Obstetric Anal Sphincter Injury Complications and Postpartum Depression Scores

Objectives: Limited data exist describing the impact of postpartum obstetric anal sphincter injury complications on maternal mental health. We aimed to assess whether patients who experience wound complications after obstetric anal sphincter injuries would be more likely to have a positive screen on postpartum depression assessments. We hypothesized that patients with wound healing complications following obstetric anal sphincter injuries would be more likely to screen positive for postpartum depression compared to patients who experienced obstetric anal sphincter injuries without wound healing complications.

Methods: We performed a retrospective cohort study from a convenience sample of patients who were evaluated in a dedicated postpartum pelvic floor healing clinic from July 2021 through May 2023. We included patients who sustained a 3rd or 4th degree perineal laceration at the time of delivery and completed a postpartum depression screen. Our primary outcome was screening positive for postpartum depression using a validated postpartum questionnaire. Both Edinburgh postnatal depression scale (EPDS) and Patient Health Questionnaire - 9 (PHQ-9) were used at our institution during the study period. A positive screen was defined as ≥11 for EPDS and ≥10 for PHQ-9. For patients who completed both screenings, the highest screening score was used for primary outcome analysis. Obstetric anal sphincter injury wound healing complications were defined as a composite outcome including wound infection or breakdown, need for additional antibiotics or return to the operating room for wound repair. We used T-test, chi-square, Fisher’s exact test, and logistic regression for statistical analyses. This project was IRB exempt.

Results: Our cohort consisted of 211 patients who had experienced an obstetric anal sphincter injury during their most recent vaginal delivery and completed a postpartum depression screening. A total of 157 patients (74.4%) completed the PHQ-9 and 59 patients (28%) completed the EPDS (5 patients completed both assessments). Fifteen patients (7.1%) screened positive for postpartum depression. Wounds complications were significantly associated with screening positive for depression (p=0.048). Age was significantly different between those with and without wound complications (30.8 years vs 32.3 years, p=0.022) and was thus included in a regression analysis. On multivariable logistic regression controlling for age, wound complications remained significantly associated with screening positive for postpartum depression (OR=4.3 and 95% CI 1.4-13.7, p=0.013).

Conclusions: Patients with complications from a third or fourth-degree obstetrical laceration may be at higher risk of screening positive for postpartum depression. As patients navigate recovery from a complex obstetrical tear, special attention for those dealing with complications may help identify opportunities to support maternal mental health.