Strengths and Limitations
Strengths of our study include its prospective design, its control
group, a full year of follow-up after birth, and the largest sample size
so far published (n=1298 including 528 with PPH). Our participation rate
was higher than that of the other studies (22% and
65%).19,20 The self-administered questionnaires were
analysed continuously, by workers masked to the study group. Finally,
the exhaustiveness of the obstetric files’ descriptive data was verified
by crossing them with 3 other databases.
Our study’s first limitation is its single-centre design. Nonetheless,
our hospital is the only level 3 in the Auvergne region and receives
most of the pregnant women at known risk of PPH. The second limitation
is that recruitment of the women in the unexposed group was difficult,
and loss to follow-up over time notable (37.4% at M2, 56.6% at M6, and
63.5% at M12). For this reason, the protocol planned to recruit 2
unexposed women for every woman with PPH. The third limitation was the
use of questionnaires rather than a psychiatric interview to assess the
psychological outcomes. The questionnaires nonetheless have been
validated in French. The last limitation of our study is that, for
ethical reasons, women identified as at risk were offered an interview
with a psychologist or a psychiatrist; this might have reduced the
prevalence at M6 and M12. Accordingly, the questionnaires at 2, 6, and
12 months asked women if they had seen a psychiatrist or a psychologist
and what medication they might be taking.