Introduction
The prevalence of postpartum depression is estimated between 10% and
20%.1,2 Studies measuring postpartum post-traumatic
stress disorder (PTSD) observe prevalences of 0.3% to 4.0%, but higher
among women with notable medical or obstetric histories (18.5%, 95%CI,
10.6-30.38).3,4 The prevalence of postpartum anxiety
ranges from 8.5% to 18%.4,5 Studies have shown that
risks of postpartum depression, PTSD, and anxiety are higher among women
with obstetric complications than with uneventful
pregnancies.3,6 Caesarean and operative vaginal
deliveries also increase the risk of depression and
PTSD.7,8 Immediate postpartum haemorrhage (PPH)
concerned around 3.4% of vaginal deliveries (>500 mL) and
2.8% of caesareans (>1000 mL) in
France.9 PPH is one of the leading causes of maternal
death.10 The 2014 French guidelines updated the
definition of PPH: blood loss ≥500 mL in the first 24 hours after birth,
regardless of mode of delivery.11 Management of severe
PPH can require medical or surgical procedures.11Postpartum anaemia after PPH can cause fatigue, infections,
cardiovascular diseases, and compromise the mother-child
bond.12–14 All of these potential consequences can
produce higher rates of psychological disorders in these
women.1,15 Few published studies have examined the
psychological impact of immediate PPH,16–21 and only
two included control groups of women without PPH.22,23Neither Eckerdal et al. nor Ricbourg et al. found any difference between
the 2 groups for the prevalence of depression or
PTSD.22,23 One study interviewed women by
telephone,17 and others sent them self-administered
questionnaires by email from 1 month to 1 year
postpartum.16,18–20,22 These studies presented
methodological problems including unvalidated
questionnaires,17,18 retrospective
designs,17 large losses to
follow-up,17,22 information bias (interview at
different intervals after delivery),17 recall
bias,17 small sample size,17,20 and
failure to adjust for antenatal risk factors known to affect postpartum
depression, PTSD, or anxiety.16–18 These articles
have studied only severe PPH.16–20 Most authors have
assessed postpartum psychological disorders only for short periods (≤ 4
months),16–20 although it is recommended that these
assessments be performed up to one year.23
Our research hypothesis is that women with PPH have a higher rate of
postpartum psychiatric disorders than controls.
Our principal objective was to assess if the prevalence, mean score and
risk of depression (assessed as described in the outcome section below)
at each postpartum study period (2, 6, and 12 months) was higher among
women with, compared to without, immediate PPH (≥500 mL). Secondary
objectives were to describe at the same intervals the prevalence, mean
score, and risk of anxiety and PTSD.