Influence of Planned Versus Unplanned Cesarean Delivery on Postpartum Peritraumatic Distress: A Prospective Observational Study

Abstract

Objectives

Postpartum post-traumatic stress disorder (PTSD) is a significant contributor to maternal morbidity. Peritraumatic distress, an immediate reaction to a traumatic event, is an early indicator of PTSD and may help identify patients at risk for postpartum PTSD soon after delivery. Previous studies report higher rates of postpartum PTSD after unplanned cesarean delivery. We hypothesized that peritraumatic distress scores, measured using the peritraumatic distress inventory (PDI), would differ between planned and unplanned cesarean deliveries.

Methods

In this observational prospective study, patients completed the PDI and patient perception score (PPS) 24 hours after cesarean delivery. The primary outcome was the median difference in PDI scores by delivery urgency (planned vs. unplanned), assessed using the Mann–Whitney U-test. Secondary outcomes included the correlation between PDI scores and patient satisfaction, as measured by Kendall tau correlation.

Results

A total of 220 patients (110 planned, 110 unplanned) were included. Patients who underwent unplanned cesarean delivery reported significantly higher PDI scores (P < 0.001). A greater proportion of unplanned versus planned deliveries exceeded the PDI threshold for PTSD risk (25.5% vs. 5.5%). There was a significant negative correlation between PDI and patient perception scores (τ = −0.25; P < 0.001).

Conclusions

Unplanned cesarean delivery was associated with elevated peritraumatic distress and increased risk for postpartum PTSD. Early PDI screening may help identify patients in need of psychological support before discharge. However, low PDI scores should not preclude follow-up because some may develop delayed trauma responses. These findings support universal screening and underscore the need for future research on serial postpartum assessments.