Iranian Society of Gynecology Oncology

Document Type : Original Research Article


1 Department of Perinatology, School of Medicine, Genomic Research Center, Ayatollah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Obstetrics and Gynecology, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran

3 Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran


Background & Objective: In all surgical interventions including cesarean section, pain is a challenging issue.  The aim of this study was to identify the underlying causes that affect post-cesarean pain intensity.
Materials & Methods: A total of 128 consecutive patients who underwent cesarean section at Taleghani hospital were included in the study. A questionnaire was used to gather the patients’ demographic and clinical data. The length of the incision was measured with a ruler on the first day following the cesarean section. In addition, the pain intensity was assessed using a Likert scale at scales: 1, 2, 4, 8, 12, and 24, on the day after surgery and 48 hours and one week later. Descriptive statistics were calculated for all variables. Analyses were conducted using SPSS version 22 and a p-value < 0.05 was considered statistically significant.
Results: The study showed that overall, patient age, BMI, level of education, type of surgical incision, duration of surgery, type of cesarean section, type of anesthesia, and breastfeeding were not predictors of postoperative pain intensity. However, the study found that “indication of the cesarean section” and the “stage of labor” in which the cesarean was performed are correlated with postoperative pain intensity. (P-value<0.05).
Conclusion: In this study, we were able to identify 2 parameters that were independently associated to postoperative pain scores: “underlying indication of cesarean section” and the “stage of labor” in which cesarean section is performed. This information helps clinicians to identify high-risk patients in terms of postoperative pain and take early action.


Main Subjects

1. Ferrell BA. Pain Management. Clin Geriatr Med. 2000;16(4):853-73. [DOI:10.1016/S0749-0690(05)70048-3] [PMID]
2. Farahani SM, Malekzadegan A, Mohammadi R, Hosseini F. Effect of the one to one midwifery care during labor on modes of delivery. J Nurs Res. 2005;18(43):71-82.
3. Barash PG. Clinical Anesthesia: Lippincott Williams & Wilkins; 2009.
4. Cançado TOdB, Omais M, Ashmawi HA, Torres MLA. Chronic pain after cesarean section. Influence of anesthetic/surgical technique and postoperative analgesia. Rev Bras Anestesiol. 2012;62:768-74. [DOI:10.1590/S0034-70942012000600002]
5. Carvalho B, Butwick AJ. Postcesarean delivery analgesia. Best Pract Res Clin Anaesthesiol. 2017;31(1):69-79. [DOI:10.1016/j.bpa.2017.01.003] [PMID]
6. Faramarzi M, Pasha H, Bakhtiari A. A survey on the knowledge and attitude of pregnant women to normal delivery in Babol, 1999. J Babol Univ Medical Sci. 2001;3(4):39-42.
7. Moghimi Hanjani S, Mehdizadeh Tourzani Z, Zeighami Mohammadi S, Nasrollahi S, Haghighi Khoshkho N, Tajvidi M. The effect of local heat therapy method on pain, childbirth's outcomes, and rate of satisfaction in primiparous women: Randomize clinical trial. Qom Univ Med Sci J. 2018;12(5):35-43. [DOI:10.29252/qums.12.5.35]
8. Abushaikha L, Oweis A. Labour pain experience and intensity: A Jordanian perspective. Int J Nurs Pract. 2005;11(1):33-8. [DOI:10.1111/j.1440-172X.2005.00496.x] [PMID]
9. Konlan KD, Afaya A, Mensah E, Suuk AN, Kombat DI. Non-pharmacological interventions of pain management used during labour; an exploratory descriptive qualitative study of puerperal women in Adidome Government Hospital of the Volta Region, Ghana. Reprod Health. 2021;18(1):1-11. [DOI:10.1186/s12978-021-01141-8] [PMID] [PMCID]
10. Ojong IN, Nsemo AD. Midwives' utilization of nonpharmacological pain relief measures for labor pain management: A descriptive cross-sectional study. J Integr Nurs. 2022;4(2):76-82. [DOI:10.4103/jin.jin_27_22]
11. Shahrbanoo L, Omme Laila R, Shahram S. < The> effect of foot and hand massage on post-cesarean section pain. 2012.
12. Saatsaz S, Rezaei R, Alipour A, Beheshti Z. Massage as adjuvant therapy in the management of post-cesarean pain and anxiety: a randomized clinical trial. Complement Ther Clin Pract. 2016;24:92-8. [DOI:10.1016/j.ctcp.2016.05.014] [PMID]
13. Miri Farahani L, Abbasi Shavazi MJ. Caesarean section change trends in Iran and some demographic factors associated with them in the past three decades. J Fasa Univ Med Sci. 2012;2(3):127-34.
14. Dadipoor S, Alavi A, Safari-Moradabadi A. A survey of the growing trend of caesarian section in Iran and the world: a review article. Iran J Obstet Gynecol Infertil. 2016;19(27):8-17.
15. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS. Williams Obstetrics. 24e ed: Mcgraw-hill New York, NY, USA; 2014.
16. Maharlouei N, Rezaianzadeh A, Hesami E, Moradi F, Mazloomi E, Joulaei H, et al. The preference of Iranian women to have normal vaginal or cesarean deliveries. J Res Med Sci. 2013;18(11):943-50.
17. Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Rep. 2010;30(1):1-31.
18. Naseh N, Khazaie T, Kianfar S, Dehghan R, Yoosefi S. Prevalence of Cesarean and its complications in women referring to Vali-e-Asr hospital. Modern Care Journal. 2010;7(1).
19. Azami-Aghdash S, Ghojazadeh M, Dehdilani N, Mohammadi M. Prevalence and Causes of Cesarean Section in Iran: Systematic Review and Meta-Analysis. Iran J Public Health. 2014;43(5):545-55.
20. Sun K, Pan P. Persistent pain after cesarean delivery. Int J Obstet Anesth. 2019;40:78-90. [DOI:10.1016/j.ijoa.2019.06.003] [PMID]
21. Demelash G, Berhe YW, Gebregzi AH, Chekol WB. Prevalence and Factors Associated with Postoperative Pain After Cesarean Section at a Comprehensive Specialized Hospital in Northwest Ethiopia: Prospective Observational Study. Open Access Surg. 2022;15:1-9. [DOI:10.2147/OAS.S347920]
22. Mekonnen ZA, Melesse DY, Kassahun HG, Flatie TD, Workie MM, Chekol WB. Prevalence and Contributing Factors Associated With Postoperative Pain in Pediatric Patients: A Cross-Sectional Follow-up Study. Perioper Care Oper Room Manag. 2021;23:100159. [DOI:10.1016/j.pcorm.2021.100159]
23. Chan JJI, Thong SY, Tan MGE. Factors affecting postoperative pain and delay in discharge from the post-anaesthesia care unit: A descriptive correlational study. Proc Singapore Healthc. 2018;27(2):118-24. [DOI:10.1177/2010105817738794]
24. Borges NC, de Deus JM, Guimarães RA, Conde DM, Bachion MM, de Moura LA, et al. The incidence of chronic pain following Cesarean section and associated risk factors: A cohort of women followed up for three months. PloS One. 2020;15(9):e0238634. [DOI:10.1371/journal.pone.0238634] [PMID] [PMCID]
25. Jasim HH, Sulaiman SABS, Khan AH. Factors Affecting Post Caesarean Pain Intensity among Women in the Northern Peninsular of Malaysia. J Clin Diagnostic Res. 2017;11(9):IC07-IC11. [DOI:10.7860/JCDR/2017/25364.10630] [PMID] [PMCID]