Severe postpartum hemorrhage increases risk of posttraumatic stress disorder: a prospective cohort study.

PURPOSE: To evaluate whether severe postpartum hemorrhage (PPH) is a risk factor for posttraumatic stress disorder (PTSD). Severe PPH can be experienced as a traumatic event. PTSD leads to negative mental health effects. Knowing risk factors for PTSD during childbirth offers opportunities for early interventions, which may prevent the development of PTSD. MATERIALS AND METHODS: In this prospective study, we compared two groups of participants; women with ≥2000 mL of blood loss (severe PPH, patients) and women with ≤500 mL of blood loss (controls). Participants were screened for PTSD using the PCL-5 four to six weeks after delivery. Positive screening was followed by the CAPS-5 to diagnose PTSD. RESULTS: We included 187 PPH patients and 121 controls. Median PCL-5 scores were higher for PPH patients (5.0) than controls (4.0, p = 0.005). Thirteen PPH patients (7.0%) and two controls (1.7%) scored ≥32 on the PCL-5, indicative of probable PTSD (OR 4.45, 95% CI 0.99-20.06, p = 0.035). Significant more PPH patients than controls met criteria for a clinical diagnosis of PTSD on the CAPS-5 (n = 10, 5.6% vs n = 0, 0.0%; p = 0.007). CONCLUSIONS: There is a significant and clinically relevant increased risk for developing PTSD after severe PPH. Gynecologists and midwives are advised to screen for PTSD at postpartum follow-up visits to prevent long-term negative mental health effects. CLINICAL TRIAL REGISTRATION: NL50273.100.14.

Mental-health, coping and support following adverse events on the work-floor : a cross-sectional study among Dutch orthopaedic surgeons.

Physicians are frequently exposed to adverse events on the work-floor, which puts them at risk for depression, anxiety- or posttraumatic stress disorder. This study aims to explore what events orthopaedic surgeons consider to have the highest emotional impact as well as support, coping strategies and mental health. A questionnaire was emailed to all members of the Dutch Society of Orthopaedic Surgeons which included resident, attending, non-practicing and retired orthopaedic surgeons. The questionnaire in- cluded questions about demographics, personal experiences and subsequent support and coping. Also the Hospital Anxiety and Depression Scale and the Trauma Screening Questionnaire were included, which are validated screening instruments for anxiety, depression and posttraumatic stress disorder (PTSD), respectively. A total of 292 questionnaires were eligible for analysis. Most common events considered a high emotional impact stressor were : missing a diagnosis (59.2%), when a patient becomes severely handicapped (36.6%) or doubting whether one is making the right decision (36.6%). The prevalence of depression was higher compared to the general population with a high income in the Netherland (4.8 vs. 3.0 %,) and for anxiety as well (8.3 vs. 6.0%). Fifty-seven (19.5%) participants expe- rienced an adverse event as traumatic. Prevalence of PTSD was 0.3% among the whole sample. Most common coping strategies after adverse events were support from colleagues (80.7%), support from friends and family (59.3%) or doing sports (26.6%). Orthopaedic surgeons are exposed to many adverse events over the course of their career, which may have a high emotional impact. The prevalence rate found for depression and anxiety were both higher compared to the general population, while the rate for PTSD was lower. Still, more awareness must be created for the mental health of physicians as well as the implementation of a well-organized support system.

Posttraumatic stress disorder in partners following severe postpartum haemorrhage: A prospective cohort study.

BACKGROUND: Partners of women are increasingly present during childbirth and may be exposed to a traumatic experience. Since parents' mental health issues (i.e. posttraumatic stress disorder) have been shown to increase the risk of problems in the child's development, it is important to identify these risk factors. Partners often describe severe postpartum haemorrhage as traumatic. AIM: Whether witnessing severe postpartum haemorrhage is a risk factor for developing posttraumatic stress disorder in partners. METHODS: In this prospective cohort study, we compared partners of women with severe postpartum haemorrhage (≥2000 mL) and partners of women with ≤500 mL of blood loss (controls). Four weeks after birth partners were screened for posttraumatic stress disorder symptoms with a self-report questionnaire. Scores ≥11 were followed by a gold standard clinical interview to diagnose posttraumatic stress disorder. FINDINGS: We included 123 severe postpartum haemorrhage partners and 62 control partners. Partners of women with severe postpartum haemorrhage reported higher scores than control partners (median 3.0 (0.0-7.0) vs 2.0 (0.0-4.0), p = 0.04) on symptoms of posttraumatic stress, but no significant difference in probable posttraumatic stress disorder diagnosis according to the self-report questionnaire was found. According to the clinical interview no partners were diagnosed with posttraumatic stress disorder. Severe postpartum haemorrhage was experienced as traumatic by the partners who felt excluded. CONCLUSION: None of the partners developed posttraumatic stress disorder, revealing the resilience of young fathers. Because some partners reported severe postpartum haemorrhage as traumatic, we recommend sufficient information and support is provided during childbirth.

Internet usage of women attempting pregnancy and pregnant women in the Netherlands.

OBJECTIVES: Research focused on Internet behavior by women attempting pregnancy and pregnant women is scarce. Some research has been done in other countries, however it cannot be assumed those results also apply to Dutch women. STUDY DESIGN: A descriptive cross-sectional study was performed using an Internet-questionnaire among women attempting pregnancy and pregnant women. MAIN OUTCOME MEASURES: The aim of this study was to identify the Internet behavior of women attempting pregnancy and pregnant women in the Netherlands. RESULTS: In total, 365 women completed the questionnaire. Of these, 95.6% used the Internet as an information source before or during their pregnancy. Most searched topics were fetal development, lifestyle and pregnancy as well as birth complications. Over 90% of the women thought the information found was reliable and based pregnancy related decisions on this information. However, only 50.1% of the women discussed the information found with their caregiver. Of the respondents, 76.2% thought a reliable website is needed provided by the caregivers. CONCLUSIONS: A vast majority of Dutch women attempting pregnancy and Dutch pregnant women use the Internet to search for information and to make decisions about their pregnancy, however they were not satisfied with the information available online. A reliable, informative, interactive and up-to-date website is deemed necessary.

Posttraumatic stress disorder related to postpartum haemorrhage: A systematic review.

In some cases childbirth leads to negative psychological responses such as posttraumatic stress disorder (PTSD). Postpartum hemorrhage (PPH) is a common and major complication of childbirth, which occasionally requires emergency hysterectomy in severe cases. Patients often describe these complications as a traumatic experience. It is unknown whether PPH is a risk factor for developing PTSD. In this systematic review we summarize the current knowledge about the association between PPH with or without emergency hysterectomy and posttraumatic stress symptoms or PTSD. If PPH is a risk factor for PTSD, this will allow adequate preventive measures with the aim to reduce the long-term effects and socioeconomic problems associated with PTSD. To conduct this review MEDLINE, EMBASE, Web of Science, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Library and PsycINFO databases were searched for publications between January 1986 and October 2017. Manuscripts evaluating the association between PPH and peripartum emergency hysterectomy and PTSD or posttraumatic stress symptoms were included. Fifty-two articles met the criteria for full-text review. Seven articles were included in this review. Five studies focused on the association between PPH and PTSD and two studies evaluated the association between emergency hysterectomy and PTSD. Three studies found no association between PPH and PTSD. Two studies reported a higher risk of developing PTSD or posttraumatic stress symptoms after PPH. Two studies reported a higher risk of developing PTSD after emergency hysterectomy. Meta-analysis was not possible due to the heterogeneity of these studies. Based on the results of these studies there may be an association between PPH and PTSD. Secondly, it seems likely that an association exists between emergency postpartum hysterectomy and PTSD, but the strength of this conclusion is limited by the small amount of studies included.