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Complexity of Cesarean Delivery Procedure Is Associated with Postpartum Depression: A Retrospective Cohort Study
Abstract Number: SAT-50
Abstract Type: Original Research
The prevalence of postpartum depression (PPD) is estimated at around 10%, which results in negative personal and child developmental outcomes. Lots of physical, psychological and social factors have influences on PPD. The aim of our study was to evaluate the association between cesarean delivery (CD) and PPD and other potential risk factors that may have impacts on PPD.
Retrospective chart review of all the parturients who delivered from 5/30/2015 to 2/4/2017 was conducted. Data including demographics, diagnosis and procedures were collected. Other risk factors as independent variables included anesthesia mode, anesthesia complexity, delivery mode, procedure complexity and coexisted conditions. Complexity of a procedure was counted as the number of various associated procedures patient received and evaluated with a score (0: without any additional step; each one additional step, such as hysterectomy, increases 1 score). Dependence variable was the occurrence of PPD. Logistic regression analysis was used for analysis of associations and interactions among these independent variables and dependent variable.
In a total of 8,968 parturients, 207 (2.3%) cases with postpartum depression were identified. The complexity of procedure significantly influenced on PPD occurrence (p=0.003), and the incidence of PPD increased with the level of complexity of procedure. There was a significant interaction between delivery procedure mode and procedure complexity (p=0.012). With the procedure complexity increasing, the possibility of PPD occurrence increased in women who experienced CD, while the possibility of PPD occurrence did not change for women who went through VD or failure to progress. Neither anesthesia modes nor delivery procedure modes had significant associations with occurrence of PPD. Coexisted uterine leiomyoma during pregnancy was an independent risk factor associated with PPD as well (p=0.004).
Previous studies reported with inconsistent results concerning the association between CD and PPD. However, meta-analyses of suitable studies failed to find evidence for a significant association. The explanations for these diverse findings may lie in the methodological weakness of some previous studies, the women’s vulnerabilities to PPD, and diversities of CD manifestation. Our results further demonstrated a positive association of complexity of procedure with PPD occurrence and an interaction between delivery procedure mode and procedure complexity, indicating that CD may not be an influence factor by itself but act as a risk factor when the procedure is complex. We did not detected significant associations with other risk factors except for coexisted uterine leiomyoma, which may be due to the limitation of the sample size.
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