Relationship between delivery with anesthesia and postpartum depression: The Japan Environment and Children’s Study (JECS)

Background Postpartum depression is one of the most commonly experienced psychological disorders for women after childbirth, usually occurring within one year. This study aimed to clarify whether women with delivery with anesthesia, including epidural analgesia, spinal-epidural analgesia, and paracervical block, had a decreased risk of postpartum depression after giving birth in Japan. Methods The Japan Environment and Children’s Study (JECS) was a prospective cohort study that enrolled registered fetal records (n = 104,065) in 15 regions nationwide in Japan. Binomial logistic regression analyses were performed to calculate the adjusted odd ratios (aORs) for the association between mode of delivery with or without anesthesia and postpartum depression at one-, six- and twelve-months after childbirth. Results At six months after childbirth, vaginal delivery with anesthesia was associated with a higher risk of postpartum depression (aOR: 1.233, 95% confidence interval: 1.079–1.409), compared with vaginal delivery without analgesia. Nevertheless, the risk dropped off one year after delivery. Among the pregnant women who requested delivery with anesthesia, 5.1% had a positive Kessler-6 scale (K6) score for depression before the first trimester (p < 0.001), which was significantly higher than the proportions in the vaginal delivery without analgesia (3.5%). Conclusions Our data suggested that the risk of postpartum depression at six months after childbirth tended to be increased after vaginal delivery with anesthesia, compared with vaginal delivery without analgesia. Requests for delivery with anesthesia continue to be relatively uncommon in Japan, and women who make such requests might be more likely to experience postpartum depressive symptoms because of underlying maternal environmental statuses.

Analgesic effect of lidocaine in paracervical block in women undergoing colposcopy and cervical biopsy: a randomized clinical trial

Objective: To investigate the effect of lidocaine in paracervical block in women undergoing colposcopy and cervical biopsy.Methods: This a triple-blind randomized controlled trial (July-September 2020) was conducted on women who were candidate for the colposcopy and cervical biopsy with American Society of Anesthesiologists classification Class I or II. They were randomly allocated to receive a single dose of lidocaine hydrochloride 2% or injectable sodium chloride 0.9% paracervical block, and then, cervical biopsy was done. The pain score was asked and intra-procedural and 5-minutes post-procedural in both groups, using the VAS tool. Also, patients' satisfaction after the procedure and complications were recorded.Results: Totally, 74 patients (37 in each groups) were enrolled, with the mean±SD age of 35.91±8.10 years. The mean±SD of pain score intra-procedural was statistically higher in patients in the treatment group (0.92±1.53 vs. 2.73±2.34, P<0.001), as well the pain score 5-minutes post-procedural (0.27±0.65 vs. 0.95±1.15, P=0.003). Also, the mean±SD of patients' satisfaction score was higher in the treatment group (4.65±0.82 vs. 4.05±1.41, P=0.03). Dizziness were observed only in the treatment group, statistically (P<0.001).Conclusion: Paracervical block using lidocaine could reduce the intra-procedural and 5-minutes post-procedural pain. Also, it can increase the patients' satisfaction with the procedure.

Relationship between painless delivery and postpartum depression: The Japan Environment and Children’s Study (JECS)

Background Postpartum depression is one of the most commonly experienced psychological disorders for women after childbirth, usually occurring within one year. This study aimed to clarify whether women with painless delivery, including epidural analgesia, spinal-epidural analgesia, and paracervical block, had a decreased risk of postpartum depression after giving birth in Japan. Methods The Japan Environment and Children’s Study (JECS) was a prospective cohort study that enrolled registered fetal records (n = 104,065) in 15 regions nationwide in Japan. Binomial logistic regression analyses were performed to calculate the adjusted odd ratios (aORs) for the association between mode of delivery with or without analgesia and postpartum depression at one-, six- and twelve-months after childbirth. Results At six months after childbirth, painless vaginal delivery was associated with a higher risk of postpartum depression (aOR: 1.218, 95% confidence interval: 1.067–1.391), compared with vaginal delivery without analgesia or cesarean section. Nevertheless, the risk disappeared one year after delivery. Among the pregnant women who requested painless delivery, 5.1% had a positive Kessler-6 scale (K6) score for depression before the first trimester (p < 0.0001), which was significantly higher than the proportions in the vaginal delivery without analgesia (3.5%) and cesarean delivery (3.5%) groups. Conclusions Our data suggested that the risk of postpartum depression at six months after childbirth tended to be increased after painless vaginal delivery, compared with vaginal delivery without analgesia or cesarean section. Requests for painless delivery continue to be relatively uncommon in Japan, and women who make such requests might be more likely to experience postpartum depressive symptoms because of underlying personality characteristics, including a tendency to worry.