Original Articles
Published August 25, 2020
Article Tools
Article Level Metrics
Share this article
facebook twitter linkedin


Cesarean section
Postoperative nausea and vomiting (PONV)

How to Cite

Khoshbin, M., Shajari, A., & Hajmohammadi, M. (2020). Correlation of preoperative stress, anxiety and depression in women undergoing cesarean section with postoperative nausea and vomiting. Internal Medicine and Medical Investigation Journal, 5(2). https://doi.org/10.24200/imminv.v5i2.265

Correlation of preoperative stress, anxiety and depression in women undergoing cesarean section with postoperative nausea and vomiting

Masoud Khoshbin
Assistant professor of aneasthesiology and pain medicine Aliebne-Abitaleb school of medicine,Islamic Azad University,Yazd branch,Yazd,Iran
Ahmad Shajari
Assistant professor of pediatrics nephrology Aliebne-Abitaleb school of medicine,Islamic Azad University,Yazd branch,Yazd,Iran
Mohammad Hajmohammadi
Medical doctor, Young Researchers and Elites Club, Faculty of Medicine, Islamic Azad University, Yazd branch, Yazd, Iran
Background: Correlation between stress, anxiety and depression in pregnant women and post-cesarean section (C-section) complications such as nausea and vomiting is among the most important studies in the world.Since nausea and vomiting after C-section cause the mother to be in uncomfortable condition, the purpose of this study was to determine the correlation of stress, anxiety and depression with postoperative nausea and vomiting (PONV).

Materials and Methods: The present descriptive-correlational study was conducted in early 2018 on 125 pregnant women under the C-section referred to Shohadaye Kargar Hospital of Yazd in Iran. After obtaining informed written consent and presenting oral explanation, the Depression Anxiety Stress Scale-21 (DASS-21) questionnaire was completed before the C-section. Then, a questionnaire was filled out after the C-section to assess the presence and intensity of nausea and vomiting. Data analysis was performed with SPSS software version 19 using analysis of variance.

Results: There was no significant correlation between stress, anxiety and depression before the C-section with presence and intensity of postoperative nausea. On the other hand, there was a significant correlation between preoperative stress and postoperative vomiting (P-value=0.024), which indicates that preoperative stress leads to postoperative vomiting in this study.

Conclusion: Based on the results of this study, increasing levels of stress, anxiety and depression in pregnant women under the C-section may have their own unpleasant side effects, but they do not increase the extent and intensity of postoperative nausea, and only preoperative stress can increase postoperative vomiting.



Rabiee L, Seyfi S, Shahrbanoo Latifi OJA, Pain. The effect of foot and hand massage on post-cesarean section pain. 2012;3(1):102-0.
2. 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 Journal of Fasa University of Medical Sciences. 2012;2(3):127-34.
3. Wirakusumah FF. Maternal and perinatal mortality/morbidity associated with cesarean section in Indonesia. Journal of obstetrics and gynaecology (Tokyo, Japan). 1995;21(5):475-81.
4. 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 J 2010;7(1):12-8.
5. Hosseini F, Khayyer M. Prediction of Behavioral and Decisional Procrastination Considering Meta-Cognition Beliefs in University Students %J Iranian Journal of Psychiatry and Clinical Psychology. 2009;15(3):265-73.
6. Liu X, Iwanaga K, Koda S. Circulatory and central nervous system responses to different types of mental stress. Ind Health. 2011;49(3):265-73.
7. Kelly RH, Russo J, Katon W. Somatic complaints among pregnant women cared for in obstetrics: normal pregnancy or depressive and anxiety symptom amplification revisited? General hospital psychiatry. 2001;23(3):107-13.
8. O'Hara MW, Stuart S, Gorman LL, Wenzel A. Efficacy of interpersonal psychotherapy for postpartum depression. Archives of general psychiatry. 2000;57(11):1039-45.
9. Spinelli MG, Endicott J. Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. The American journal of psychiatry. 2003;160(3):555-62.
10. Mirbagher Ajorpaz N, Aghajani M, Shahshahani Ms. The effects of music and Holy Quran on patient’s anxiety and vital signs before abdominal surgery %J Evidence Based Care. 2011;1(1):63-76.
11. Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales: Psychology Foundation of Australia; 1996.
12. Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. The British journal of clinical psychology. 2005;44(Pt 2):227-39.
13. Kuo SH, Wang RH, Tseng HC, Jian SY, Chou FH. A comparison of different severities of nausea and vomiting during pregnancy relative to stress, social support, and maternal adaptation. Journal of Midwifery & Women's Health. 2007;52(1):e1-e7.
14. Swallow BL, Lindow SW, Masson EA, Hay DM. Psychological health in early pregnancy: Relationship with nausea and vomiting. Journal of Obstetrics and Gynaecology. 2004;24(1):28–32.
15. Strahl C, Kleinknecht RA, Dinnel DL. The role of pain anxiety, coping, and pain self-efficacy in rheumatoid arthritis patient functioning. Behaviour research and therapy. 2000;38(9):863-73.
16. Nikibakhsh A, Neisani samani L, Keshavarz M, Hoseini F. Incidence and Severity of Nausea and Vomiting during Pregnancy and its Association with Anxiety and Depression in Pregnant Women %J Iran Journal of Nursing. 2016;29(101):1-11.
Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.