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Recovery after Nulliparous Birth: Detailed Analysis and Predictions of Pain Analgesia and Recovery of Function
Abstract Number: GM-04
Abstract Type: Original Research
Background: There is limited information on postpartum pain, analgesic requirement and functional recovery after childbirth beyond the hospital stay. Factors predicting poor recovery have not been identified. The aim of this study was to describe and evaluate factors associated with worse pain, longer opioid use and delayed recovery after delivery.
Methods: Two hundred and thirteen nulliparous women were enrolled and assessed daily until they completed the following endpoints: pain resolution, opioid cessation, complete analgesic cessation, self-assessed functional recovery and composite outcome (pain and opioid-free functional recovery) from vaginal (VD) and cesarean delivery (CD). Pain burden was assessed by area under the curve (AUC) derived by multiplying daily pain scores by days required to attain pain resolution. Times to attain endpoints after CD and VD were evaluated using Kaplan-Meier survival analysis. The study subjects were divided into two categories (worst 20th percentile vs the rest of the study cohort) for multivariate logistic regressions to predict poorly preforming individuals for pain, analgesic and recovery outcomes. Candidate predictors in the model included demographic, obstetric, breastfeeding and psychological (PROMIS anxiety and depression scales, civilian version PTSD check list, and SF-36) characteristics.
Results: Pain and opioid-free functional recovery, opioid cessation, complete analgesic cessation, pain resolution, and functional recovery (median [Q1, Q3]) occurred at 20 [11, 26], 0.5 [0.5, 2], 11[6, 17], 15 [8, 24], 20 [11, 24] days after VD, and 27 [19, 40], 8[4, 11], 17 [11, 24], 21 [14, 27], 27 [19, 40] days after CD, with all attained earlier after VD than CD (Log-rank P<0.05). Pain-burden-AUC was 1.7 times larger after CD than VD. Predictors left in final multivariate models for being in worst 20th percent for outcomes are shown in the table. Labor induction (vs. spontaneous or augmented labor) and higher postpartum day 1 pain numeric rating scale were predictive of increased postpartum pain and prolonged functional recovery.
Conclusions: Recovery to pre-delivery function was marginally longer after CD than VD, but opioids use was more apparent after CD. Labor induction was a robust predictor of prolonged recovery after correction for delivery type, CD only predicted opioid use postpartum. Data for this study can be used to set maternal expectation and predict recovery after childbirth.