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Preliminary Analysis of Pre- and Post-Partum Neurosensory Testing in Parturients Undergoing Cesarean Section versus Vaginal Delivery
Abstract Number: F 12
Abstract Type: Original Research
Pain in pregnancy is highly variable among women throughout the entire antepartum, intrapartum, and postpartum periods. Chronic pain after delivery can develop. Prediction of pain an individual woman may experience is very difficult, but could be helpful in medical therapy. We present neuro-sensory data from an ongoing longitudinal study that will include future genetic analysis. Future genetic markers combined with other tests could help predict an individual woman’s pain tolerance where other methods have failed.
This pilot study evaluates pain in a healthy cohort of women before, during, and after delivery. Women are recruited in early pregnancy from hospital obstetrical practices, sign informed consent, have no preexisting chronic pain or mood disorders, and plan for labor analgesia. Four components of data are collected: Quantitative sensory testing (QST) and Psychosocial questionnaires (PSQ) are done several times in the peri-pregnancy period, a survey of labor pain experience is recorded post delivery, and genetic testing (blood or saliva) samples are collected. See Figure. LPGS Flow diagram (Labor Pain Genetics Study). Standard PSQ surveys and QST testing methodology (mechanical –algometer, Thermal –Medoc thermal, Windup 47 tests) are performed. Gracely Box Scale and Situational Pain Catastrophizing Scale are done after QST.
Current QST results for the 140 consented patients over three of 4 survey periods are presented. Survey periods include visit 1 (QST 1+ PSQ 1) – up to 20 weeks pregnant, visit 2 (QST2 + PSQ2) – 37-40 weeks gestation, visit 3 the delivery period, and visit 4 (QST3+PSQ3) – 6 weeks postpartum. Patient data is stratified by women who delivered vaginally either assisted or spontaneously (VD), and those who had cesarean deliveries (CS). Significant decreases in pressure and heat thresholds were seen in CS patients only from visit 2 to 4. Pressure tolerance increased in all groups between visit 1 and 2. Gracely Box scale decreased progressively from visit 1 thru 4. Heat threshold and tolerance uniformly increased from visit 1 to 2, but decreased only in CS women thresholds by visit 4.
Long term clinical research studies face many challenges including patient cooperation and follow through. Inter-individual communication and enthusiasm are key characteristics to study longevity and progression. Interesting trends emerged with regards to pregnant female heat and pressure QST tests. Future analysis include genetic tests and examining the relationship between labor and delivery pain scores and analgesic pain medication in the first 24 hours postpartum in this same cohort of women.