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. 2026 Oct 17;20:646618. doi: 10.2147/DDDT.S646618

Figure 2.

Infographic on peripartum care: antenatal assessment, delivery regimens, postpartum outcomes and evidence gaps. The infographic outlines the multimodal peripartum care context across five sections. A) Antenatal assessment includes antenatal depressive symptoms, anxiety and sleep disturbance, mode of delivery and analgesic plan, hypertensive or psychiatric risk. Candidate factors under investigation are not validated selection criteria. B) Labor or cesarean delivery features trial-derived peri-delivery esketamine regimens: intravenous bolus or infusion, neuraxial adjunct, postoperative PCIA component. These are investigational adjuncts within multimodal care, not standardized dosing recommendations. C) Early postpartum (0-72 h) shows concentration of current clinical evidence across domains: pain, mood, sleep and safety. Pain scores, opioid-related outcomes, PCIA activations, early depressive-symptom scores, subjective sleep-quality measures, maternal neuropsychiatric events, Apgar and short-term neonatal outcomes are studied. D) Postpartum weeks 1-6 cover mood-related follow-up, sleep-related follow-up, recovery and safety. E) Beyond 6 weeks highlights major evidence gaps: durability of mood benefit, objective postpartum sleep architecture, long-term maternal outcomes, infant neurodevelopmental safety. Multimodal peripartum care context includes neuraxial analgesia, opioid-sparing strategies, psychological support, sleep support, routine obstetric care.

Timeline of current clinical evidence and major evidence gaps for peripartum esketamine. (A) summarizes antenatal assessment and candidate clinical factors under investigation, which should not be interpreted as validated criteria for selecting patients. (B) illustrates trial-derived esketamine regimens used around labor or cesarean delivery, including intravenous bolus or infusion, neuraxial adjuncts, and postoperative patient-controlled intravenous analgesia. These regimens do not constitute standardized dosing recommendations. (C) summarizes clinical outcomes studied during the early postpartum period (0–72 h), including pain, mood, subjective sleep, and short-term maternal and neonatal safety. (D) summarizes follow-up during postpartum weeks 1–6, including depressive symptoms, limited diagnostic mood outcomes, subjective sleep, maternal recovery, and neonatal observation. (E) highlights major evidence gaps beyond 6 weeks, including the durability of mood-related benefits, objective postpartum sleep architecture, long-term maternal outcomes, and offspring neurodevelopmental safety. Direct clinical evidence is concentrated around labor or cesarean delivery and the early postpartum period, with the most consistent findings relating to short-term analgesic outcomes. Mood-related studies have predominantly used EPDS-defined screening outcomes, whereas structured diagnostic outcomes remain limited. Sleep-related evidence is mainly subjective, and objective postpartum sleep architecture has not been directly evaluated. Italicized text denotes interpretive evidence-status statements, qualifications, or cautions rather than additional measured clinical outcomes. Horizontal dotted or dashed separator lines distinguish these interpretive notes from the surrounding information; they do not represent dashed evidence boxes. The timeline reflects the approximate timing and distribution of the available evidence.

Abbreviations: EPDS, Edinburgh Postnatal Depression Scale; PCIA, patient-controlled intravenous analgesia.