(454) The Association between Post-Traumatic Stress and Perineal Pain in Patients with Birth Injury

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author(s)

Dana R. Canfield, MD

Maternal Fetal Medicine Fellow
UC San Diego Health
San Diego, CA, United States

Presenting Author(s)

Emmanuel Elijah, BS (he/him/his)

Medical Student
University of California, San Diego
San Diego, California, United States

Coauthor(s)

Omar Mesina, MD (he/him/his)

Assistant Professor
University of California San Diego Health
San Diego, California, United States
Rachel L. Wiley, MD, MPH (she/her/hers)

MFM Fellow
University of California, San Diego
San Diego, California, United States
AS

Aava Saffarnia

Undergraduate Student Researcher
University of California, San Diego
San Diego, California, United States
AN

Alexandra Nutaitis, DO

Urogynecology Fellow
University of California, San Diego
San Diego, California, United States
LB

Lindsey A. Burnett, MD, PhD

Assistant Professor
UC San Diego Medical Center
La Jolla, California, United States

Objective: While the impact of emotional distress on perceived pain has been shown in several studies, few have focused on patients with birth injury. Our goal was to determine whether post-traumatic stress is associated with a higher incidence of reported pain in birth-injured patients.

Study Design: This was a retrospective cohort study of patients seen in a urogynecology clinic specializing in the management of birth injury. Patients completed surveys addressing physical and emotional wellbeing which included a Peritraumatic Stress Inventory (PDI) to assess for childbirth-related trauma symptoms. Demographic and delivery variables were compared between patients who had a PDI score of >14, a cut-off associated with a greater risk of developing post-traumatic stress disorder. Pain was assessed as a binary variable based on response to the question “are you having perineal/vaginal pain?”. Demographic and delivery factors associated with high PDI were added to a multivariable logistic regression model of pain (Table 1). Edinburgh Depression Scale (EPDS) score was excluded given concern for effect mediation.

Results: 48 patients completed the PDI and were included in our analysis. Patients with low PDI were assessed at an average of 11.34 (SD 4.53) weeks postpartum and patients with high PDI at 10.33 weeks (SD 6.24). Incidence of stool and gas incontinence was significantly greater in the high PDI group. While antepartum EPDS scores did not significantly differ, postpartum scores were greater in high PDI group. After adjusting for stool and gas incontinence, patients were more likely to report pain (OR 1.22; 95% CI -0.26, 0.47) but this difference was not statistically significant. However, elevated PDI was associated with leakage of stool in our adjusted model (OR 1.75; 95% CI 1.14, 2.17).

Conclusion: We found that psychologically traumatic birth was positively but insignificantly related to reported pain and significantly associated with increased stool incontinence. While further studies are needed, our results point towards a relationship between an emotionally traumatic birth and physical recovery.