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.