Effect of the acupuncture at acupoint combined with epidural labor analgesia on postpartum depression

Objective To explore the effects of the acupuncture at acupoint combined with epidural labor analgesia on the postpartum depression(PPD) and its mechanism.

Methods One hundred and eighty full-term single primiparas were randomly divided into the acupuncture at acupoint combined with epidural labor analgesia group(group SA) and epidural labor analgesia group(group S), and the parturients without labor analgesia requirements were set as the control group(group C)(60 cases in each group).The group SA was treated with acupuncture at Sanyinjiao point and Hegu point combined with 0.5 μg/mL sufentanil and 0.08% ropivacaine for epidural labor analgesia.The group S was treated with 0.5 μg/mL sufentanil combined with 0.08% ropivacaine for epidural labor analgesia.The group C was not treated with labor analgesia, and the cases were treated with the routine process of natural labor.The visual pain analogue scores(VAS) in three groups were recorded when the uterine orifice was opened for 2 cm(T₀), the uterine orifice was fully opened(T₁), and the fetus was delivered(T₂).The serum levels of glutamate(Glu) in three groups were measured by double-antibody sandwich ELISA method immediately before analgesia, at the end of the third stage of labor and postpartum 42 days, and the edinburgh postpartum depression scale(EPDS) scores were evaluated at postpartum 42 days.The incidence rates of PPD were compared among the three groups.The analgesic pump and adverse reactions in three groups were recorded at T₀-T₂.The labor course, postpartum 2 h blood loss and Bromage motion score after analgesia were recorded.

Results There was no statistical significance in the VAS score among three groups at T₀(P>0.05).At T₁ and T₂, the VAS scores in group SA and group S were significantly lower than that in group C(P < 0.01), and which in group SA was also significantly lower than that in group S(P < 0.01).There was no statistical significance in the blood loss among three groups in the first and second stage of labor and at postpartum 2 h(P>0.05).The second labor stage in group SA and group C was significantly shorter than that in group S(P < 0.01), but there was no statistical significance between group SA and group C(P>0.05).The EPDS score and PPD incidence in group SA and group S were lower than those in group C(P < 0.05 to P < 0.01), and the EPDS score and PPD incidence in group SA were lower than those in group S(P < 0.01 and P < 0.05).Immediately before analgesia, there was no statistical significance in the serum Glu levels among three groups(P>0.05).At the end of the third labor stage and postpartum 42 days, the maternal Glu levels in group SA and group S were lower than that immediately before analgesia(P < 0.01 and P < 0.05), which in the two groups were lower than that in group C(P < 0.01 and P < 0.05), and the maternal Glu level in group SA was significantly lower than that in group S(P < 0.01).The Bromage motion scores in three groups were 0, and the motor nerve block was not found in any of them.

Conclusions The acupuncture at acupoint combined with epidural labor analgesia can reduce the incidence rate of PPD, and the mechanism may be related to the decrease of serum Glu levels and alleviating labor pain.