Abstract / Summary
Abstract Background Persistent maternal pain following cesarean delivery (CD) is common and can have deleterious consequences. Data about persistent pain characteristics, including distribution, predictors and trajectories following CD, especially in women undergoing repeated CD, are still limited. Methods This prospective observational study was performed at the Women’s Hospital of Nanjing Medical University from May 2022 to November 2023 to identify factors associated with persistent pain in this cohort by LASSO and multivariable logistic regression analysis. Pain scores and anatomical locations were recorded through 90 days post‑CD to delineate temporal patterns. And we also performed an exploratory analysis of postoperative pain trajectory distributions among the parturient by LCMM analysis. Results Of the 360 parturient women enrolled, 357 completed the final analysis of prevalence, risk factors, and pain trajectory. Pain prevalence after repeated CD fell sharply over time, from 99.7% on postoperative day (POD) 1 to 25.9% by POD 90. Multivariable logistic regression identified two independent risk factors for persistent pain at POD 90 using LASSO-selected variables across 20 imputed datasets: anxiety (adjusted OR 2.933; 95% CI 1.55 to 5.549; P = 0.001) and higher uterine contraction pain score on POD 1 (adjusted OR 1.174; 95% CI 1.015 to 1.361; P = 0.031). The logistic model showed modest discrimination (AUC 0.638; 95% CI 0.571 to 0.706). At the optimal cutoff of 0.259, sensitivity was 50.0% and specificity was 74.0%. An exploratory LCMM analysis identified three 90-day pain trajectories after repeated CD: Slow recovery from severe pain (Class 1, 37 (10.4%)), Persistent moderate pain (Class 2, 30 (8.4%)), and Consistent low pain (Class 3, 290 (81.2%)). Conclusions Approximately one in four women experience all-caused postoperative pain at day 90 following repeated CD. Prenatal anxiety and greater visceral pain at POD 1 are associated with higher likelihood of reporting persistent pain, with only modest discriminatory power. Further multi-center studies are needed to explore better interventions, such as emotional reassurance or multimodal analgesia, in anxious parturient when undergoing repeated CD. Exploratory trajectory analysis indicates a subset at higher risk either follow a slow-recovery trajectory or remain in a persistent pain state, who will also require increased attention in the future. Trial registration This study was registered in the Chinese Clinical Trial Registry (ChiCTR2200059487) on 02/05/2022.