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.