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An analysis of preoperative anxiety in an obstetric population
Abstract Number: S-04
Abstract Type: Original Research
Introduction: Preoperative anxiety is common, unpleasant and can affect the conduct of anaesthesia, postoperative pain and outcome (1,2). Allied to the natural anxieties surrounding childbirth women undergoing cesarean section (LSCS) may experience additional stressors related to the surgery. A review by Blankfield(3) suggests that hypnosis and relaxation can shorten postoperative admission, promote recovery, and help emotional responses following surgery. Our aim was to evaluate preoperative anxiety levels amongst women having an elective LSCS. We believe maternal experience can be improved using relaxation techniques.
Methods: A single centre prospective study completed over two months. Data collection proformas were completed by nursing staff preoperatively. Using the visual analogue scale (VAS) women were asked to rate their level of preoperative anxiety. Results were divided into three categories; mild (0-39mm), moderate (40-69mm) and severe (70-100cm)(2). Data analysis was completed using GraphPad.
Results: 100 responses were collected, 45% of women were primiparous, 20% were nulliparous and 52% had had a previous LSCS. Overall 43% of women described experiencing severe anxiety preoperatively, 36% moderate anxiety and only 6% no anxiety. There was no significant difference in VAS scores between nulliparous (mean=67.1mm), primiparous (mean=51.3mm) and multiparous (mean=58.8mm) women (p=0.056 one-way Anova). Women who had a previous LSCS had a mean VAS score of 55.0mm versus 61.9mm for those never having had a LSCS (p=0.24 unpaired t-test).
Discussion: Overall 94% of women experience some anxiety preoperatively, 79% experiencing moderate to severe anxiety. Parity or previous LSCS had no influence of the degree of anxiety. We propose that more can be done to relieve maternal anxiety thus improving the birth experience for the mother and family. Introducing relaxation based therapy for mothers preoperatively should be trialed and anxiety levels reviewed post implementation.
1.Markland D, Hardy L. Anxiety, relaxation and anaesthesia for day case surgery. Br J of Clin Psych,1993,32(4),493-504
2.Orbach-Zinger S, Ginosar Y, Elliston J, et al. Influence of preoperative anxiety on hypotension after spinal anaesthesia in women undergoing Caesarean delivery. BJA Sept 2012, 109(6):943-949
3.Blankfield RP. Suggestion, relaxation and hypnosis as adjuncts in the care of surgery patients: a review of the literature. Am J Clin Hypn.1991 Jan;33(3):172-86