Maternal anxiety and its correlation with pain experience during chorion villus sampling and amniocentesis

Risk factors and prediction model for postpartum psychiatric disorders: a retrospective cohort study of 1418 Chinese women from 2020 to 2022

BACKGROUND

Postpartum psychiatric disorders (PPDs) have been deemed as a significant public health concern, affecting both maternal health and family dynamics. This study aimed to examine the current status of PPDs, identify the potential risk factors of PPDs, and further develop a clinical nomogram model for predicting PPDs in Chinese women.

METHOD

In this retrospective cohort study, 1418 postpartum women attending the routine postpartum examination at the 42nd day after delivery in Jiangsu Women and Children Health Hospital were recruited as participants from December 2020 to December 2022. The Symptom Checklist-90 (SCL-90) was utilized to assess the status of postpartum psychiatric disorders. A prediction model was constructed by multivariate logistic regression and presented as a nomogram. The performance of nomogram was measured by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). The relationships between predictive factors of PPDs and SCL-90 were also evaluated using Pearson correlation analysis. The relationships between predictive factors of PPDs and SCL-90 were evaluated using Pearson correlation analysis.

RESULTS

With the SCL-90 cutoff value of 160, the incidence of postpartum psychiatric disorders was 9.17% among Chinese urban women. The univariate and multivariate logistic regression analyses indicated that age ≤ 25 years old (OR = 10.07, 95%CI = 1.83-55.33), prenatal mood disorder (OR = 4.12, 95%CI = 1.99-8.53), invasive prenatal diagnostic procedures (OR = 4.39, 95%CI = 1.16-16.56), poor relationship with husband (OR = 2.86, 95%CI = 1.58-5.16) and poor relationship with mother-in-law (OR = 5.10, 95%CI = 2.70-9.64) were significantly associated with PPDs. A nomogram prediction model for PPDs was further constructed based on these five independent risk factors, and the area under the receiver operating characteristic curve (AUC) of the nomogram model was 0.823 (95% CI = 0.781-0.865). The calibration curves showed remarkable accuracy of the nomogram and the DCA exhibited high clinical net benefit of the nomogram. Besides, we also explored the relationships between the five risk factors and different symptom dimensions of PPDs and found that the five risk factors were almost associated with increased levels of all symptom dimensions.

CONCLUSIONS

Five psychosocial risk factors for PPDs were identified in Chinese women and the nomogram prediction model constructed based on these five risk factors could predict the risk of PPDs intuitively and individually. Systematic screening these risk factors and further conducting psychosocial interventions earlier during the pregnancy period are crucial to prevent PPDs. For future research, we intend to incorporate additional risk factors, including blood biomarkers and facial expression indicators, to refine our risk model.

Empowering Patients' Knowledge, Attitude, and Practices in Low Resource Settings: A Study of Pictorial Tools for Pretest Counseling of Invasive Prenatal Diagnostic Procedures

OBJECTIVE

This study aimed to evaluate the effectiveness of a bilingual (English-Telugu) poster in enhancing pregnant individuals' knowledge, attitudes, and practices regarding invasive prenatal diagnosis procedures.

METHODS

A cross-sectional survey involving 100 pregnant individuals attending prenatal diagnostic counseling was conducted. Participants reviewed the bilingual poster and completed a questionnaire assessing their understanding, satisfaction, and anxiety levels.

RESULTS

Quantitative analysis revealed that 83% of participants were unaware of the procedures prior to viewing the poster, while 97% found the poster to be "easy" or "very easy" to understand. Anxiety levels decreased for 90% of participants, with many expressing reassurances about procedure safety. Thematic analysis highlighted the importance of clarity, safety reassurance, and uncertainty reduction in patient education. Suggestions for improvement included adding more language options and enhancing visual elements.

CONCLUSION

The study concludes that culturally tailored visual aids, such as bilingual posters, are valuable tools in improving patient education and alleviating anxiety during prenatal diagnostic counseling. These findings emphasize the need for accessible, patient-centered educational resources to foster informed decision-making.

The effect of video-based multimedia information before amniocentesis on pain, anxiety, and pregnancy outcomes

Amniocentesis is the most commonly used invasive prenatal diagnostic test. This study aimed to investigate the effect of video-based multimedia information (MMI) on the anxiety and pain levels of patients undergoing amniocentesis. This randomized controlled study included all consecutive women aged 18-45 years scheduled for amniocentesis. Subjects were assigned to receive video-based MMI or standard written information. Anxiety levels were assessed pre-procedure and post-procedure using the State and Trait Anxiety Inventory-State (STAI-S). All patients underwent standard amniocentesis by the same perinatologists. After amniocentesis, Likert scale was used to evaluate the ease of the procedure and patient satisfaction, and a visual analog scale was used to evaluate pain. Pregnancy results and amniocentesis results were noted. Eighty-four patients were randomized to receive video-based MMI, and 76 were randomized to receive written information. The post-procedure STAI-S score was significantly lower in both the video group and the control group compared to the pre-procedure STAI-S score (47.8 ± 5.23 vs. 45.86 ± 5.02, 95% CI: [2.38-1.52], p < 0.001, and 46.75 ± 7.35 vs. 44.82 ± 6.85, 95% CI: [2.33-1.51], p < 0.001). The satisfaction rate of the video group was significantly higher than controls (69.05% vs. 48.68%, p = 0.01). Procedure pain, ease of procedure, and pregnancy outcomes were similar for both groups (p > 0.05). Performing video-based MMI before the amniocentesis procedure is associated with higher patient satisfaction than standard written information. Video-based MMI was not associated with reductions in pain and anxiety in patients undergoing amniocentesis.

Network meta-analysis of randomized controlled trials comparing the effectiveness of different treatments in reducing amniocentesis-associated pain and anxiety

OBJECTIVE

This network meta-analysis compared different methods to determine which is most efficient at lowering pain and anxiety in women undergoing amniocentesis.

METHOD

We looked through all published randomized controlled trials in the databases PubMed, Scopus, Web of Science, Cochrane, and EM base. Anxiety and pain were the predominant results. We used the R software version 4.2.1 to analyze the data.

RESULTS

We included a total of 20 studies, with sample sizes ranging from 60 to 570. Virtual reality was the most effective strategy for lowering pain during AC [MD = -1.30, 95% CI (-2.11, -0.49)]. In addition, paracetamol use was the most successful approach for lowering pain following AC [MD = -1.68, 95% CI (-1.99, -1.37)]. The use of H7 acupressure, however, was the strategy that significantly reduced anxiety following AC [SMD = -15.46, 95% CI (-17.77, -13.15)].

CONCLUSION

The most effective method for reducing pain is the combination of virtual reality with paracetamol. Whereas, the most effective way to reduce anxiety is to combine an ice gel pack with H7 acupressure before applying AC.

Evaluation of Fetal and Maternal Outcomes in Chorion Villus Sampling (CVS)

Background

Chorionic villus sampling (CVS) is one of the invasive diagnostic methods used to diagnose chromosomal, genetic, and metabolic diseases in the embryonic period. The use of this method is associated with maternal and fetal consequences, the most serious of which is abortion. Therefore, the present study was conducted to investigate the incidence of these consequences and the factors affecting the incidence of abortion.

Materials and Methods

A cross-sectional study was performed on 98 pregnant women with CVS indications. Maternal and fetal outcomes including abortion, vaginal bleeding, subchorionic hematoma, premature rupture of membrane (PROM), chorioamnionitis, preterm delivery, limb abnormality, fetal growth retardation, and preeclampsia were recorded.

Results

The results of the present study showed that the incidence of fetal outcomes including fetal growth failure, premature rupture of membranes, abortion, and limb abnormalities was 4.1%, 7.1%, 3.1%, and 1%, and the incidence of maternal outcomes including preterm delivery, subchorionic hematoma, preeclampsia, and hemorrhage was 14.3%, 3.1%, 6.1%, and 10.2%, respectively. In addition, a decrease in free BHCG and an increase in NT were significantly associated with the occurrence of abortion (OR: 0.11 and 4.25, respectively, P value < 0.05).

Conclusion

It should be noted that due to a long time between placental sampling and the occurrence of vaginal bleeding, premature rupture of membrane, and preterm delivery, it seems that placental sampling has no effect. In addition, only a decrease in free BHCG or an increase in NT significantly increased the chance of miscarriage.

Anxiety and Psychological Flexibility in Women After Childbirth in the Rooming-in Unit during the COVID-19 Pandemic

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic has intensified perinatal anxiety disorders. Psychological flexibility (PF), considered a specific mental toughness, has not been examined with regard to its relationship with anxiety in women after childbirth. We aimed to compare levels of anxiety, PF, and pain in women depending on the mode of birth, parity, and the magnitude of risk of developing an anxiety disorder. We also investigated the association of anxiety with PF and pain.

METHODS

A total of 187 women after childbirth completed validated questionnaires for anxiety (State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale-Anxiety, Numerical Rating Scale for anxiety [NRS-A]), PF, and pain (Numerical Rating Scale for pain). Specific postpartum anxieties were assessed with a numerical scale from 0 to 10. The relationship of anxiety with PF and pain was examined. Women at low and high risk of developing anxiety disorder were compared in terms of PF, anxiety, and pain.

RESULTS

On the second postpartum day, women after cesarean birth demonstrated significantly greater anxiety on NRS-A and pain than those after vaginal birth. Primiparous women experienced significantly greater anxieties and pain compared to multiparous women. The higher the PF patients demonstrated, the less anxiety and pain they had. Patients at high risk of developing an anxiety disorder had a lower level of PF (P < .001) and higher levels of anxiety (P < .001) and pain (P < .01) than patients at low risk of developing an anxiety disorder. No difference in the anxiety of getting COVID-19 was observed between the groups (P > .05).

CONCLUSIONS

PF is an important psychological construct related to the mental and physical condition of women after childbirth. Increasing PF in women after childbirth may be considered as an important goal of preventive and intervention measures.

The effect of education on anxiety of pregnant mothers before amniocentesis

BACKGROUND

Pregnancy alone is associated with many anxieties and worries for many women. Prenatal diagnosis of fetal malformations is one of the most important anxious events for women. Increasing knowledge empowers the person to identify the important issues and by increasing understanding, creates a positive attitude in people. Therefore, the aim of this study was to investigate the effect of education on the level of anxiety of pregnant mothers before invasive screening for fetal abnormalities (amniocentesis).

MATERIALS AND METHODS

This is a quasi-experimental study with two parallel designs in three stages: Pretest (before intervention), posttest (after intervention), and after amniocentesis. This study was performed on 80 pregnant women candidates for amniocentesis (40 pregnant women in the control group and 40 pregnant women in the intervention group) referred to the perinatology clinic in Yazd in 2020. Data collection tools were demographic and midwifery questionnaires and Spiel Berger anxiety questionnaires. In the experimental group, the intervention was performed as group training for 90 min immediately before amniocentesis. In the control group, only routine procedures (brief description by a perinatologist during amniocentesis) were performed. SPSS software version 16 was used to analyze the data.

RESULTS

The mean age of the research units was 67/5 ± 5/33 years. The results of Mann-Whitney intergroup test showed that the mean scores of overt anxiety before the intervention between the control and intervention groups were not significant (P < 0.014) but were significant after training and after amniocenter (P < 0.001). Furthermore, the results of Mann-Whitney group test showed that the mean scores of overt anxiety in the intervention group before and after training were significant (P < 0.001). Furthermore, the results of the control group showed significant results (P < 0.001). The results of the independent t-test showed that the mean scores of latent anxiety before the intervention between the control and intervention groups were not significant (P < 0.194) but were significant after the training (P < 0.57) but The results were not significant after amniocentesis (P < 0.216). Furthermore, the results of paired t-test within the group showed that the mean scores of overt anxiety in the intervention group before and after training was significant (P < 0.001). Furthermore, the results of the control group showed significant results (P < 0.001).

CONCLUSION

The findings of the present study indicate the positive effect of education on anxiety of pregnant women candidates for amniocentesis. The results also show the important role of education on the psychological dimension of high-risk pregnant women in relation to the consequences of pregnancy and childbirth. According to the research results, it seems that education affects the cognitive system and information processing by increasing people's awareness of the amniocentesis process and its consequences.

Enhanced Serum Levels of sFlt1: Impact on Materno-Fetal CMV Transmission

Background: Antenatal Cytomegalovirus infection (CMV) can be associated with severe fetal symptoms and newborn outcome. The current prenatal diagnosis is based on amniocentesis (AC). No reliable biomarker for fetal infection is available. Methods: We measured Placenta-derived growth factor (PlGF), and soluble fms-like tyrosine kinase 1 (sFlt1), concentrations in maternal serum and amniotic fluid (AF) in context of maternal CMV primary infection. Blood sampling was carried out at the time of AC for detection of fetal CMV infection. The study cohort was divided into four subcohorts according to the presence or absence of fetal infection and preemptive hyperimmunoglobulin (HIG) treatment during the time interval between diagnosis of the CMV primary infection and AC. Results: The study cohort involved 114 pregnancies. In the non-transmitting subcohorts (NT) with and without prior HIG treatment, the median sFlt1 concentrations were 1.5 ng/mL (NT, HIG+) and 1.4 ng/mL (NT, HIG−), respectively. In the two transmitting groups (T) the concentrations were 1.3 ng/mL (T, HIG+) and 2.3 ng/mL (T, HIG−), respectively (NT, HIG− vs. T, HIG−, p < 0.001). The corresponding PlGF levels and the sFlt1/PlGF ratios showed no significant differences between the cohorts. The empirical cut-off values <1504 pg/mL sFlt1 and <307 pg/mL PlGF, were associated with the exclusion of CMV transmission (p < 0.001). Conclusion: sFlt1 concentration in the maternal blood could be a predictive biomarker for maternofetal CMV transmission.

Physician experience is associated with greater underestimation of patient pain

OBJECTIVE

Procedural pain is unique in that physicians simultaneously cause and assess it. Experienced male physicians are known to underestimate their female patients' pain more than other physicians. However, it is unknown whether this also occurs in obstetrics/gynecology, where all patients are females. This study addresses the gap in literature on procedural pain assessment accuracy.

METHODS

The present research compares paired pain evaluations from 20 obstetricians/gynecologists and their 92 female patients.

RESULTS

Our data demonstrate that patients' reported pain levels (M = 5.53, SD = 2.7) were significantly higher than their physicians' pain estimates (M = 4.89, SD = 2.19), t = 2.64, p < 0.005. The gap between patients' and physicians' pain estimates was greatest among physicians with the greatest procedural experience (M = 1.49, SD = 2.24), f = 5.72, p < 0.005. Male physicians underestimated their patients' pain significantly more than female physicians do, t = 2.27, p < 0.05.

CONCLUSION

Our results shed light on systematic underestimation of procedural pain and highlight the significance of experience and sex differences in pain evaluation.

PRACTICE IMPLICATIONS

Physicians' experience influences their perception of patient pain while performing procedures. Experienced male physicians, even those who exclusively treat female patients, need to be aware of this ubiquitous bias in assessing their female patients' procedural pain.

Pain perception during transabdominal chorionic villus sampling: a randomized trial comparing topical ethyl chloride anesthetic spray and lidocaine injection

Background: Chorionic villus sampling is an important invasive procedure used for early antenatal genetic testing that can be associated with anxiety and fear of pain. Pain analgesia prior to chorionic villus sampling can be offered with subdermal lidocaine; however, lidocaine injection itself is associated with pain. Our objective was to determine whether administration of topical ethyl chloride anesthetic spray is associated with decreased pain perception during transabdominal chorionic villus sampling compared to 1% lidocaine subdermal injection.Study design: Women undergoing transabdominal chorionic villus sampling from 10 to 13 weeks and 6 days in an outpatient setting were randomized with equal allocation to either 1% lidocaine injection or topical ethyl chloride anesthetic spray prior to the procedure. Women were asked about their pain on a scale of 0-100 prior to, during, and after the procedure. The primary outcome was pain perception during time of transabdominal chorionic villus sampling as measured on a 100-mm visual analog scale. The secondary outcome was pain immediately after procedure.Results: From October 2016 to June 2017, a total of 120 women were enrolled (63 in the lidocaine injection group and 57 in the topical ethyl chloride anesthetic spray group). Baseline demographic characteristics were similar between groups. During the procedure, patients in the topical ethyl chloride arm demonstrated significantly higher pain scores compared to the lidocaine injection group (median score of 50 mm (interquartile range [IQR]: 40-65) versus 50 mm (IQR: 30-60); p = .03). There was no significant difference in pain scores before or after the procedure.Conclusion: During transabdominal chorionic villus sampling procedures, topical ethyl chloride anesthetic spray is associated with a higher distribution of pain scores as compared to 1% lidocaine subdermal injection, which suggests higher levels of pain.Clinical trial registration: This trial is registered with clinicaltrials.gov (NCT03140293). https://clinicaltrials.gov/ct2/show/NCT03140293?term=NCT03140293&rank=1.

Managing pain and anxiety during transabdominal chorionic villus sampling. A noninferiority randomized trial of nitrous oxide vs local anesthesia

INTRODUCTION

Transabdominal chorionic villus sampling (CVS) is an invasive procedure for prenatal diagnosis reported to be associated with anxiety and pain. In this context, the need for analgesia during CVS has been considered useful. Even though several authors have been interested in pain management during amniocentesis, no study has been published on pain reduction during CVS. Our objective was to evaluate pain and anxiety management during transabdominal CVS using nitrous oxide (N₂ O) and local anesthesia.

MATERIAL AND METHODS

In a randomized controlled noninferiority trial, self-administered nitrous oxide (N₂ O) inhalation (equimolar premix of oxygen and nitrous oxide) was compared with local anesthesia (1% lidocaine) before CVS. Primary outcome was pain and secondary outcome was anxiety, both measured on a visual analog scale 30-60 minutes before, immediately after (5-10 minutes) and 30-60 minutes after CVS. With a statistical power of 90%, type I error of 5% and two-sided test and potential exclusions, a sample size of 96 patients per group was enrolled and randomized. No patient was enrolled before the trial registration date.

RESULTS

From 13 March 2013 through 10 February 2015, 192 patients (96 per group) were screened and randomized. Most characteristics were similar across groups. Pain in the N₂ O group was 2.65 ± 0.22 vs 3.32 ± 0.26 in local anesthesia group [mean ± standard error of mean  (SEM)]. Mean anxiety in the N₂ O group was 3.17 ± 0.27 vs 5.19 ± 0.30 in the local anesthesia group.

CONCLUSION

N₂ O was as efficient and even superior to local anesthesia for both pain and anxiety reduction during CVS, as the 95% confidence intervals were both below the prespecified noninferiority margin of 0.8 and below zero.

A retrospective cohort survey of problems related to second childbirths during the 2-child policy period in Jiangbei District of Ningbo City in China

From 1979 to 2014 in China, a 1-child policy was imposed to control population growth. During 2014 to 2015, families in which 1 spouse was only 1 child were eligible to apply for planning a second child. To foresee issues affecting obstetrical departments related to the introduction of the universal 2-child policy in 2016, we retrospectively investigated the demographics and health-related outcomes of second pregnancies in families applying for a second child in Jiangbei District of Ningbo City during January 17, 2014, to January 14, 2016.A retrospective cohort survey was conducted for Jiangbei District of Ningbo City from January 17, 2014, to January 14, 2016, with reference to data from 2012 to 2014.Applications for a second birth increased after implementation of the 2-child policy, from 505 in 2012 to 2013, to 1222 in 2014 to 2015. Until the end of this study (December 31, 2016), 739 women gave birth to a second child, among whom 21.38% were aged ≥35 years. Rates of cesarean deliveries (59.68%) and gestational diabetes mellitus (14.21% of women) were each positively associated with the age of the mother. Among women aged ≥35 years, 37.97% refused prenatal screening.Introduction of the 1-child policy encouraged more families to apply for a second child, with many women aged ≥35 years, leading to higher rates of cesarean deliveries and adverse complications. A high percentage of eligible older women refused prenatal screening. Obstetric departments should adjust perinatal health management schemes to prepare for similar probable changes associated with the universal 2-child policy.