Prévalence et facteurs de risque de la douleur génito-pelvienne persistante deux mois après un accouchement par voie basse

Position du problème et objectif(s) de l’étude

Beyond the feeling of pain in itself, persistent pain after childbirth can have a significant impact on maternal health outcomes, particularly on maternal well-being, mental health and the ability to care for a newborn baby. Effective prevention is therefore essential and relies on a comprehensive understanding of its risk factors. In contrast to caesarean section, representative data on persistent pain after vaginal birth are lacking. This study aimed to assess the prevalence and risk factors for persistent genito-pelvic pain two months after vaginal birth using population-based data.

Matériel et méthodes

Data were obtained from the 2021 National Perinatal Survey, a French nationwide cross-sectional population-based survey. The study population included women who delivered vaginally. The main outcome was persistent genito-pelvic pain at two months postpartum, assessed by a self-reported questionnaire. Its prevalence with 95% confidence intervals (CI) was estimated overall and according to parity and degree of perineal tear at birth. Risk factors for postpartum persistent genito-pelvic pain were identified using univariable and multivariable logistic regression. All analyses were weighted to account for 2-month attrition.

Résultats & Discussion

This study included 5,802 women who delivered vaginally. The overall prevalence of persistent genito-pelvic pain at 2 months postpartum was 12.8% (95%CI [11.8-13.8%]), ranging from 5.5% (95% CI [3.8-7.9]) in multiparous women who delivered spontaneously without perineal tears, to 48.3% (95% CI [30.8-66.1]) in primiparous women who delivered by operative vaginal birth with obstetric anal sphincter injury (OASI) (Figure 1). In multivariable analyses, all degrees of perineal tear were associated with an increased risk of persistent genito-pelvic pain compared with intact perineum (1st/2nd degree, aOR 2.08; 95%CI [1.51-2.87]; episiotomy: 3.37 [2.27-4.99] and OASI: 5.92 [3.03-11.55]). Other risk factors included being born in Africa (1.51 [1.06-2.16]), primiparity (1.50 [1.20-1.87]), poor maternal psychological status during pregnancy (2.05 [1.48-2.83]), operative birth (1.43 [1.14-1.79]), negative childbirth experience (2.03 [1.50-2.77]), and dissatisfaction with pain management during the maternity stay (somewhat satisfied: 1.59 [1.28-1.98]; and not very or not satisfied: 3.11 [2.27-4.26]) (Figure 2).

Conclusion

Persistent genito-pelvic pain at two months postpartum after vaginal delivery affects 1 in 10 women and increases with the degree of perineal injury. To reduce this pain, it is necessary to prevent perineal injuries and operative births as much as possible, while improving women's satisfaction during their maternity stay, probably by optimizing postpartum analgesic management.

Auteurs

Clara ROLLET (1) , Anne CHANTRY (2), Marie-Pierre BONNET (3) - (1)Equipe Oppale, Cress, Inserm 1153 / Maternité Port Royal, Aphp, Paris, France, (2)Equipe Oppale, Cress, Inserm 1153, Paris, France, (3)Equipe Oppale, Cress, Inserm 1153 / Hôpital Trousseau, Aphp, Paris, France

Orateur(s)

Clara ROLLET (Paris)