Brief Title: Intranasal Dexmedetomidine for Postpartum Depression Prevention: A Randomized Trial This study aims to evaluate the effect of intranasal dexmedetomidine (Dex) administered before combined spinal-epidural labor analgesia on the incidence of postpartum depression (PPD) in women undergoing vaginal delivery. This prospective, randomized, double-blind, placebo-controlled trial will enroll 270 parturients scheduled for vaginal delivery with neuraxial labor analgesia at Chengdu Jinjiang Maternal and Child Health Hospital from 2026 to 2027. Participants will be randomly assigned in a 1:1 ratio to receive either intranasal Dex (50 μg) or an equal volume of normal saline before the initiation of labor analgesia.
Primary Outcome Measure:
Incidence of PPD at 42 days postpartum, defined as an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10
Secondary Outcome Measures:
Incidence of PPD at 7 days postpartum (EPDS ≥ 10) Sleep quality assessed by Numerical Rating Scale (NRS) and incidence of sleep disturbance (NRS ≥ 6) at 7 and 42 days postpartum Analgesic effect: NRS pain scores before labor analgesia and at 30 minutes, 1 hour, and 3 hours after analgesia Sedative effect: Ramsay Sedation Scale scores at the same time points Adverse events: bradycardia, hypotension, nausea/vomiting, respiratory depression, oversedation, intrapartum fever Labor characteristics: duration of first, second, and third stages of labor, and total labor duration Duration of labor analgesia Mode of delivery: spontaneous vaginal delivery or cesarean section Neonatal outcomes: Apgar scores at 1, 5, and 10 minutes, and NICU admission rate We hypothesize that intranasal Dex administered before labor analgesia will significantly reduce the incidence of PPD at 42 days postpartum compared to placebo. This study is expected to provide a novel, non-invasive, and effective strategy for PPD prevention in women undergoing vaginal delivery, thereby improving maternal mental health and neonatal outcomes.
ASA physical status II or III.
Age ≥ 18 years.
Singleton pregnancy, cephalic presentation
No contraindications to neuraxial anesthesia and voluntarily requesting labor analgesia for planned vaginal delivery
History of bipolar disorder, psychiatric disorders, or suicidal ideation
Severe cardiac, cerebral, hepatic, or renal disease
Allergy to α2-adrenergic receptor agonists
Baseline bradycardia (heart rate < 60 bpm) or cardiac conduction abnormalities before labor analgesia
Parallel
Dexmedetomidine
DrugIntranasal dexmedetomidine 50 μg administered as a single dose immediately before initiation of Combined Spinal-Epidural labor analgesia. The drug is delivered via nasal spray device, with one spray of 25 μg in each nostril (total two sprays). The intervention is prepared and administered by the attending anesthesiologist who is aware of group allocation but does not participate in postoperative follow-up or outcome assessment.
Placebo
DrugIntranasal normal saline (one spray per nostril, total two sprays) administered as a single dose before initiation of Combined Spinal-Epidural labor analgesia. Identical in appearance, color, odor, and packaging to the dexmedetomidine nasal spray to maintain blinding.
Incidence of Postpartum Depression at 42 Days Postpartum
Proportion of participants with Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10 at 42 days postpartum. EPDS total score ranges from 0 to 30, with higher scores indicating more severe depressive symptoms.
Incidence of Postpartum Depression at 7 Days Postpartum
Proportion of participants with Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10 at 7 days postpartum. EPDS total score ranges from 0 to 30, with higher scores indicating more severe depressive symptoms.
Postpartum Sleep Quality
Sleep quality assessed by Numerical Rating Scale (NRS) at 7 and 42 days postpartum. NRS ranges from 0 to 10, with 0 indicating best sleep and 10 indicating worst sleep. Sleep disturbance is defined as NRS ≥ 6.
Pain Scores During Labor
Pain intensity assessed by Numerical Rating Scale (NRS) before labor analgesia and at 30 minutes, 1 hour, and 3 hours after analgesia. NRS ranges from 0 (no pain) to 10 (worst pain imaginable).
Sedation Scores During Labor
Sedation level assessed by Ramsay Sedation Scale before labor analgesia and at 30 minutes, 1 hour, and 3 hours after analgesia. Ramsay scale ranges from 1 (anxious/agitated) to 6 (no response).
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