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Postpartum Uterine Contraction Pain After Vaginal Delivery: A Prospective Observational Study
Abstract Number: F3D-151
Abstract Type: Original Research
BACKGROUND Postpartum uterine contraction pain (PUCP) is one of the most concerned issues for women after childbirth, but there is a lack of baseline research. The aim of this study was to assess the incidence, intensity and risk factors of PUCP.
METHODS In this prospective observational study, singleton primiparous and multiparous women delivered vaginally were included; the numerical rating scale (NRS) score for uterine contraction pain at 6h, 12h, 24h and 48h after delivery was surveyed using a self-administered questionnaire. The primary outcome was the onset of uterine contraction pain within 48h after delivery. Subjects included in the final analysis were (1) the time to onset of PUCP; (2) the onset of significant PUCP (NRS score≥3); (3) PUCP assessed before, during and after breastfeeding by NRS and (4) the nature or feeling of PUCP. Univariate analysis was assessed by Kaplan-Meier curve and Log-Rank test, or univariate cox regression analysis with demographic, obstetric, and neonatal characteristics as candidate factors; followed by time-dependent cox regression analysis; in order to determine the factors associated with PUCP.
RESULTS 265 primiparous women and 139 multiparous women were included in the final analysis. About 77.5% (313 of 404) of all women suffered from uterine contraction pain (NRS score≥1) within 48h after delivery. According to multivariate analysis, multiparous women had an increased risk of PUCP compared with primiparous women (p<0.001, HR=1.834, 95% CI=1.451-2.316). In addition, primiparous women who had a history of tocolytic therapy were more likely to suffer PUCP, and its hazard ratio decreased with delayed in the time to onset of PUCP [p<0.001, HR=EXP (2.182-0.101*t)]. The incidence of PUCP decreased with every degree of age (one degree is 5 years) of multiparous women (p=0.007, HR=0.758, 95% CI=0.620-0.926). Both primiparous and multiparous women had more intensive PUCP during breastfeeding at 12h, 24h and 48h postpartum (p<0.001). Primiparous women with labor analgesia had lower NRS score of PUCP compared with those without labor analgesia at 6h after delivery [0 (0-0) vs. 0 (0-2), p=0.001].
CONCLUSIONS PUCP was common after delivery, but its’ intensity was mild. Parity and tocolytic therapy were associated with the onset of PUCP. Primiparous women with labor analgesia had a lower NRS score of PUCP than those without labor analgesia in the early postpartum period. Therefore, it suggests that women at risk for PUCP may have personalized interventions.