• Amrit Kaur, Sukanya Mitra, Jasveer Singh, Rashi Sarna, Dilpreet Kaur Pandher, Richa Saroa, and Subhash Das.
• Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
• Saudi J Anaesth. 2020 Oct 1; 14 (4): 473-479.

BackgroundPain and depression are associated, but it is uncertain if effective pain relief during labor by labor analgesia reduces the incidence of postpartum depression (PPD). This randomized, controlled study assessed whether combined spinal-epidural (CSE) labor analgesia is associated with a decreased risk of PPD. Other reported risk factors for PPD were also assessed.Materials And MethodsParturients were randomly assigned to either CSE labor analgesia or normal vaginal delivery (n = 65 each). CSE parturients received 0.5 ml of 0.5% hyperbaric bupivacaine intrathecally and PCEA with continuous infusion of 0.1% levobupivacaine and 2 μg/ml fentanyl @5 ml/h along with patient-controlled boluses with a lockout interval of 15 min. Parturients of both the groups were assessed using Edinburgh Postnatal Depression Scale (EPDS) for depressive symptoms at day 3 and PPD at 6 weeks (primary outcome; defined as EPDS score ≥10 at 6 weeks postpartum). Secondary outcomes included pain scores, maternal satisfaction, and Apgar scores at 1 and 5 min. Parturients were also screened for several risk factors for PPD.ResultsIncidence of PPD was 22.3%. The difference in incidence of PPD between the CSE group vs. control group was not significant (27.7% vs. 16.9%; Fisher's exact P = 0.103). Of all the risk factors analyzed in logistic regression model, perceived stress during pregnancy was the only significant predictor of the development of PPD (adjusted Odds Ratio 11.17, 95% Confidence interval 2.86-43.55; P = 0.001).ConclusionCSE analgesia in laboring parturients does not reduce PPD at 6 weeks. Instead, perceived high stress during pregnancy appears to be the most important factor.Copyright: © 2020 Saudi Journal of Anesthesia.

4 keywords...

hide…