Burden of chronic postsurgical pain after caesarean delivery on maternal quality of life: a systematic review

Abstract

Summary Introduction Chronic postsurgical pain after caesarean delivery is an important cause of postpartum morbidity, yet its impact on maternal quality of life has not been comprehensively synthesised. The aims of this systematic review were to evaluate the impact of chronic postsurgical pain on quality of life, including possible temporal changes in the impact of pain on physical function, sleep, mood, fatigue and sexual wellbeing. Methods A comprehensive database review was performed to identify studies reporting quality of life outcomes ≥ 3 months after caesarean delivery, in women with persistent pain attributed to, or reported after, surgery. Owing to heterogeneity in chronic postsurgical pain definitions, anatomical pain attribution and quality of life measures, a narrative synthesis was undertaken. Results Thirty studies involving 28,295 women were included. Across studies, chronic postsurgical pain was associated with, or accompanied by, persistent interference in daily activity, sleep, mood and energy. Interference appeared to evolve over time, with activity‐related interference more prominent at 3 months postpartum (54%) and mood‐related interference more prominent at 6 and 12 months (53% and 68%, respectively). Fatigue showed little improvement between 6 and 12 months. Postpartum depression was common in the first year (7–46%) and depressive symptoms and fatigue were frequently associated with chronic postsurgical pain. Discussion Chronic postsurgical pain after caesarean delivery is associated with clinically important impairment across multiple domains of quality of life. Early postpartum disruption appears more strongly characterised by functional limitation, whereas affective and psychosocial interference may become relatively more prominent over time. These findings support a multidimensional understanding of persistent pain and recovery after caesarean delivery, and underscore the limitations of assessing pain intensity alone as an outcome in perioperative research.