Tan Daryl Jian An, Sultana Rehena, Chow Sheryl Yu Xuan, Tan Chin Wen, Tan Hon Sen, Chen Helen Yu, Chua Tze-Ern, Sng Ban Leong
Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore, Singapore.
Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.
Neuropsychiatr Dis Treat. 2024 Feb 29;20:439-447. doi: 10.2147/NDT.S448853. eCollection 2024.
This study aimed to validate a proposed association model previously published to determine the clinical relevance of pre-operative determinants in the development of PND after Cesarean delivery (CD).
Parturients undergoing elective CD under neuraxial anesthesia were recruited for a prospective cohort study between Oct 2021 and Oct 2022 at KK Women's and Children's Hospital, Singapore. Predelivery pain, psychological and mechanical temporal summation, and demographic data were recorded. A follow-up survey was conducted at 6 to 10 weeks after CD. The primary outcome was the incidence of PND, defined as an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10.
A total of 180 patients were recruited for validation. PND 6 to 10 weeks post-delivery occurred in 18.9% of recruited parturients. Multivariate regression analyses showed that higher pre-operative CSI scores (p=0.0156), higher anxiety levels about upcoming surgery (p=0.0429), increased pre-operative pain scores on movement (p=0.0110), and higher pre-operative HADS subscale scores on anxiety (p=0.0041) were independently associated with the development of PND weeks post-CD. Lower anticipation of pain medication needs (p=0.0038) was independently associated with the development of PND post-CD. The area under curve (AUC) of this multivariable model (training cohort), internal cross validation (training cohort) and external cross validation (validation cohort) were 0.818 (95% CI, 0.746 to 0.889), 0.785 (95% CI, 0.707 to 0.864) and 0.604 (95% CI, 0.497 to 0.710) respectively.
The proposed model performed well in a local population. Further refinement is necessary to test the proposed model in populations with social and cultural differences.
本研究旨在验证先前发表的一个拟议关联模型，以确定剖宫产术后发生产后抑郁（PND）的术前决定因素的临床相关性。
2021年10月至2022年10月期间，在新加坡KK妇女儿童医院招募接受椎管内麻醉下择期剖宫产的产妇进行一项前瞻性队列研究。记录产前疼痛、心理和机械性时间总和以及人口统计学数据。在剖宫产术后6至10周进行随访调查。主要结局是产后抑郁的发生率，定义为爱丁堡产后抑郁量表（EPDS）评分≥10分。
共招募180例患者进行验证。18.9%的入选产妇在产后6至10周发生产后抑郁。多因素回归分析显示，术前剖宫产应激指数（CSI）评分较高（p = 0.0156）、对即将进行的手术焦虑水平较高（p = 0.0429）、术前活动时疼痛评分增加（p = 0.0110）以及术前医院焦虑抑郁量表（HADS）焦虑分量表评分较高（p = 0.0041）与剖宫产术后几周产后抑郁的发生独立相关。对止痛药物需求的较低预期（p = 0.0038）与剖宫产术后产后抑郁的发生独立相关。该多变量模型（训练队列）、内部交叉验证（训练队列）和外部交叉验证（验证队列）的曲线下面积（AUC）分别为0.818（95%CI，0.746至0.889）、0.785（95%CI，0.707至0.864）和0.604（95%CI，0.497至0.710）。
拟议模型在当地人群中表现良好。有必要进一步完善该模型，以便在具有社会和文化差异的人群中进行测试。
