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).