuan
- Department of Nursing, the Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan Province, 410013, China; Department of Pediatrics, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan Proviince, 410013, China
| | - Tang Guanxiu
- Department of Nursing, the Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan Province, 410013, China; Department of Geriatrics, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan Province, 410013, China.
| | - Lei Jun
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan Province, 410013, China.
| |
Collapse
|
8
|
Orovou E, Eskitzis P, Mrvoljak-Theodoropoulou I, Tzitiridou-Chatzopoulou M, Arampatzi C, Rigas N, Palaska E, Dagla M, Iliadou M, Antoniou E. The Involvement of Neonatal Intensive Care Unit and Other Perinatal Factors in Postpartum PTSD After Cesarean Section. JOURNAL OF MOTHER AND CHILD 2023; 27:158-167. [PMID: 37920113 PMCID: PMC10623112 DOI: 10.34763/jmotherandchild.20232701.d-23-00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The experience of a neonate hospitalised in the Neonatal Intensive Care Unit (NICU) is an understandably traumatic experience for the parents, especially, for the mothers of neonates. This mental distress resulting from preterm birth and/or NICU hospitalisation can be understood as post-traumatic symptomatology, according to the Diagnostic and Statistical Manual-5 version. The aim of this study is to investigate the impact of the admission of a neonate to the NICU (from any reason) on the development of postpartum post-traumatic stress disorder (PTSD) in a sample of women after cesarean sections. MATERIAL AND METHODS A total of 469 women who gave birth with cesarean section from July 2019 to June 2020 participated in this study, from the original sample of 490 women who consented to participate. Data were obtained from the researcher's socio-demographic questionnaire, the past traumatic Life Events Checklist, the perinatal stressor Criterion A, and the Post-Traumatic Stress Checklist from the Diagnostic and Statistical Manual-5 version. RESULTS A percentage of 46.64% of sample experienced postpartum PTSD. Factors associated with PTSD were placenta previa type4, abruption, bleeding (β = .07, p = .049), premature contractions (β = .08, p = .039), heavy medical history or previous gynecological history and preeclampsia (β = .08, p = .034), abnormal heart rate, premature rupture of membrane, premature contractions, infections (β = .14, p = .004), life of child in danger (β = .12, p = .025), complications involving child (β = .15, p = .002), complications involving both (child and mother) (β = .12, p = .011), traumatic cesarean section (β = .041, p < .001) and prematurity (β = .12, p = .022). CONCLUSIONS Additional measures must be taken for mothers of children who have been admitted to the NICU with psychological support interventions and reassessment of their mental state.
Collapse
Affiliation(s)
- Eirini Orovou
- Department of Midwifery, University of West Attica, Egaleo, Greece
- Department of Midwifery, University of Western Macedonia, Keptse, Ptolemaida, Greece
| | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, Keptse, Ptolemaida, Greece
| | | | | | - Christiana Arampatzi
- Department of Midwifery, University of Western Macedonia, Keptse, Ptolemaida, Greece
| | - Nikolaos Rigas
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | - Ermioni Palaska
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | - Maria Dagla
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | | |
Collapse
|
9
|
Stav M, Matatov Y, Hoffmann D, Heesen P, Gliesche V, Binyamin Y, Ioscovich A, Eidelman LA, Orbach-Zinger S. Incidence of conversion to general anaesthesia and need for intravenous supplementation in parturients undergoing caesarean section under spinal anaesthesia: A retrospective observational study. Acta Anaesthesiol Scand 2023; 67:29-35. [PMID: 36056463 DOI: 10.1111/aas.14146] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/14/2022] [Accepted: 08/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Conversion from spinal anaesthesia to general anaesthesia (GA) was shown to be associated with more complications. It has been postulated that spinal injection of a low dose of local anaesthetic is a risk factor. We aimed to discover the rate of conversion from spinal anaesthesia to GA in women who received at least 10 mg heavy bupivacaine and opioids and assess its risk factors. METHODS All women that underwent spinal anaesthesia for caesarean section from 1 January 2017 to 31 December 2020 were included in this analysis. Spinal anaesthesia was performed according to department protocol using heavy bupivacaine 0.5% 10-13 mg, fentanyl 20 μg, and morphine 0.1 mg. We examined rate of conversion from spinal anaesthesia to GA and rate of need for analgesia/sedation. RESULTS There were 1.7% of women that required conversion to GA. Bupivacaine dose (OR 0.54 [95% CI 0.38 to 0.75], p < 0.001), surgery time (OR 1.03 [95% CI 1.02 to 1.04], p < 0.001), emergency caesarean section (OR 1.06 [95% CI 1.16 to 3.76], p = 0.015), and postpartum haemorrhage (OR 5.96 [95% CI 1.09 to 25.18], p = 0.025) were independent predictors of need for conversion to GA. Of the women who had CS under spinal anaesthesia, 4.1% of parturients required intraoperative analgesics/sedatives and 9.1% required anxiolysis. CONCLUSIONS A small proportion of women required conversion to GA. This conversion occurred especially with emergency caesarean section and when low spinal bupivacaine doses were used.
Collapse
Affiliation(s)
- Michael Stav
- Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Yuri Matatov
- Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Dana Hoffmann
- Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Soroka University Medical Center, Beer Sheva, Israel
| | - Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Leonid A Eidelman
- Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Orbach-Zinger
- Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
10
|
Nagle U, Naughton S, Ayers S, Cooley S, Duffy RM, Dikmen-Yildiz P. A survey of perceived traumatic birth experiences in an Irish maternity sample – prevalence, risk factors and follow up. Midwifery 2022; 113:103419. [DOI: 10.1016/j.midw.2022.103419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
|
11
|
Orovou E, Dagla M, Eskitzis P, Savvidis GS, Rigas N, Papatrechas A, Sarella A, Arampatzi C, Antoniou E. The Involvement of Past Traumatic Life Events in the Development of Postpartum PTSD after Cesarean Delivery. Healthcare (Basel) 2022; 10:healthcare10091761. [PMID: 36141373 PMCID: PMC9498371 DOI: 10.3390/healthcare10091761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/07/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Although childbirth is considered a natural process, a high percentage of postpartum women consider it traumatic. Any previous traumatic event in a woman’s life can be revived through a traumatic birth experience, especially after a complicated vaginal delivery or cesarean delivery. The purpose of this study was to clarify the relationship between previous traumatic life events and posttraumatic stress disorder (PTSD) in postpartum women after cesarean section and which specific events exerted the greatest influence. Methods: A sample of 469 women who had undergone cesarean sections at a Greek university hospital consented to participate in this prospective study. Data from a medical/demographic questionnaire, life events checklist, perinatal stressor criterion A, and posttraumatic stress checklist were used to evaluate past traumatic life events and diagnose postpartum posttraumatic stress. Results: Out of 469 women, 25.97% had PTSD and 11.5% a PTSD profile, while 2.7% had PTSD and 2.7% a PTSD profile. Also, it appeared that only specific direct exposure to a traumatic event and/or witnessing one were predictors of postpartum PTSD. Conclusions: This survey identified specific traumatic life events, psychiatric history, stressor perinatal criterion A, preterm birth, and emergency cesarean section as risk factors for the development of PTSD or a PTSD profile in women after cesarean delivery.
Collapse
Affiliation(s)
- Eirini Orovou
- Department of Midwifery, University of Western Macedonia, 50100 Kozani, Greece
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
- Correspondence: (E.O.); (E.A.); Tel.: +30-6937205679 (E.O.); +30-6977960041 (E.A.)
| | - Maria Dagla
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, 50100 Kozani, Greece
| | - Georgios S. Savvidis
- Department of Occupational Therapy, University of Western Macedonia, 50100 Kozani, Greece
| | - Nikolaos Rigas
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | | | - Angeliki Sarella
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | | | - Evangelia Antoniou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
- Correspondence: (E.O.); (E.A.); Tel.: +30-6937205679 (E.O.); +30-6977960041 (E.A.)
| |
Collapse
|
12
|
Stanford SER. What is 'genuine' failure of neuraxial anaesthesia? Anaesthesia 2022; 77:523-526. [PMID: 35332526 DOI: 10.1111/anae.15723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 01/26/2023]
|
13
|
Bodin E, Peretti V, Rouillay J, Tran PL, Boukerrou M. [Posttraumatic stress disorder and emergency cesarean delivery: Incidence and risk factors]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:240-260. [PMID: 35017128 DOI: 10.1016/j.gofs.2021.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is declared in 3 to 6 % of postpartum women (PP) and up to 18.5 % in cases of complications of pregnancy or childbirth. The objective of this study is to assess the prevalence of PTSD after a red code cesarean section and to identify the risk factors among the prenatal vulnerability factors, the birth alert factors and the maintenance factors in PP. METHOD A phone or computerized questionnaire including an Questionnaire de stress immédiat and the Posttraumatic Stress Disorder Checklist for DSM-5 was offered to patients who had a red code cesarean section between 05/12/2015 and 02/28/2021 at the University South Hospital of Reunion Island. RESULTS Among the 555 cesarean sections selected, 329 parturients responded. The prevalence of PTSD was 20.1 % and was stable over time. The 2 risk factors found were the negative experience of childbirth and the proven traumatic experience. Prenatal vunerability factors were not found to be statistically significant. Almost 3 in 4 women had not been informed of the risk of cesarean section and more than 1 in 2 women did not have an explanation in PP. CONCLUSION Red code cesarean sections cause PTSD in 1 in 5 women. This lasting disorder can last up to 6 years after childbirth. This indicates the seriousness of this disorder and the need to prevent it. The risk of developing it is 4 times greater in the event of a traumatic experience proven in the Questionnaire de stress immédiat. Offering this questionnaire in the maternity could be an important element of secondary prevention. The role of health personnel remains essential.
Collapse
Affiliation(s)
- E Bodin
- Service de PMA, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
| | - V Peretti
- Service de gynécologie obstétrique, CHU Sud Réunion, avenue François-Mitterrand, 97410 Saint-Pierre, Réunion.
| | - J Rouillay
- UMPP Ouest, EPSMR Saint-Paul, 11, rue de l'Hôpital, 97460 Saint-Paul, Réunion.
| | - P L Tran
- Service de gynécologie obstétrique, CHU Sud Réunion, avenue François-Mitterrand, 97410 Saint-Pierre, Réunion.
| | - M Boukerrou
- Service de gynécologie obstétrique, CHU Sud Réunion, avenue François-Mitterrand, 97410 Saint-Pierre, Réunion.
| |
Collapse
|
14
|
Orbach-Zinger S, Grant T, Zahalka M, Ioscovich A, Fein S, Ginosar Y, Matkovski O, Weiniger C, Binyamin Y. A national Israeli survey of neuraxial anesthesia for cesarean delivery: pre-operative block assessment and intra-operative pain management. Int J Obstet Anesth 2022; 50:103255. [DOI: 10.1016/j.ijoa.2022.103255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 12/25/2022]
|
15
|
Abstract
The integration of trauma-informed care practices into the care of obstetric patients requires an understanding of psychological trauma, its impact on this population, and how trauma-informed care can be adapted to improve outcomes for those patients with a previous history of trauma or for those that experience peripartum trauma. System-based changes to policies, protocols, and practices are needed to achieve sustainable change. Maternal morbidity and mortality that result from trauma-related and other mental health conditions in the peripartum period are significant. Innovative approaches to the prevention of negative birth experiences and retraumatization during labor and delivery are needed.
Collapse
Affiliation(s)
- Tracey M Vogel
- Department of Anesthesiology, West Penn Hospital/Allegheny Health Network, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.
| | - Erica Coffin
- Obstetric Anesthesia, Department of Anesthesiology, West Penn Hospital/Allegheny Health Network, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA. https://twitter.com/coffin_erica
| |
Collapse
|
16
|
Keltz A, Heesen P, Katz D, Neuman I, Morgenshtein A, Azem K, Binyamin Y, Hadar E, Eidelman LA, Orbach-Zinger S. Intraoperative pain during caesarean delivery: Incidence, risk factors and physician perception. Eur J Pain 2021; 26:219-226. [PMID: 34448323 PMCID: PMC9291577 DOI: 10.1002/ejp.1856] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/24/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Intraoperative pain is a possible complication of neuraxial anaesthesia for caesarean delivery. There is little information available about its incidence, risk factors and physician perception. METHODS Parturients undergoing spinal anaesthesia for elective caesarean delivery were enrolled. Before surgery, parturients were asked about preoperative anxiety on a verbal numerical scale (VNS), anticipated analgesic requirement, postoperative pain levels, Spielberger STATE-TRAIT inventory index, Pain Catastrophizing Scale. After surgery, parturients were asked to answer questions (intraoperative VNS pain). The anaesthesiologist and obstetrician were asked to fill out a questionnaire asking about perceived intraoperative pain. Influence of preoperative anxiety on intraoperative pain (yes/no) was assessed using logistic regression. Mc Fadden's R2 was calculated. The agreement in physician perception of intraoperative pain with reported pain by the parturient was examined by calculating Cohen's kappa and 95% Confidence Intervals (CI). RESULTS We included 193 parturients in our analysis. Incidence of intraoperative pain was 11.9%. Median intraoperative VNS pain of parturients with pain was 4.0 (1st quartile 4.0; 3rd quartile 9.0). Preoperative anxiety was not a good predictor of intraoperative pain (p-value of β-coefficient = 0.43, Mc Fadden's R2 = 0.01). Including further preoperative variables did not result in a good prediction model. Cohen's kappa between reported pain by parturient and by the obstetrician was 0.21 (95% CI: 0.01, 0.41) and by the anaesthesiologist was 0.3 (95% CI: 0.12, 0.48). CONCLUSIONS We found a substantial incidence (11.9%) of intraoperative pain during caesarean delivery. Preoperative anxiety did not predict intraoperative pain. Physicians did not accurately identify parturients' intraoperative pain. SIGNIFICANCE Intraoperative pain occurred in 11.9% and severe intraoperative pain occurred in 1.11% of parturients undergoing elective caesarean delivery under spinal anaesthesia. We did not find any preoperative variables that could reliably predict intraoperative pain. Obstetricians and anaesthesiologists underestimated the incidence of intraoperative pain in our cohort and thus, more attention must be put to parturients' pain.
Collapse
Affiliation(s)
- Amir Keltz
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philip Heesen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel Katz
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ido Neuman
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anna Morgenshtein
- Department of women's surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Karam Azem
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eran Hadar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Rabin Medical Center, Helen Schneider Hospital for Women, Beilinson Hospital, Petach Tikva, Israel
| | - Leonid A Eidelman
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Orbach-Zinger
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
17
|
Orovou E, Theodoropoulou IM, Antoniou E. Psychometric properties of the Post Traumatic Stress Disorder Checklist for DSM-5 (PCL-5) in Greek women after cesarean section. PLoS One 2021; 16:e0255689. [PMID: 34388199 PMCID: PMC8363016 DOI: 10.1371/journal.pone.0255689] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/21/2021] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to examine psychometric properties of the revised Posttraumatic Stress Checklist (PCL-5) for Diagnostic and Statistical Manual- 5th Edition (DSM-5) in Greek postpartum women after Cesarean Section(CS) (emergency-elective).So far, there was no study in Greece assessing psychometric properties of the PCL-5 in women after CS. The participating women (N = 469), who gave birth with emergency and elective CS at the Greek University Hospital of Larisa, have consented to participate in two phases of the survey and completed self-report questionnaires, the 2nd day after CS and at the 6th week after CS. Measures used in this study were the PCL-5 for DSM-5, the Life Events Checklist (LEC-5), Criteria B, C, D, E, and Criterion A, specifically designed for detection of posttraumatic stress disorder (PTSD) symptoms in postpartum period. To evaluate the internal reliability of the PCL-5 two different indices of internal consistency were calculated, i.e., Cronbach's alpha (.97) and Guttman'ssplit-half (.95), demonstrating high reliability level. The data were positively skewed, suggesting that the reported levels of PTSD among our participants were low. Factor analyses demonstrated acceptable construct validity; a comparison of thePCL-5 with the other measures of the same concept showed a good convergent validity of the scale. Overall, all the results suggest that the four-factor PCL-5 seemed to work adequately for the Greek sample of women after CS.
Collapse
Affiliation(s)
- Eirini Orovou
- Department of Midwifery, University of West Attica, Aigaleo, Greece
| | | | | |
Collapse
|
18
|
Ituk U, Wong CA. Anesthetic Choices for Intrapartum Cesarean Delivery in Patients with Epidural Labor Analgesia. Adv Anesth 2021; 38:23-40. [PMID: 34106837 DOI: 10.1016/j.aan.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Unyime Ituk
- Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 6JCP, Iowa City, IA 52242, USA
| | - Cynthia A Wong
- Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Drive, JCP6618, Iowa City, IA 52242, USA.
| |
Collapse
|
19
|
Orbach-Zinger S, Eidelman LA, Livne MY, Matkovski O, Mangoubi E, Borovich A, Wazwaz SA, Ioscovich A, Zekry ZHB, Ariche K, Weiniger CF. Long-term psychological and physical outcomes of women after postdural puncture headache: A retrospective, cohort study. Eur J Anaesthesiol 2021; 38:130-137. [PMID: 32858584 DOI: 10.1097/eja.0000000000001297] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postdural puncture headache after accidental dural puncture during labour may lead to chronic sequalae. OBJECTIVES We aimed to measure the incidence of postpartum depression, posttraumatic stress disorder, chronic headache, backache and breastfeeding rates after a postdural puncture headache. DESIGN A retrospective, case-matched cohort study. SETTING A review of documented cases of dural puncture and matched case controls occurring at Rabin Medical Center and Shamir Medical Center from 01 January 2012 to 30 September 2018. PATIENTS The study cohort consisted of women with a documented postdural puncture headache and the controls were women with uneventful labour epidurals in the same 24-h period. Women were interviewed by telephone. PRIMARY OUTCOMES MEASURE The primary outcome measure was the incidence of postpartum depression after a postdural puncture headache. RESULTS Women with postdural puncture headache (n = 132) and controls (n = 276) had similar demographic data. The incidence of postpartum depression was 67/128 (52.3%) versus 31/276 (11.2%) for controls, P < 0.0001, 95% confidence intervals of the difference 31.5 to 50.2. Posttraumatic stress disorder was more frequent among women with postdural puncture headache, 17/132 (12.8%) versus controls 1/276 (0.4%), P < 0.0001, 95% confidence intervals of the difference 7.6 to 19.5. Women with postdural puncture headache breastfed less, 74/126 (54.5%) versus controls 212/276 (76.8%), P < 0.0001, 95% confidence intervals of the difference 33.1 to 55.2. Current headache and backache were significantly more frequent among women with postdural puncture headache [current headache 42/129 (32.6%) versus controls 42/276 (15.2%) P < 0.00001, 95% confidence intervals 0.085 to 0.266; current backache 58/129 (43.9%) versus controls 58/275 (21%) P < 0.0001, 95% confidence intervals 14.1 to 33.5]. CONCLUSION We report an increased incidence of postpartum depression, posttraumatic stress disorder, chronic headache and backache and decreased breastfeeding following a postdural puncture headache. Our findings emphasise the need for postpartum follow-up for women with postdural puncture headache. TRIAL REGISTRY NUMBER Clinical trial registry number: NCT03550586.
Collapse
Affiliation(s)
- Sharon Orbach-Zinger
- From the Department of Anesthesia, Rabin Medical Centre and Sackler Faculty of Medicine, Tel Aviv University (SOZ, LAE, MYL, EM, SW), the Department of Anesthesia, Assaf Harofeh Medical Centre, Shamir Medical Centre (OM, ZHBZ), the Department of Obstetrics Gynaecology, Rabin Medical Centre and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv (AB), the Department of Anesthesia, Shaare Zedek Medical Centre (AI), Hebrew University (AI), the Pain Clinic, Hadassah Hospital, Hebrew University, Jerusalem (KA) and the Department of Anesthesia, Critical Care and Pain Medicine, Tel Aviv Medical Centre, Tel-Aviv, Israel (CFW)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Deforges C, Stuijfzand S, Noël Y, Robertson M, Breines Simonsen T, Eberhard-Gran M, Garthus-Niegel S, Horsch A. The relationship between early administration of morphine or nitrous oxide gas and PTSD symptom development. J Affect Disord 2021; 281:557-566. [PMID: 33421836 DOI: 10.1016/j.jad.2020.12.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Posttraumatic Stress Disorder (PTSD) is a debilitating mental health disorder. Certain drugs, such as morphine and nitrous oxide gas (N2O), are administered to individuals who just experienced a traumatic event (e.g., soldiers, injured civilians). It is therefore crucial to understand if they incidentally affect PTSD symptom development. Furthermore, such observations could pave the way for the development of pharmacological prevention strategies of PTSD. METHODS In this prospective population-based cohort study (n = 2,070), we examined the relationship between morphine or N2O administration during childbirth, and subsequent childbirth-related PTSD symptoms at eight weeks postpartum. Pain during labour, prior PTSD symptoms, and birth medical severity were included as covariates in the analyses. RESULTS In women who developed PTSD symptoms, N2O administration during childbirth predicted reduced PTSD symptom severity (p < .001, small to medium effect size). A similar tendency was observed for morphine, but was not significant (p < .065, null to small effect size). Both drugs predicted increased PTSD symptoms when combined with severe pain during labour. LIMITATIONS This study was observational, thus drug administration was not randomised. Additionally, PTSD symptoms were self-reported. CONCLUSIONS Peritraumatic N2O administration may reduce subsequent PTSD symptom severity and thus be a potential avenue for PTSD secondary prevention. This might also be the case for morphine. However, the role of severe peritraumatic pain in context of drug administration deserves further investigation.
Collapse
Affiliation(s)
- Camille Deforges
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland.
| | - Suzannah Stuijfzand
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland.
| | | | - Moira Robertson
- Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.
| | - Tone Breines Simonsen
- HØKH - Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway; Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway.
| | - Malin Eberhard-Gran
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Women's Health, Women and Children's Division, Oslo University Hospital, Oslo, Norway.
| | - Susan Garthus-Niegel
- Department of Medicine, Medical School Hamburg, Hamburg, Germany; Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway; Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland; Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.
| |
Collapse
|
21
|
Vogel TM, Homitsky S. Antepartum and intrapartum risk factors and the impact of PTSD on mother and child. BJA Educ 2021; 20:89-95. [PMID: 33456935 DOI: 10.1016/j.bjae.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- T M Vogel
- West Penn Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - S Homitsky
- West Penn Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| |
Collapse
|
22
|
Elaboration and Validation of Two Predictive Models of Postpartum Traumatic Stress Disorder Risk Formed by Variables Related to the Birth Process: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010092. [PMID: 33374483 PMCID: PMC7795639 DOI: 10.3390/ijerph18010092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 11/21/2022]
Abstract
This study aimed to develop and validate two predictive models of postpartum post-traumatic stress disorder (PTSD) risk using a retrospective cohort study of women who gave birth between 2018 and 2019 in Spain. The predictive models were developed using a referral cohort of 1752 women (2/3) and were validated on a cohort of 875 women (1/3). The predictive factors in model A were delivery type, skin-to-skin contact, admission of newborn to care unit, presence of a severe tear, type of infant feeding at discharge, postpartum hospital readmission. The area under curve (AUC) of the receiver operating characteristic (ROC) in the referral cohort was 0.70 (95% CI: 0.67–0.74), while in the validation cohort, it was 0.69 (95% CI: 0.63–0.75). The predictive factors in model B were delivery type, admission of newborn to care unit, type of infant feeding at discharge, postpartum hospital readmission, partner support, and the perception of adequate respect from health professionals. The predictive capacity of model B in both the referral cohort and the validation cohort was superior to model A with an AUC-ROC of 0.82 (95% CI: 0.79–0.85) and 0.83 (95% CI: 0.78–0.87), respectively. A predictive model (model B) formed by clinical variables and the perception of partner support and appropriate treatment by health professionals had a good predictive capacity in both the referral and validation cohorts. This model is preferred over the model (model A) that was formed exclusively by clinical variables.
Collapse
|
23
|
Bayrı Bingöl F, Bal MD, Dişsiz M, Sormageç MT, Yildiz PD. Validity and reliability of the Turkish version of the City Birth Trauma Scale (CityBiTS). J OBSTET GYNAECOL 2020; 41:1023-1031. [PMID: 33263267 DOI: 10.1080/01443615.2020.1821354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The City Birth Trauma Scale (CityBiTS) was developed to be consistent with the current Diagnostic and Statistical Manual of Mental Disorders-DSM-5. It has been used as a complementary instrument that measures the psychological trauma related to childbirth. The aim of this study was to investigate the validity and reliability of the Turkish version of the CityBiTS. This research is a methodological study. This study was conducted with 315 women who had 6-month-old infants from August to October 2018. The CityBiTS is a 29-item instrument that was developed according to DSM-5 criteria to assess childbirth-related Post-Traumatic Stress Disorder. Test-retest measurements were performed at two-week intervals to evaluate the invariance of the scale over time. Cronbach's alpha coefficient of reliability was used to analyse internal consistency of scale. Cronbach's alpha coefficients were .76 for re-experiencing symptoms, .57 for avoidance symptoms, .77 for negative cognitions and mood, .83 for hyperarousal and .82 for dissociative symptoms. In conclusion, The Turkish version of the CityBiTS, as an instrument developed to be consistent with DSM-5 criteria in assessing childbirth-related trauma symptoms, is a valid and reliable tool.Impact statementWhat is already known on this subject? One of the possible barriers for this is the lack of validated questionnaires that measure the postpartum PTSD.What do the results of this study add? The aim of this study was to investigate the validity and reliability of the Turkish version of the CityBiTS. The City Birth Trauma Scale has good psychometric properties and the two symptom clusters identified are consistent with previous research on symptoms of postpartum PTSD.What are the implications of these findings for clinical practice and/or further research? The City Birth Trauma Scale provides with a measure of birth-related PTSD foruse in research and clinical practice.
Collapse
Affiliation(s)
- Fadime Bayrı Bingöl
- Midwifery Department, Marmara University, Health Sciences Faculty, Istanbul, Turkey
| | - Meltem Demirgöz Bal
- Midwifery Department, Marmara University, Health Sciences Faculty, Istanbul, Turkey
| | - Melike Dişsiz
- Hamidiye Faculty of Nursing, University of Health Science, Uskudar, Istanbul, Turkey
| | | | | |
Collapse
|
24
|
Heesen P, Orbach-Zinger S, Grigoriadis S, Halpern S, Eidelman LA. The Effect of Analgesia and Anesthesia on Postpartum Depression. Adv Anesth 2020; 38:157-165. [PMID: 34106832 DOI: 10.1016/j.aan.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Philip Heesen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Sharon Orbach-Zinger
- Department of Anesthesia, Beilinson Hospital, Petach Tikvah, Israel; Affiliated with Saklar Medical School, Tel Aviv University
| | - Sophie Grigoriadis
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, FG 44, Psychiatry, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Stephen Halpern
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, 63 Elm Ridge Drive, Toronto, Ontario M6B 1A2, Canada
| | - Leonid A Eidelman
- Department of Anesthesia, Beilinson Hospital, Petach Tikvah, Israel; Affiliated with Saklar Medical School, Tel Aviv University.
| |
Collapse
|
25
|
Bayri Bingol F, Demirgoz Bal M. The risk factors for postpartum posttraumatic stress disorder and depression. Perspect Psychiatr Care 2020; 56:851-857. [PMID: 32175591 DOI: 10.1111/ppc.12501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/22/2020] [Accepted: 03/07/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE In this study, we examined the association between specific birth-related variables and postpartum posttraumatic stress disorder (PTSD) and depressive symptoms. DESIGN AND METHODS In this descriptive study, data were collected using a personal information form, the City Birth Trauma Scale, and the Edinburgh Postpartum Depression Scale. FINDINGS The findings revealed that 8.5% of participants met all the diagnostic criteria for PTSD. The risk of developing depression was 9.7 times higher among women who met all the criteria for PTSD than among those who did not meet all the criteria. PRACTICE IMPLICATIONS During the postpartum period, at-risk mothers should be followed and screened for PTSD and depressive symptoms.
Collapse
Affiliation(s)
- Fadime Bayri Bingol
- Department of Midwifery, Health Sciences Faculty, Marmara University, Istanbul, Maltepe, Turkey
| | - Meltem Demirgoz Bal
- Department of Midwifery, Health Sciences Faculty, Marmara University, Istanbul, Maltepe, Turkey
| |
Collapse
|
26
|
Kountanis JA, Muzik M, Chang T, Langen E, Cassidy R, Mashour GA, Bauer ME. Relationship between postpartum mood disorder and birth experience: a prospective observational study. Int J Obstet Anesth 2020; 44:90-99. [PMID: 32861082 DOI: 10.1016/j.ijoa.2020.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aims to investigate the relationship between the birth experience and the risk of developing postpartum depression or post-traumatic stress disorder. METHODS In this prospective, longitudinal, observational study, women were assessed at different time points for depression and post-traumatic stress disorder. The risk of depression or post-traumatic stress disorder based on patient characteristics and specific birth events was assessed within three months postpartum. RESULTS We enrolled 600 women; 426 were eligible for postpartum assessment. At six weeks and three months postpartum, 15.9% and 12.7% screened positive for depression respectively. Positive post-traumatic stress disorder screenings at six weeks and three months postpartum were 6.2% and 5.1% respectively. Twenty-seven women (8.3%) with a negative screening at six weeks converted to a positive depression or post-traumatic stress disorder screening at three months. A pre-existing history of anxiety or depression was associated with an increased risk of developing depression (aOR 2.12, 95% CI 1.30 to 3.47) and post-traumatic stress (aOR 3.15, 95% CI 1.42 to 7.02) within three months postpartum. The risk of developing post-traumatic stress disorder within three months postpartum was also increased among patients experiencing their first delivery (aOR 2.55, 95% CI 1.10 to 5.88) or operative management of postpartum hemorrhage (aOR 4.44, 95% CI 1.16 to 17.02). CONCLUSION Depression and post-traumatic stress symptoms either persisted or had new onset at three months postpartum. Mental health screening and postpartum follow-up after six weeks should be considered in high-risk patients who have a history of psychopathology, nulliparity, or undergo operative management of postpartum hemorrhage.
Collapse
Affiliation(s)
- J A Kountanis
- Department of Anesthesiology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA; Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA.
| | - M Muzik
- Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA; Department of Psychiatry, Michigan Medicine, 1500 E Medical Center Dr, MI, USA; U-M for Healthcare Policy and Innovation, 2800 Plymouth Road, North Campus Research Complex, Building 16, MI, USA
| | - T Chang
- Department of Family Medicine, Michigan Medicine, 1500 E Medical Center Dr, MI, USA; U-M for Healthcare Policy and Innovation, 2800 Plymouth Road, North Campus Research Complex, Building 16, MI, USA
| | - E Langen
- Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA
| | - R Cassidy
- Department of Anesthesiology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA
| | - G A Mashour
- Department of Anesthesiology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA
| | - M E Bauer
- Department of Anesthesiology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA; Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA
| |
Collapse
|
27
|
Correlation between Kind of Cesarean Section and Posttraumatic Stress Disorder in Greek Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051592. [PMID: 32121561 PMCID: PMC7084417 DOI: 10.3390/ijerph17051592] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/20/2020] [Accepted: 02/27/2020] [Indexed: 11/22/2022]
Abstract
A birth experience with cesarean section (CS) can be a cause of the development of post-traumatic stress disorder after a cesarean (PTSD-AC) or profile PTSD, for a percentage of women. So far, there is no data on the frequency of PTSD-AC in Greece and this syndrome is often associated with other mental disorders of the postpartum period. The purpose of this research is to associate the kind of CS with PTSD-AC for Greek mothers and the combination of factors that make them less resistant to trauma. A sample of ahundred and sixty-six mothers who gave birth with emergency cesarean section (EMCS) and elective cesarean section (ELCS) at a Greek University hospital have consented to participate in the two phases of the survey, in the 2nd day postpartum and a follow-up in the 6th week postpartum. Medical/demographic data and a life events checklist (LEC-5) with Criterion A and post-traumatic stress checklist (PCL-5) were used to diagnose PTSD and PTSD Profile. Out of166 mothers enrolled, 160 replied to the follow-up (96.4%), ELCS 97 (97%) and EMCS 63 (95%). Twenty (31.7%) EMCS had PTSD and nine (14.3%) had Profile. One (1%) ELCS had PTSD and 4 (4.1%) had Profile. This survey shows a high prevalence rate of PTSD after EMCS with additional risk factors of preterm labor, inclusion in the Neonatal Intensive Care Unit (NICU), a lack of breastfeeding, and a lack of support from the partner.
Collapse
|
28
|
Chen Y, Yang X, Guo C, Liao Y, Guo L, Chen W, Chen I, Krewski D, Wen SW, Xie RH. Prevalence of Post-Traumatic Stress Disorder Following Caesarean Section: A Systematic Review and Meta-Analysis. J Womens Health (Larchmt) 2019; 29:200-209. [PMID: 31532326 DOI: 10.1089/jwh.2019.7750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: While caesarean section (CS) can be a lifesaving intervention when performed in a timely manner to overcome dystocia or other complications, it is a traumatic event and may increase the risk of post-traumatic stress disorder (PTSD). No attempt has been made to assess prevalence of PTSD after CS specifically. This study aimed to quantify pooled prevalence of PTSD after CS through a systematic review and meta-analysis. Methods: MEDLINE, PsycINFO, EMBASE, and CINAHL were searched using PTSD terms crossed with CS terms. Studies were included if they reported the prevalence of PTSD after CS using an instrument based on Diagnostic and Statistical Manual of Mental Disorders-criteria to identify PTSD. The pooled prevalence was then estimated by meta-analysis in overall eligible studies and in subgroups. Results: Nine studies were included with a total of 1,134 postpartum women, of which 136 were identified as having PTSD. Pooled prevalence of PTSD after CS was 10.7% (95% confidence interval [CI]: 4.0-20.2). Pooled prevalence of PTSD after emergency CS (10.3% [95% CI: 1.7-24.9]) was higher than that after elective CS (7.1% [95% CI: 0.7-19.4]), but the difference was not statistically significant. Subgroup analysis showed that pooled prevalence of PTSD after CS differed according to study setting, time interval of PTSD assessment, and type of participants. Meta-regression analysis showed that study setting and type of study participants were significant sources of heterogeneity. Conclusions: Women with CS apparently have higher rates of PTSD as compared with women without CS. However, the susceptibility to PTSD appears to vary based on emergency/elective CS, study methodology, self-perceived traumatic birth, and country of study. Further targeted research is needed to elucidate the role of these factors in relationship between CS and PTSD.
Collapse
Affiliation(s)
- Yanfang Chen
- Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Xiaoxian Yang
- School of Nursing, Wuxi Taihu University, Wuxi, Jiangsu, China
| | - Chentao Guo
- Department of Epidemiology, Xishan Center for Disease Control and Prevention, Wuxi, Jiangsu, China
| | - Yan Liao
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lixing Guo
- Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Wenjun Chen
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Innie Chen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Ri-Hua Xie
- Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
| |
Collapse
|
29
|
Gondwe KW, Brandon D, Yang Q, Malcom WF, Small MJ, Holditch-Davis D. Emotional distress in mothers of early-preterm infants, late-preterm infants, and full-term infants in Malawi. Nurs Outlook 2019; 68:94-103. [PMID: 31375345 DOI: 10.1016/j.outlook.2019.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 05/19/2019] [Accepted: 05/28/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mothers of preterm infants, early or late, report more distress than mothers of full-term infants. Malawi has the highest preterm birth rate in the world, but nothing is known about the relation of preterm birth to maternal mental health. PURPOSE To compare emotional distress among mothers of early-preterm, late-preterm, and full-term infants. METHODS We recruited 28 mothers of early-preterm, 29 mothers of late-preterm, and 28 mothers of full-term infants. Emotional distress was assessed 24-72 hr following birth. One-way ANOVA and regression analysis were used to compare the three groups. FINDINGS Mothers of early-preterm infants reported more distress symptoms than mothers of full-term infants, and scores of mothers of late-preterm infants fell between the other two groups. Having a support person present was associated with lower symptoms and caesarean birth was associated with more symptoms. DISCUSSION Promoting maternal mental health is important following preterm birth and health care providers need to support mothers.
Collapse
Affiliation(s)
- Kaboni Whitney Gondwe
- University of Wisconsin, Milwaukee, Milwaukee, WI; School of Nursing, Duke University, Durham, NC.
| | | | - Qing Yang
- School of Nursing, Duke University, Durham, NC
| | | | | | | |
Collapse
|
30
|
Hernández-Martínez A, Rodríguez-Almagro J, Molina-Alarcón M, Infante-Torres N, Donate Manzanares M, Martínez-Galiano JM. Postpartum post-traumatic stress disorder: Associated perinatal factors and quality of life. J Affect Disord 2019; 249:143-150. [PMID: 30772741 DOI: 10.1016/j.jad.2019.01.042] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/31/2018] [Accepted: 01/22/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The relationship between obstetric variables and postpartum post-traumatic stress disorder (PTSD), and its influence on quality of life (QoL), have scarcely been studied. OBJECTIVE Determine the prevalence of PTSD at postpartum weeks 4 and 6, and its relation with perinatal variables and quality of life METHOD: A cross-sectional study with 2990 Spanish puerperal women in Spain. Data were collected on socio-demographic and obstetric variables, and on newborns. An online ad hoc questionnaire was used, including the Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) and SF-36. The crude and adjusted odds ratios were estimated by binary logistic regression. RESULTS 10.6% (318) of the women appeared at risk for PTSD symptoms. Factors like having a respected birth plan (aOR: 0.52; 95%CI: 0.34, 0.80), using epidural analgesia (aOR: 0.64; 95%CI: 0.44, 0.92) and performing skin-to-skin contact (aOR: 0.37; 95%CI: 0.28, 0.50) were protective factors against PTSD, among others. Instrumental birth (aOR: 2.50; 95%CI: 1.70, 3.69) and caesarean section (aOR: 3.79; 95%CI: 2.43, 5.92) were found to be risk factors, among others. The area under the ROC curve in this model was 0.79 (95%CI: 0.76, 0.81). The women with PTSD presented a mean difference for QoL of -13.37 points less than those without PTSD (95%CI: -11.08, -15.65). CONCLUSIONS The women with PTSD symptoms had a worse quality of life at postpartum weeks 4-6. Birth type, analgesia methods and humanising practices, like skin-to-skin contact and using respected birth plans, were related with presence of the postpartum PTSD risk.
Collapse
Affiliation(s)
| | | | | | | | | | - Juan Miguel Martínez-Galiano
- Department of Health Sciencies, University of Jaen, Jaen, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Madrid, Spain
| |
Collapse
|
31
|
Beck CT, Casavant S. Synthesis of Mixed Research on Posttraumatic Stress Related to Traumatic Birth. J Obstet Gynecol Neonatal Nurs 2019; 48:385-397. [PMID: 30958993 DOI: 10.1016/j.jogn.2019.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To synthesize mixed-research results (quantitative and qualitative) on posttraumatic stress in women who experienced traumatic births. DATA SOURCES PubMed, Scopus, and PsycINFO databases. STUDY SELECTION Quantitative and qualitative studies were included if they were published in English from January 1, 2009, through December 31, 2018, and focused on posttraumatic stress in the postpartum period related to traumatic childbirth. DATA EXTRACTION The final sample consisted of 59 studies: 4 qualitative and 55 quantitative. Both authors independently appraised each study using the Critical Appraisal Skills Programme. Quantitative studies were synthesized by narrative synthesis and vote counting, and qualitative studies were synthesized by content analysis. DATA SYNTHESIS In the included studies, prevalence rates of elevated posttraumatic stress ranged from 0.8% to 26%. Significant predictors of posttraumatic stress that occurred before childbirth and those that were birth related were identified. Reports of six intervention studies to decrease posttraumatic stress symptoms after traumatic births were included. These interventions focused on postnatal debriefing, expressive writing, online cognitive behavioral therapy, a brief cognitive intervention, and the implementation of the nine instinctive stages of the infant during the first hour after birth. We created four themes from the findings of the qualitative studies: Distressing Symptoms, Detrimental Effect of Posttraumatic Stress on Women's Relationships With Their Infants and Partners, Critical Influence ofSupport, and Debriefing. CONCLUSION When a woman experiences posttraumatic stress related to a traumatic birth, the entire family unit is vulnerable. Findings from quantitative predictor studies can be used to develop an instrument to screen women for risk factors for posttraumatic stress related to birth trauma. Primary interventions are needed to prevent women from experiencing traumatic births.
Collapse
|
32
|
Liu F, Lv L, Jiang H, Yan R, Dong S, Chen L, Wang W, Chen YQ. Alterations in the Urinary Microbiota Are Associated With Cesarean Delivery. Front Microbiol 2018; 9:2193. [PMID: 30258432 PMCID: PMC6143726 DOI: 10.3389/fmicb.2018.02193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/27/2018] [Indexed: 12/20/2022] Open
Abstract
Similar to the gut, the bladder contains urinary microbiota, and its bacterial composition and structure are determined by the individual’s health status. Cesarean section is a traumatic event for women and it is correlated with postpartum complications. To better understand the urinary microbiota alterations caused by cesarean section, 16S rDNA sequencing was used to assess urine specimens collected by transurethral catheterization from 30 healthy women undergoing cesarean section pre-delivery (PreD) and post-delivery (PostD). A significant increase in bacterial diversity and more detectable bacteria at the phylum, family, and genus levels was observed in the PostD group compared to the PreD group, indicating that cesarean delivery (a process that includes surgery and delivery) altered the bacterial community. Specifically, the phylum Firmicutes and its affiliated family Lactobacillaceae and genus Lactobacillus dramatically decreased in the PostD group, suggesting that beneficial bacteria decreased after cesarean section, and clinicians should be aware that this might increase the risk of complications. Concurrently, the phylum Proteobacteria and its affiliated bacteria Pseudomonadaceae and Pseudomonas increased in the PostD group compared to the PreD group. This indicates that pathogen growth increases after cesarean section, making it important for clinicians to combat these changes to protect women from infectious diseases. Interestingly, several metabolic pathways, such as metabolism of energy, cofactors and vitamins were strengthened in the PostD group, whereas membrane transport was lessened in this group. This suggests that women’s metabolic disorders might be cured by balancing urinary microbiota. In conclusion, the altered urinary microbiota between the PreD and PostD periods appears to provide insight into how to prevent postpartum metabolic disorders.
Collapse
Affiliation(s)
- Fengping Liu
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Longxian Lv
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huiyong Jiang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ren Yan
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shurong Dong
- Key Laboratory of Advanced Micro/Nano Electronic Devices and Smart Systems of Zhejiang, College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, China
| | - Liping Chen
- Intensive Unit, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Wei Wang
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yong Q Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| |
Collapse
|
33
|
Zhang D, Zhang J, Gan Q, Wang Q, Fan N, Zhang R, Song Y. Validating the Psychometric Characteristics of the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) in a Chinese Context. Arch Psychiatr Nurs 2018; 32:57-61. [PMID: 29413073 DOI: 10.1016/j.apnu.2017.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 07/19/2017] [Accepted: 09/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perinatal posttraumatic stress disorder (PPTSD) is a common stress-induced mental disorder worldwide. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) is an excellent questionnaire that measures the symptoms of PPTSD, but has not been translated into Chinese yet. OBJECTIVES The aims of this study were to develop a translated Chinese version of the (PPQ) and validate the psychometric characteristics of the PPQ in a Chinese context. METHODS After translation, back-translation, and expert discussion, 280 mothers at 1 to 18months postpartum filled out the questionnaires through the Internet. Then the reliability and validity of the translated questionnaire were tested. RESULTS The Chinese version of PPQ (PPQ-C) was composed of 14 items. Cronbach's α coefficient was 0.84, test-retest reliability was 0.88, and the content validity was 0.99. Exploratory factor analysis extracted three factors (representing "arousal", "avoidance" and "intrusion") accounted for 53.30% of the variance. The established 3 factors model was well fitted with the collected data (χ2=76.40, p<0.05). IMPLICATIONS FOR PRACTICE The PPQ-C is a short, reliable, and valid instrument that measures the symptoms of PPTSD, and it is recommend for clinical screening. IMPLICATIONS FOR RESEARCH Further research could involve diverse participants, as well as better adapt the PPQ-C to Chinese culture.
Collapse
Affiliation(s)
- Di Zhang
- WuHan University School of Health Sciences, 155 Donghu Rd., Wuchang District, WuHan 430071, PR China
| | - Jun Zhang
- WuHan University School of Health Sciences, 155 Donghu Rd., Wuchang District, WuHan 430071, PR China.
| | - Quan Gan
- Hubei Maternal and Child Health Hospital, 745 Wuluo Rd., Hongshan District, WuHan 430070, PR China
| | - Qiaoling Wang
- Wuhan Medical Care Center for Women and Children, 100 Hongkong Rd., Jiang'an District, WuHan 430015, PR China
| | - Nian Fan
- Wuhan Medical Care Center for Women and Children, 100 Hongkong Rd., Jiang'an District, WuHan 430015, PR China
| | - Rong Zhang
- Wuhan Medical Care Center for Women and Children, 100 Hongkong Rd., Jiang'an District, WuHan 430015, PR China
| | - Yayun Song
- WuHan University School of Health Sciences, 155 Donghu Rd., Wuchang District, WuHan 430071, PR China
| |
Collapse
|
34
|
Simpson M, Schmied V, Dickson C, Dahlen HG. Postnatal post-traumatic stress: An integrative review. Women Birth 2018; 31:367-379. [PMID: 29337007 DOI: 10.1016/j.wombi.2017.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/24/2017] [Accepted: 12/04/2017] [Indexed: 11/28/2022]
Abstract
PROBLEM Post-traumatic stress disorder and post-traumatic stress symptoms following birth occur amongst a small proportion of women but can lead to poor maternal mental health, impairment in mother-infant bonding and relationship stress. This integrative review aims to examine the associated risk factors and women's own experiences of postnatal post-traumatic stress in order to better understand this phenomenon. METHOD Fifty three articles were included and critically reviewed using the relevant Critical Appraisal Skills Program checklists or Strengthening the Reporting of Observational studies in Epidemiology assessment tool. FINDINGS Risk factors for postnatal post-traumatic stress symptoms and disorder include factors arising before pregnancy, during the antenatal period, in labour and birth and in the postnatal period. Potential protective factors against postnatal post-traumatic stress have been identified in a few studies. The development of postnatal post-traumatic stress can lead to negative outcomes for women, infants and families. DISCUSSION Risk factors for post-traumatic stress symptoms and disorder are potentially identifiable pre-pregnancy and during the antenatal, intrapartum and postnatal periods. Potential protective factors have been identified however they are presently under researched. Predictive models for postnatal post-traumatic stress disorder development have been proposed, however further investigation is required to test such models in a variety of settings. CONCLUSIONS Postnatal post-traumatic stress symptoms and disorder have been shown to negatively impact the lives of childbearing women. Further investigation into methods and models for identifying women at risk of developing postnatal post-traumatic stress following childbirth is required in order to improve outcomes for this population of women.
Collapse
Affiliation(s)
- Madeleine Simpson
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751 NSW, Australia.
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751 NSW, Australia
| | - Cathy Dickson
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751 NSW, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751 NSW, Australia; Ingham Institute, Liverpool, NSW, Australia.
| |
Collapse
|