Evolution of Cloacal Exstrophy Research: A Comprehensive Bibliometric and Scientometric Assessment.

According to the World Health Organization’s 2023 Global Health Report, approximately 135 million women give birth worldwide each year, with the global prevalence of perinatal mental disorders ranging from 17.2% to 24.7% (). This translates to roughly 40 million women experiencing psychological problems associated with childbirth annually. Maternal mental health has thus emerged as a critical global public health priority. Childbirth is generally regarded as a natural biological instinct for women and a joyful event that usually evokes positive psychological responses. However, this perception tends to overlook the fact that the uncertainty and unpredictability of the childbirth process may cause profound and lasting psychological harm to mothers. Studies have shown that traumatic experiences caused by adverse childbirth processes (), fluctuations in hormone levels before and after delivery, as well as conflicts in maternal role adaptation and lifestyle changes, may all lead to psychological maladjustment and negative emotional responses in mothers. As a unique psychological experience for women, childbirth trauma has been reported to cause psychological distress in 9% to 44% of women, and in more severe cases may develop into postpartum post-traumatic stress disorder (PP-PTSD). Post-traumatic stress disorder (PTSD) refers to delayed and persistent physical and psychological disturbances caused by exposure to extraordinarily threatening or catastrophic traumatic events (). PP-PTSD refers to a delayed mental stress disorder occurring after childbirth, which may be triggered by previous traumatic experiences, pregnancy and delivery complications, traumatic childbirth experiences, or the birth of critically ill infants (). Its main symptoms include re-experiencing negative feelings related to childbirth, avoidance of anything associated with delivery or the infant, heightened vigilance, and a state of excessive stress. PP-PTSD can seriously affect women’s physical and mental health, family relationships, and social relationships, and its impact may persist for a long time. Women with PP-PTSD are more likely to experience irritability, sadness, depression, sleep disturbances, and even suicidal ideation. The prevalence of PP-PTSD varies considerably across countries and regions. A cross-sectional study in Spain that assessed 290 postpartum women at 4–6 weeks after childbirth found a PP-PTSD prevalence of 10.6% (). A multicenter study conducted by Dutch scholars in midwifery institutions, general hospitals, and teaching hospitals reported a PP-PTSD prevalence of 1.2% (). In China, Xu Guiru et al. surveyed 233 postpartum women and reported a PP-PTSD prevalence of 10.3% (). Among maternal populations, primiparas represent an important group in women’s health research because they undergo unique physiological, psychological, and social changes. Primiparas not only face the challenges of pregnancy, childbirth, and postpartum recovery, but also need to adapt to the transition to motherhood (). Owing to their lack of prenatal and postnatal experience, primiparas often experience greater anxiety and stress, making them more vulnerable to PP-PTSD. Seng JS and colleagues in the United States followed 1, 581 primiparas () and found that the prevalence of PP-PTSD was 32%, which was much higher than that in multiparas. Given the various risks associated with PP-PTSD, healthcare professionals must promptly understand the post-traumatic psychological responses of primiparas in order to implement appropriate short- and long-term medical interventions and alleviate problems caused by PP-PTSD symptoms. At present, research on PP-PTSD mainly focuses on investigations of its current status and influencing factors. Studies on influencing factors have primarily explored psychosocial-related variables (, ). However, comprehensive assessment of PP-PTSD among primiparas remains inadequate, and there is still a lack of studies exploring influencing factors from an overall perspective and constructing predictive models.