Results
During the study period, our maternity department had 7274 births, including 887 PPH. The study finally included 1298 participants. Among the women who had a PPH, 819 were eligible and 64.4% agreed to participate (528 women) (Figure 2).
The descriptive socio-economic, medical, and obstetric date are available in Tables S1 to S5. Several variables differed between the groups of women with and without PPH: geographic origin, obstetric history, pregnancy by medically assisted reproduction, multiple pregnancy, disease during pregnancy, induction of labour, surgical delivery, and perineal lesions.
The mean blood loss was 922.0 ±520 mL in the PPH group and 182.3±110.4 mL in the other (p<0.0001). A second-line surgical procedure (defined as a B-Lynch suture, Cho suture, hypogastric arterial ligation, other vessel ligation, cervical suture, hysterectomy, repair of uterine wound closure, other surgery), and/or a vascular arterial embolization were performed for respectively 0.6% (n=3) and 0.2% (n=1) of the women with PPH. The packed red blood cell transfusion rate was 6.8% in women with PPH.
The newborns in the PPH group more often had a low (<2500 g) or high (>4000 g) (p<0.0001) birth weight as well as a 5-min Apgar < 7 (7.0% vs 1.7%, p<0.0001). They were also transferred more often to a neonatology units (18.3% vs 3.5%, p<0.0001) (Table S4).
The MINI questionnaire results scores were, among the women with PPH, compared with the control group, at M0, M6 and M12, respectively, 12.6%vs 16.3% (p=0.07), 19.3% vs 18.6% (p=0.85), and 16.5%vs 20.6% (p=0.26). At inclusion, the mean STAI Y-B score was 41.9% in the PPH group vs 48.2% in the control group (p=0.04). The percentage of women with anxiety (STAI Y-A >46) who sought some psychiatric and/or psychological at M2, M6 and M12 did not differ statistically differ between the 2 groups (Table S5).
The percentages of women receiving psychological and/or psychiatric treatment in the groups with and without PPH at M2, M6, and M12 were respectively 6.4% vs 2.9% (p=0.01); 5.8% vs 3.9% (p=0.29), and 7.1% vs 3.8% (p=0.11). Psychiatric treatment in the groups with and without PPH at M2, M6, and M12 was reported for, respectively, 5.1% vs 1.8% (p=0.008), 5.0% vs 1.5% (p=0.02), and 4.6% vs 3.1% (p=0.47).
At 2 months after giving birth, the women who had had a PPH had higher prevalence rates of both postpartum depression and PTSD than the women without PPH (24.4% vs 18.2%, p=0.03, and 12.8% vs7.6%, p=0.02) (table1). The prevalence of generalised anxiety disorders at 2 months did not differ between the groups, nor did the prevalence of the 3 disorders studied at 6 months or at one year (table 1). The prevalence of anxiety measured by the STAI Y-A was higher in the PPH group than in the control group at inclusion (18.1% vs 10.3%, p=0.01) and at M2 (20.0% vs 13.3%, p=0.01) but did not differ at either M6 or M12 (respectively, 16.8% vs 14.5%, p=0.46 and 11.7% vs 14.5%, p=0.39) (Table S6).
At one year, the group of women with PPH had an adjusted mean for the PTSD higher than the other group (7.6 [6.3-9.1] vs . 5.8 [4.9-6.8], p=0.02). The comparison of the least square means at the 3 study points after inclusion found that postpartum depression was more frequent among women without PPH at M12 (p=0.04) and PTSD more common in women with PPH at M2 (p=0.02) (table 1). The adjustment factors are described in Table S7. After adjustment, the only significant difference between the groups was a higher prevalence of PTSD in the PPH group at one year (7.6, 95%CI, 6.3-9.1 vs 5.8, 95%CI, 4.9-6.8, p=0.02) (table 1). The adjusted risks of depression, anxiety, and PTSD at 2, 6, and 12 months postpartum did not differ between the 2 groups (Table S8).