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Osório FL, Borges MM. Posttraumatic stress disorder prevalence and childbirth: update meta-analysis after the introduction of the DSM-5 and COVID-19 pandemic. Arch Womens Ment Health 2024; 27:337-357. [PMID: 38265513 DOI: 10.1007/s00737-024-01423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Meta-analyses were previously performed to estimate PTSD prevalence in the postpartum period. Significant events that could impact this outcome occurred in the last decade, such as the publication of the DSM-5 in 2013 and the COVID-19 pandemic in 2020. This systematic literature review with a meta-analysis addressed studies published after 2014 to estimate PTSD prevalence after childbirth. METHOD The methodological guidelines recommended by PRISMA were followed. The meta-analysis estimate was the proportion of PTSD cases. The restricted maximum likelihood (REML) was the method adopted for estimation in addition to multilevel random effect models. Subgroup analyses were performed to assess the impact of interest variables. RESULTS The estimated prevalence was 0.10 (95%CI: 0.8-0.13; I2 = 98.5%). No significant differences were found regarding the introduction of the DSM-5 (p = 0.73) or COVID-19 (p = 0.97), but instead, between low- and middle-income countries, e.g., the Middle East presents a higher prevalence (p < 0.01) than European countries. CONCLUSIONS There is a potential increase in PTSD prevalence rates after childbirth in the last decade not associated with the pandemic or the current diagnostic classification. Most studies showed a methodological fragility that must be overcome to understand this phenomenon better and support preventive actions and treatment for puerperal women.
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Affiliation(s)
- Flávia L Osório
- Medical School of Ribeirão Preto. São Paulo University, Avenida Dos Bandeirantes, 3900, Ribeirão Preto, SP, 14048-900, Brazil.
- National Institute of Science and Technology (INCT-TM, CNPq), Brasília, Brazil.
| | - Maira Morena Borges
- Medical School of Ribeirão Preto. São Paulo University, Avenida Dos Bandeirantes, 3900, Ribeirão Preto, SP, 14048-900, Brazil
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Froeliger A, Deneux-Tharaux C, Loussert L, Madar H, Sentilhes L. Posttraumatic stress disorder 2 months after cesarean delivery: a multicenter prospective study. Am J Obstet Gynecol 2024:S0002-9378(24)00440-X. [PMID: 38494069 DOI: 10.1016/j.ajog.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND The prevalence and risk factors of posttraumatic stress disorder after cesarean delivery, outside high-risk contexts, remain unclear. OBJECTIVE This study aimed to assess posttraumatic stress disorder prevalence and risk factors at 2 months postpartum among a general population of women with cesarean delivery. STUDY DESIGN This was a prospective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, conducted in 27 French hospitals from 2018 to 2020, enrolling women expected to undergo cesarean delivery before or during labor at ≥34 weeks of gestation. After randomization, characteristics of the cesarean delivery and postpartum blood loss were prospectively collected. Two months after childbirth, posttraumatic stress disorder profile (presence of posttraumatic stress disorder symptoms) and provisional diagnosis (positive screening for diagnosis consistent with a posttraumatic stress disorder) were assessed by 2 self-administered questionnaires (Impact of Event Scale - Revised and Traumatic Event Scale). The corrected posttraumatic stress disorder prevalence was estimated with inverse probability weighting to take nonresponse into account. Associations between potential risk factors and posttraumatic stress disorder were analyzed by multivariate logistic or linear regression modeling according to the type of dependent variable. RESULTS In total, 2785 of 4431 women returned the Impact of Event Scale - Revised questionnaire and 2792 the Traumatic Event Scale (response rates of 62.9% and 63.0%). The prevalence of posttraumatic stress disorder profile was 9.0% (95% confidence interval, 7.8%-10.3%) and of provisional diagnosis 1.7% (95% confidence interval, 1.2%-2.4%). Characteristics associated with a higher risk of posttraumatic stress disorder profile were prepregnancy vulnerability factors (young age, high body mass index, and African-born migrant) and cesarean delivery-related obstetrical factors (cesarean delivery after induced labor [adjusted odds ratio, 1.81; 95% confidence interval, 1.14-2.87], postpartum hemorrhage [adjusted odds ratio, 1.61; 95% confidence interval, 1.04-2.46] and high-intensity pain during the postpartum stay [adjusted odds ratio, 1.90; 95% confidence interval, 1.17-3.11]). Women who had immediate skin-to-skin contact with their newborn were at lower risk of posttraumatic stress disorder (adjusted odds ratio, 0.66; 95% confidence interval, 0.46-0.98), and women with bad memories of delivery on day 2 postpartum were at higher risk (adjusted odds ratio, 3.20; 95% confidence interval, 1.97-5.12). The Impact of Event Scale - Revised and the Traumatic Event Scale yielded consistent results. CONCLUSION Approximately 1 in 11 women with cesarean deliveries had posttraumatic stress disorder symptoms at 2 months postpartum. Some obstetrical interventions and components of cesarean delivery management may influence this risk.
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Affiliation(s)
- Alizée Froeliger
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France; Université Paris Cité, Women's Health, Institut Hors-Murs, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Research on Epidemiology and Statistics (CRESS) U1153, Inserm, Paris, France.
| | - Catherine Deneux-Tharaux
- Université Paris Cité, Women's Health, Institut Hors-Murs, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Research on Epidemiology and Statistics (CRESS) U1153, Inserm, Paris, France
| | - Lola Loussert
- Université Paris Cité, Women's Health, Institut Hors-Murs, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Research on Epidemiology and Statistics (CRESS) U1153, Inserm, Paris, France; Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse, France
| | - Hugo Madar
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France; Université Paris Cité, Women's Health, Institut Hors-Murs, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Research on Epidemiology and Statistics (CRESS) U1153, Inserm, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
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Deruelle P, Debalme C, Garcia-Lebailly K, Di Giusto C, Sentilhes L. [Women's experience following prophylactic low molecular weight heparin treatment post-cesarean section]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024:S2468-7189(24)00083-7. [PMID: 38437947 DOI: 10.1016/j.gofs.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/23/2024] [Accepted: 02/22/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To assess women's experiences with skin-related side effects following subcutaneous low molecular weight heparin (LMWH) injections after a cesarean section, and to analyze their impact on treatment adherence. METHOD A questionnaire was developed in collaboration with Cesarine, a patients' association, to explore various aspects of LMWH administration, including prevention methods, cutaneous side effects, treatment compliance, perceived constraints, apprehension, and understanding of treatment benefits. Additionally, women's opinions on an alternative oral administration approach were solicited, taking into consideration breastfeeding contraindication. The questionnaire was on the Facebook® page and blog of the association. RESULTS One hundred and sixty-four women participated in the survey. Among them, 139 women (84.8%) reported bruising, while 117 (71.3%) reported pruritus, erythema, or nodules at the injection site. Treatment discontinuation was observed in 36 cases (22%), decided mostly by the women themselves (77.8%). The main reasons cited for discontinuation were discomfort during injection (71.4%), skin reactions (31.4%), and a perceived lack of effectiveness (54.3%). Furthermore, 88 women (53.7%) wanted to quit the treatment prematurely, citing similar reasons. Thirty-three women (20.1%) reported oversights. For most women, the treatment was perceived as burdensome and caused apprehension. An alternative oral administration method was of interest to 131 women (79.9%). However, only 28 (17.8%) would have accepted if the medication was incompatible with breastfeeding. CONCLUSION Cutaneous side effects of LMWH injections, as well as injection process itself, have a negative impact on adherence in the postpartum period following a c-section. These findings highlight the need to explore alternative to improve women's compliance and comfort.
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Affiliation(s)
- Philippe Deruelle
- Service de gynécologie-obstétrique, CHU de Montpellier, université de Montpellier, Montpellier, France.
| | | | | | | | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
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4
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Froeliger A, Deneux-Tharaux C, Loussert L, Bouchghoul H, Madar H, Sentilhes L. Prevalence and risk factors for postpartum depression 2 months after a vaginal delivery: a prospective multicenter study. Am J Obstet Gynecol 2024; 230:S1128-S1137.6. [PMID: 38193879 DOI: 10.1016/j.ajog.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Very little is known about the prevalence and risk factors of postpartum depression among women with vaginal births without major pregnancy complications. OBJECTIVE This study aimed to assess the prevalence of postpartum depression and identify its characteristics 2 months after singleton vaginal delivery at or near term. STUDY DESIGN This was an ancillary cohort study of the TRanexamic Acid for Preventing Postpartum Hemorrhage After Vaginal Delivery randomized controlled trial, which was conducted in 15 French hospitals in 2015-2016 and enrolled women with singleton vaginal deliveries after 35 weeks of gestation. After randomization, the characteristics of labor, delivery, and the immediate postpartum experience, including the experience of childbirth, were prospectively collected. Medical records provided women's other characteristics, particularly any psychiatric history. Of note, 2 months after childbirth, provisional postpartum depression diagnosis was defined as a score of ≥13 on the Edinburgh Postnatal Depression Scale, a validated self-administered questionnaire. The corrected prevalence of postpartum depression was calculated with the inverse probability weighting method to take nonrespondents into account. Associations between potential risk factors and postpartum depression were analyzed by multivariate logistic regression. Moreover, an Edinburgh Postnatal Depression Scale cutoff value of ≥11 was selected to perform a sensitivity analysis. RESULTS The questionnaire was returned by 2811 of 3891 women (72.2% response rate). The prevalence rates of the provisional diagnosis were 9.9% (95% confidence interval, 8.6%-11.3%) defined by an Edinburgh Postnatal Depression Scale score of ≥13 and 15.5% (95% confidence interval, 14.0%-17.1%) with a cutoff value of ≥11. The characteristics associated with higher risks of postpartum depression in multivariate analysis were mostly related to prepregnancy characteristics, specifically age of <25 years (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-2.9) and advanced age (adjusted odds ratio, 1.8; 95% confidence interval, 1.2-2.6), migration from North Africa (adjusted odds ratio, 2.9; 95% confidence interval, 1.9-4.4), previous abortion (adjusted odds ratio, 1.4; 95% confidence interval, 1.0-2.0), and psychiatric history (adjusted odds ratio, 2.9; 95% confidence interval, 1.8-4.8). Some characteristics of labor and delivery, such as induced labor (adjusted odds ratio, 1.5; 95% confidence interval, 1.1-2.0) and operative vaginal delivery (adjusted odds ratio, 1.4; 95% confidence interval, 1.0-2.0), seemed to be associated with postpartum depression. In addition, bad memories of childbirth in the immediate postpartum were strongly associated with postpartum depression symptoms at 2 months after giving birth (adjusted odds ratio, 2.4; 95% confidence interval, 1.3-4.2). CONCLUSION Approximately 10% of women with vaginal deliveries have postpartum depression symptoms, assessed by a score of ≥13 on the depression scale that was used at 2 months. Prepregnancy vulnerability factors; obstetrical characteristics, such as induced labor and operative vaginal delivery; and bad memories of childbirth 2 days after delivery were the main factors associated with this provisional diagnosis. A screening approach that targets risk factors may help to identify women at risk of postpartum depression who could benefit from early intervention.
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Affiliation(s)
- Alizée Froeliger
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France; Perinatal Obstetrical and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics, National Institute of Health and Medical Research, Université Paris Cité, Paris, France
| | - Catherine Deneux-Tharaux
- Perinatal Obstetrical and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics, National Institute of Health and Medical Research, Université Paris Cité, Paris, France
| | - Lola Loussert
- Perinatal Obstetrical and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics, National Institute of Health and Medical Research, Université Paris Cité, Paris, France; Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse, France
| | - Hanane Bouchghoul
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Hugo Madar
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
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Froeliger A, Deneux-Tharaux C, Madar H, Bouchghoul H, Le Ray C, Sentilhes L. Closed- or open-glottis pushing for vaginal delivery: a planned secondary analysis of the TRAnexamic Acid for Preventing postpartum hemorrhage after vaginal delivery study. Am J Obstet Gynecol 2024; 230:S879-S889.e4. [PMID: 37633725 DOI: 10.1016/j.ajog.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The effect on obstetrical outcomes of closed- or open-glottis pushing is uncertain among both nulliparous and parous women. OBJECTIVE This study aimed to assess the association between open- or closed-glottis pushing and mode of delivery after an attempted singleton vaginal birth at or near term. STUDY DESIGN This was an ancillary planned cohort study of the TRAAP (TRAnexamic Acid for Preventing postpartum hemorrhage after vaginal delivery) randomized controlled trial, conducted in 15 French maternity units from 2015 to 2016 that enrolled women with an attempted singleton vaginal delivery after 35 weeks' gestation. After randomization, characteristics of labor and delivery were prospectively collected, with special attention to active second-stage pushing and a specific planned questionnaire completed immediately after birth by the attending care provider. The exposure was the mode of pushing, classified into 2 groups: closed- or open-glottis. The main endpoint was operative vaginal delivery. Secondary endpoints were items of maternal morbidity, including severe perineal laceration, episiotomy, postpartum hemorrhage, duration of the second stage of labor, and a composite severe neonatal morbidity outcome. We also assessed immediate maternal satisfaction, experience of delivery, and psychological status 2 months after delivery. The associations between mode of pushing and outcome were analyzed by multivariate logistic regression to control for confounding bias, with multilevel mixed-effects analysis, and a random intercept for center. RESULTS Among 3041 women included in our main analysis, 2463 (81.0%) used closed-glottis pushing and 578 (19.0%) open-glottis pushing; their respective operative vaginal delivery rates were 19.1% (n=471; 95% confidence interval, 17.6-20.7) and 12.5% (n=72; 95% confidence interval, 9.9-15.4; P<.001). In an analysis stratified according to parity and after controlling for available confounders, the rate of operative vaginal delivery did not differ between the groups among nulliparous women: 28.7% (n=399) for the closed-glottis and 27.5% (n=64) for the open-glottis group (adjusted odds ratio, 0.93; 95% confidence interval, 0.65-1.33; P=.7). The operative vaginal delivery rate was significantly lower for women using open- compared with closed-glottis pushing in the parous population: 2.3% (n=8) for the open- and 6.7% (n=72) for the closed-glottis groups (adjusted odds ratio, 0.43; 95% confidence interval, 0.19-0.90; P=.03). Other maternal and neonatal outcomes did not differ between the 2 modes of pushing among either the nulliparous or parous groups. CONCLUSION Among nulliparous women with singleton pregnancies at term, the risk of operative vaginal birth did not differ according to mode of pushing. These results will inform shared decision-making about the mode of pushing during the second stage of labor.
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Affiliation(s)
- Alizée Froeliger
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Catherine Deneux-Tharaux
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics, Institut National de la Sante et de la Recherche Medicale, Université Paris Cité, Paris, France
| | - Hugo Madar
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Hanane Bouchghoul
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Camille Le Ray
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics, Institut National de la Sante et de la Recherche Medicale, Université Paris Cité, Paris, France; Assistance Publique - Hôpitaux de Paris, Maternity Port Royal, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
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Sentilhes L, Bénard A, Madar H, Froeliger A, Petit S, Deneux-Tharaux C. Tranexamic acid for reduction of blood loss after Caesarean delivery: a cost-effectiveness analysis of the TRAAP2 trial. Br J Anaesth 2023; 131:893-900. [PMID: 37690946 DOI: 10.1016/j.bja.2023.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Prophylactic administration of tranexamic acid is associated with a reduction of blood loss after Caesarean delivery, but cost-effectiveness for this indication has not been assessed. METHODS We used data from the TRAAP2 trial, a multicentre, double-blinded, RCT aimed at estimating the efficacy of tranexamic acid for preventing postpartum haemorrhage among women undergoing Caesarean delivery. Women recruited at 27 French maternity hospitals from 2018 to 2020 were enrolled before the procedure if they had a Caesarean delivery before or during labour at 34 or more weeks of gestation. The main outcomes were the cost of hospital stay for delivery and the incremental cost per delivery without complication within 90 days after delivery with tranexamic acid compared with placebo. Differences in costs and the incremental net monetary benefit (INMB) were estimated using linear regression models, and the cost-effectiveness probability of tranexamic acid compared with placebo was estimated through the parametric distribution of the INMB. RESULTS The proportion of women without complications at day 90 was 70.7% in the tranexamic acid group and 66.0% in the placebo group. Mean total costs until occurrence of a complication of interest were €3321 in the tranexamic acid group and €3260 in the placebo group, resulting in a difference between the two groups of 7.2% and €55 after multiple imputation. The adjusted incremental cost-effectiveness ratio was €762 per additional Caesarean delivery without a complication at 90 days after delivery. At a cost-effectiveness threshold of €10,000, the cost-effectiveness probability of tranexamic acid compared with placebo was 99.9%, varying from 5.8% to 100.0% for thresholds from €0 to €10,000 per additional delivery without a complication at day 90. CONCLUSION Tranexamic acid for the prevention of blood loss is cost-effective in reducing complications after Caesarean delivery at day 90 postpartum. However, the effect size (in cost and effectiveness) is very low. CLINICAL TRIAL REGISTRATION NCT03431805.
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Affiliation(s)
- Loïc Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France.
| | - Antoine Bénard
- CHU Bordeaux, Clinical Epidemiology Unit (USMR), INSERM, Bordeaux Population Health, Bordeaux, France
| | - Hugo Madar
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
| | - Alizée Froeliger
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
| | - Solène Petit
- INSERM, Bordeaux Population Health, UMR 1219, Bordeaux, France
| | - Catherine Deneux-Tharaux
- Université de Paris, CRESS, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, DHU Risks in Pregnancy, Paris, France
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Morales-Suárez-Varela M, Peraita-Costa I, Perales-Marín A, Marcos Puig B, Llopis-Morales J, Picó Y. Effect of Adherence to the Mediterranean Diet on Maternal Iron Related Biochemical Parameters during Pregnancy and Gestational Weight Gain. Life (Basel) 2023; 13:life13051138. [PMID: 37240783 DOI: 10.3390/life13051138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Gestation is a crucial life stage for both women and offspring, and outcomes are affected by many environmental factors, including diet. The Mediterranean dietary pattern (MD) is considered a healthy eating pattern that can provide the nutritional requirements of pregnancy. Meanwhile, iron deficiency anemia is one of the most frequent complications related to pregnancy. This study aimed to evaluate how the level of adherence to the MD influences maternal gestational weight gain and specific iron-related maternal biochemical parameters during the pregnancy. Accordingly, an observational, population-based study using data from pregnant women conducted over the entire course of their pregnancy was carried out. Adherence to the MD was assessed once using the MEDAS score questionnaire. Of the 506 women studied, 116 (22.9%) were classified as demonstrating a high adherence, 277 (54.7%) a medium adherence, and 113 (22.3%) a low adherence to the MD. No differences were observed in gestational weight gain among the MD adherence groups but the adequacy of weight gain did vary among the groups, with the proportions of inadequate (insufficient or excessive) weight gain presenting the most notable differences. Total anemia prevalence was 5.3%, 15.6%, and 12.3%, respectively, during the first, second, and third trimesters. For iron-related biochemical parameters, no differences are observed among the adherence groups during pregnancy. With high adherence to the MD as the reference group, the crude odds of iron deficiency diagnosis are significant in the first trimester for both the medium [OR = 2.99 (1.55-5.75)] and low [OR = 4.39 (2.15-8.96)] adherence groups, with deficient adherence to the Mediterranean dietary pattern being responsible for 66.5% (35.5-82.6) and 77.2% (53.5-88.8) of the risk of iron deficiency diagnosis for medium and low adherence, respectively. However, adjusted odds ratios were not significant, possibly due to the small sample size. Our data suggest that MD adherence could be related to gestational weight gain adequacy and that optimal adherence could reduce iron deficiency and/or anemia during pregnancy in the studied population.
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Affiliation(s)
- María Morales-Suárez-Varela
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
- Biomedical Research Center in Epidemiology and Public Health Network, Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Madrid, Spain
| | - Isabel Peraita-Costa
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
- Biomedical Research Center in Epidemiology and Public Health Network, Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Madrid, Spain
| | - Alfredo Perales-Marín
- Department of Gynecology and Obstetrics, La Fé University and Polytechnic Hospital, Avda. Fernando Abril Martorell, 106, 46026 València, Valencia, Spain
| | - Beatriz Marcos Puig
- Department of Gynecology and Obstetrics, La Fé University and Polytechnic Hospital, Avda. Fernando Abril Martorell, 106, 46026 València, Valencia, Spain
| | - Juan Llopis-Morales
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
| | - Yolanda Picó
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
- Biomedical Research Center in Epidemiology and Public Health Network, Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Madrid, Spain
- Environmental and Food Safety Research Group (SAMA-UV), Desertification Research Centre, (CIDE, CSIC-UV-GV), Moncada-Naquera Road Km 4.5, 46113 Moncada, Valencia, Spain
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8
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Sentilhes L, Madar H, Le Lous M, Sénat MV, Winer N, Rozenberg P, Kayem G, Verspyck E, Fuchs F, Azria E, Gallot D, Korb D, Desbrière R, Le Ray C, Chauleur C, de Marcillac F, Perrotin F, Parant O, Salomon LJ, Gauchotte E, Bretelle F, Sananès N, Bohec C, Mottet N, Legendre G, Letouzey V, Haddad B, Vardon D, Mattuizzi A, Froeliger A, Bouchghoul H, Daniel V, Regueme S, Roussillon C, Georget A, Darsonval A, Benard A, Deneux-Tharaux C. Tranexamic acid for the prevention of blood loss after cesarean among women with twins: a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery randomized clinical trial. Am J Obstet Gynecol 2022; 227:889.e1-889.e17. [PMID: 35724759 DOI: 10.1016/j.ajog.2022.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Although prophylactic tranexamic acid administration after cesarean delivery resulted in a lower incidence of calculated estimated blood loss of >1000 mL or red cell transfusion by day 2, its failure to reduce the incidence of hemorrhage-related secondary clinical outcomes (TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery trial) makes its use questionable. The magnitude of its effect may differ in women at higher risk of blood loss, including those with multiple pregnancies. OBJECTIVE This study aimed to compare the effect of tranexamic acid vs placebo to prevent blood loss after cesarean delivery among women with multiple pregnancies. STUDY DESIGN This was a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery trial data, a double-blind, randomized controlled trial from March 2018 to January 2020 in 27 French maternity hospitals, that included 319 women with multiple pregnancies. Women with a cesarean delivery before or during labor at ≥34 weeks of gestation were randomized to receive intravenously 1 g of tranexamic acid (n=160) or placebo (n=159), both with prophylactic uterotonics. The primary outcome was a calculated estimated blood loss of >1000 mL or a red blood cell transfusion by 2 days after delivery. The secondary outcomes included clinical and laboratory blood loss measurements. RESULTS Of the 4551 women randomized in this trial, 319 had a multiple pregnancy and cesarean delivery, and 298 (93.4%) had primary outcome data available. This outcome occurred in 62 of 147 women (42.2%) in the tranexamic acid group and 67 of 152 (44.1%) receiving placebo (adjusted risk ratio, 0.97; 95% confidence interval, 0.68-1.38; P=.86). No significant between-group differences occurred for any hemorrhage-related clinical outcomes: gravimetrically estimated blood loss, provider-assessed clinically significant hemorrhage, additional uterotonics, postpartum blood transfusion, arterial embolization, and emergency surgery (P>.05 for all comparisons). CONCLUSION Among women with a multiple pregnancy and cesarean delivery, prophylactic tranexamic acid did not reduce the incidence of any blood loss-related outcomes.
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Affiliation(s)
- Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
| | - Hugo Madar
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Maëla Le Lous
- Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes, France
| | - Marie Victoire Sénat
- Department of Obstetrics and Gynecology, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, Nantes, France; National Institute of Agricultural Research, Unité Mixte de Recherche 1280, Physiology of Nutritional Adaptations, University of Nantes, Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine-Ouest, Nantes, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy, France
| | - Gilles Kayem
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre de Recherche en Épidémiologie et StatistiqueS, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Universitary Hospital Departement - Risks in Pregnancy, Université de Paris, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Verspyck
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
| | - Florent Fuchs
- Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier, France; Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development, Villejuif, France
| | - Elie Azria
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre de Recherche en Épidémiologie et StatistiqueS, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Universitary Hospital Departement - Risks in Pregnancy, Université de Paris, Paris, France; Maternity Unit, Paris Saint-Joseph Hospital, Paris Descartes University, Paris, France
| | - Denis Gallot
- Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Diane Korb
- Department of Obstetrics and Gynecology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raoul Desbrière
- Department of Obstetrics and Gynecology, Saint-Joseph Hospital, Marseille, France
| | - Camille Le Ray
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre de Recherche en Épidémiologie et StatistiqueS, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Universitary Hospital Departement - Risks in Pregnancy, Université de Paris, Paris, France; Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Universitéde Paris, Fighting Prematurity University Hospital Federation, Paris, France
| | - Céline Chauleur
- Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Fanny de Marcillac
- Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg, France
| | - Franck Perrotin
- Department of Obstetrics and Gynecology, Tours University Hospital, Tours, France
| | - Olivier Parant
- Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse, France
| | - Laurent J Salomon
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emilie Gauchotte
- Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy, France
| | - Florence Bretelle
- Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Nicolas Sananès
- Department of Obstetrics and Gynecology, Hôpital Centre Médico-Chirurgical et Obstétrical, Schiltigheim, France
| | - Caroline Bohec
- Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau, France
| | - Nicolas Mottet
- Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon, France
| | - Guillaume Legendre
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Vincent Letouzey
- Department of Obstetrics and Gynecology, Carémeau University Hospital, Nimes, France
| | - Bassam Haddad
- Department of Obstetrics, Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Delphine Vardon
- Department of Obstetrics and Gynecology, Caen University Hospital, Caen, France
| | - Aurélien Mattuizzi
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Alizée Froeliger
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Hanane Bouchghoul
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Valérie Daniel
- Department of Pharmacy, Angers University Hospital, Angers, France; Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest, France
| | - Sophie Regueme
- Department of Clinical Research and Innovation, Bordeaux University Hospital, Bordeaux, France
| | - Caroline Roussillon
- European Clinical Trials Platform & Development, French Clinical Research Infrastructure Network, Department of Clinical Research and Innovation, Bordeaux University Hospital, Bordeaux, France
| | - Aurore Georget
- Epidemiology Unit, Public Health Department, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Astrid Darsonval
- Department of Pharmacy, Angers University Hospital, Angers, France; Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest, France
| | - Antoine Benard
- Epidemiology Unit, Public Health Department, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Catherine Deneux-Tharaux
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre de Recherche en Épidémiologie et StatistiqueS, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Universitary Hospital Departement - Risks in Pregnancy, Université de Paris, Paris, France
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Barut S, Uçar T, Yılmaz AN. Comparison of pregnant women's anxiety, depression and birth satisfaction based, on their traumatic childbirth perceptions. J OBSTET GYNAECOL 2022; 42:2729-2737. [PMID: 35929979 DOI: 10.1080/01443615.2022.2106832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study was conducted to identify and compare pregnant women's anxiety, depression, and birth satisfaction levels based on their traumatic childbirth perceptions. This study used a cross-sectional design. The data were collected at two stages, namely, the prenatal and postpartum stages. First, the Traumatic Childbirth Perception Scale, the Beck Anxiety Inventory, and the Beck Depression Inventory were applied to the pregnant women. Next, in the postpartum period, the Childbirth Information Form and the Birth Satisfaction Scale-Revised were applied. It was found that the participants with high levels of traumatic childbirth perception had higher mean anxiety and depressive symptom scores (26.13 ± 11.30 and 16.16 ± 9.02, respectively), whereas the participants with low levels of traumatic childbirth perception had a higher mean birth satisfaction score (17.50 ± 4.91). The findings indicated that high levels of traumatic childbirth perception may lead to have anxiety and depression, while low levels of traumatic childbirth perception may enhance their birth satisfaction. IMPACT STATEMENTWhat is already known on this subject? In the literature, it is stated that the perception of a traumatic birth can lead to permanent or long-term negative consequences in women's lives, negatively affecting their future health, subsequent birth experiences, and family relationships.What do the results of this study add? In this study, 37.7% of the participants were found to have high levels of traumatic childbirth perception. It was determined that the anxiety and depression levels of the participants with high levels of perception of traumatic birth were higher, and the levels of birth satisfaction were higher in the pregnant women with low levels of perception of traumatic birth. The results indicated that severe depressive symptoms, severe anxiety, and low levels of birth satisfaction were likely to raise traumatic childbirth perception levels in pregnant women.What are the implications of these findings for clinical practice and/or further research? The care to be given under the leadership of midwifery professionals is important in terms of reducing pregnant women's perceptions of a traumatic birth, anxiety, and depression levels and increasing their levels of birth satisfaction.
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Affiliation(s)
- Sümeyye Barut
- Department of Midwifery, Faculty of Health Sciences, Fırat University, Elazig, Turkey
| | - Tuba Uçar
- Department of Midwifery, Faculty of Health Sciences, Inonu University, Malatya, Turkey
| | - Ayşe Nur Yılmaz
- Department of Midwifery, Faculty of Health Sciences, Fırat University, Elazig, Turkey
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10
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Orovou E, Dagla M, Eskitzis P, Savvidis GS, Rigas N, Papatrechas A, Sarella A, Arampatzi C, Antoniou E. The Involvement of Past Traumatic Life Events in the Development of Postpartum PTSD after Cesarean Delivery. Healthcare (Basel) 2022; 10:healthcare10091761. [PMID: 36141373 PMCID: PMC9498371 DOI: 10.3390/healthcare10091761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/07/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Although childbirth is considered a natural process, a high percentage of postpartum women consider it traumatic. Any previous traumatic event in a woman’s life can be revived through a traumatic birth experience, especially after a complicated vaginal delivery or cesarean delivery. The purpose of this study was to clarify the relationship between previous traumatic life events and posttraumatic stress disorder (PTSD) in postpartum women after cesarean section and which specific events exerted the greatest influence. Methods: A sample of 469 women who had undergone cesarean sections at a Greek university hospital consented to participate in this prospective study. Data from a medical/demographic questionnaire, life events checklist, perinatal stressor criterion A, and posttraumatic stress checklist were used to evaluate past traumatic life events and diagnose postpartum posttraumatic stress. Results: Out of 469 women, 25.97% had PTSD and 11.5% a PTSD profile, while 2.7% had PTSD and 2.7% a PTSD profile. Also, it appeared that only specific direct exposure to a traumatic event and/or witnessing one were predictors of postpartum PTSD. Conclusions: This survey identified specific traumatic life events, psychiatric history, stressor perinatal criterion A, preterm birth, and emergency cesarean section as risk factors for the development of PTSD or a PTSD profile in women after cesarean delivery.
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Affiliation(s)
- Eirini Orovou
- Department of Midwifery, University of Western Macedonia, 50100 Kozani, Greece
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
- Correspondence: (E.O.); (E.A.); Tel.: +30-6937205679 (E.O.); +30-6977960041 (E.A.)
| | - Maria Dagla
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, 50100 Kozani, Greece
| | - Georgios S. Savvidis
- Department of Occupational Therapy, University of Western Macedonia, 50100 Kozani, Greece
| | - Nikolaos Rigas
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | | | - Angeliki Sarella
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | | | - Evangelia Antoniou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
- Correspondence: (E.O.); (E.A.); Tel.: +30-6937205679 (E.O.); +30-6977960041 (E.A.)
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11
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Malaju MT, Alene GD, Bisetegn TA. Longitudinal path analysis for the directional association of depression, anxiety and posttraumatic stress disorder with their comorbidities and associated factors among postpartum women in Northwest Ethiopia: A cross-lagged autoregressive modelling study. PLoS One 2022; 17:e0273176. [PMID: 35969630 PMCID: PMC9377604 DOI: 10.1371/journal.pone.0273176] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Vulnerability for depression, anxiety and posttraumatic stress disorder symptoms due to perceived traumatic birth increase during the postpartum period. Traumatic birth has been defined as an event occurring during labour and birth that may be a serious threat to the life and safety of the mother and/or child. However, the comorbidity and multimorbidity of depression, anxiety and PTSD with their direct and indirect predictors is not well investigated in the postpartum period. In addition, the longitudinal directional association of depression, anxiety and PTSD with their comorbidities is not studied in Ethiopia. Objective The aim of this study was to assess prevalence of postnatal comorbid and multimorbid anxiety, depression and PTSD. It also aimed to determine the directional association of postnatal anxiety, depression and PTSD with the comorbidity and multimorbidity of these mental health problems over time and to explore the factors that are directly or indirectly associated with comorbidity and multimorbidity of anxiety, depression and PTSD. Methods A total of 775 women were included at the first, second and third follow-up of the study (6th, 12th and 18th week of postpartum period) during October, 2020 –March, 2021. A cross-lagged autoregressive path analysis was carried out using Stata 16.0 software in order to determine the autoregressive and cross-lagged effects of depression, anxiety and PTSD with their comorbidities. In addition, a linear structural equation modelling was also carried out to determine the direct and indirect effects of independent variables on the comorbidities of depression, anxiety and PTSD. Results Comorbidity of anxiety with depression was the most common (14.5%, 12.1% and 8.1%) at the 6th, 12th and 18th week of postnatal period respectively. With regard to the direction of association, comorbidity of PTSD (due to perceived traumatic birth) with depression, PTSD with anxiety, depression with anxiety and triple comorbidity predicted depression and anxiety in subsequent waves of measurement. Direct and indirect maternal morbidity, fear of childbirth and perceived traumatic childbirth were found to have a direct and indirect positive association with comorbidities of depression, anxiety and PTSD. In contrast, higher parity, higher family size and higher social support had a direct and indirect negative association with these mental health disorders. Conclusion Postnatal mental health screening, early diagnosis and treatment of maternal morbidities, developing encouraging strategies for social support and providing adequate information about birth procedures and response to mothers’ needs during childbirth are essential to avert comorbidity of anxiety, depression and PTSD in the postpartum period.
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Affiliation(s)
- Marelign Tilahun Malaju
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- * E-mail:
| | - Getu Degu Alene
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Telake Azale Bisetegn
- Department of Health Education and Behavioral Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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12
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Neural Networks for Early Diagnosis of Postpartum PTSD in Women after Cesarean Section. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The correlation between the kind of cesarean section and post-traumatic stress disorder (PTSD) in Greek women after a traumatic birth experience has been recognized in previous studies along with other risk factors, such as perinatal conditions and traumatic life events. Data from early studies have suggested some possible links between some vulnerable factors and the potential development of postpartum PTSD. The classification of each case in three possible states (PTSD, profile PTSD, and free of symptoms) is typically performed using the guidelines and the metrics of the version V of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) which requires the completion of several questionnaires during the postpartum period. The motivation in the present work is the need for a model that can detect possible PTSD cases using a minimum amount of information and produce an early diagnosis. The early PTSD diagnosis is critical since it allows the medical personnel to take the proper measures as soon as possible. Our sample consists of 469 women who underwent emergent or elective cesarean delivery in a university hospital in Greece. The methodology which is followed is the application of random decision forests (RDF) to detect the most suitable and easily accessible information which is then used by an artificial neural network (ANN) for the classification. As is demonstrated from the results, the derived decision model can reach high levels of accuracy even when only partial and quickly available information is provided.
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Ginter N, Takács L, Boon MJM, Verhoeven CJM, Dahlen HG, Peters LL. The Impact of Mode of Birth on Childbirth-Related Post Traumatic Stress Symptoms beyond 6 Months Postpartum: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148830. [PMID: 35886682 PMCID: PMC9316477 DOI: 10.3390/ijerph19148830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 02/05/2023]
Abstract
(1) Background: A traumatic birth can lead to the development of childbirth-related posttraumatic stress symptoms or disorder (CB-PTS/D). Literature has identified the risk factors for developing CB-PTS/D within the first six months postpartum thoroughly. However, the impact of mode of birth on CB-PTS/D beyond 6 months postpartum is scarcely studied. (2) Methods: A systematic search of the literature was conducted in the databases PubMed, Embase and CINAHL and PRISMA guidelines were followed. Studies were included if they reported the impact of mode of birth on CB-PTS/D beyond 6 months postpartum. (3) Results: In total, 26 quantitative and 2 qualitative studies were included. In the quantitative studies the percentage of women with CB-PTS/D ranged from 0.7% to 42% (between six months and five years postpartum). Compared with vaginal birth, operative vaginal birth, and emergency caesarean section were associated with CB-PTS/D beyond 6 months postpartum. Qualitative studies revealed that some women were suffering from CB-PTS/D as long as 18 years after birth. (4) Conclusions: Long- term screening of women for PTSD in the postnatal period could be beneficial. More research is needed on models of care that help prevent CB-PTS/D, identifying women at risk and factors that maintain CB-PTS/D beyond 6 months postpartum.
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Affiliation(s)
- Nicole Ginter
- Department of General Practice & Elderly Medicine, Section Midwifery Science, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.J.M.B.); (L.L.P.)
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
- Correspondence:
| | - Lea Takács
- Department of Psychology, Faculty of Arts, Charles University, 116 42 Prague, Czech Republic;
| | - Martine J. M. Boon
- Department of General Practice & Elderly Medicine, Section Midwifery Science, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.J.M.B.); (L.L.P.)
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
| | - Corine J. M. Verhoeven
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, 5504 DB Veldhoven, The Netherlands
| | - Hannah G. Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia;
| | - Lilian L. Peters
- Department of General Practice & Elderly Medicine, Section Midwifery Science, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.J.M.B.); (L.L.P.)
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia;
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14
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Malaju MT, Alene GD, Bisetegn TA. Longitudinal mediation analysis of the factors associated with trajectories of posttraumatic stress disorder symptoms among postpartum women in Northwest Ethiopia: Application of the Karlson-Holm-Breen (KHB) method. PLoS One 2022; 17:e0266399. [PMID: 35404954 PMCID: PMC9000968 DOI: 10.1371/journal.pone.0266399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/18/2022] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION In recent years, literatures identified childbirth as a potentially traumatic experience resulting in posttraumatic stress disorder (PTSD), with 19.7 to 45.5% of women perceiving their childbirth as traumatic. A substantial variation in PTSD symptoms has been also indicated among women who experience a traumatic childbirth. However, there has been no research that has systematically investigated these patterns and their underlying determinants in postpartum women in Ethiopia. OBJECTIVE The aim of this study was to investigate the trajectories of PTSD symptoms and mediating relationships of variables associated with it among postpartum women in Northwest Ethiopia. METHODS A total of 775 women were recruited after childbirth and were followed at the 6th, 12th and 18th week of postpartum period during October, 2020 -March, 2021. A group-based trajectory modeling and mediation analysis using KHB method were carried out using Stata version 16 software in order to determine the trajectories of PTSD symptoms and mediation percentage of each mediator on the trajectories of PTSD symptoms. RESULTS Four distinct trajectories of postpartum posttraumatic stress disorder symptoms were identified. Perceived traumatic childbirth, fear of childbirth, depression, anxiety, psychological violence, higher WHODAS 2.0 total score, multigravidity, stressful life events of health risk, relational problems and income instability were found to be predictors of PTSD with recovery and chronic PTSD trajectory group membership. Depression and anxiety not only were strongly related to trajectories of PTSD symptoms directly but also mediated much of the effect of the other factors on trajectories of PTSD symptoms. In contrast, multiparity and higher mental quality of life scores were protective of belonging to the PTSD with recovery and chronic PTSD trajectory group membership. CONCLUSION Women with symptoms of depression, anxiety, fear of childbirth and perceived traumatic childbirth were at increased risk of belonging to recovered and chronic PTSD trajectories. Postnatal screening and treatment of depression and anxiety may contribute to decrease PTSD symptoms of women in the postpartum period. Providing adequate information about birth procedures and response to mothers' needs during childbirth and training of health care providers to be mindful of factors that contribute to negative appraisals of childbirth are essential to reduce fear of childbirth and traumatic childbirth so as to prevent PTSD symptoms in the postpartum period.
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Affiliation(s)
- Marelign Tilahun Malaju
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail:
| | - Getu Degu Alene
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Telake Azale Bisetegn
- School of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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15
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Cherel Q, Burey J, Rousset J, Picard A, Mirza D, Dias C, Jacquet H, Mariani P, Raffegeau N, Saupin I, Bornes M, Lapidus N, Quesnel C, Garnier M. Epidural analgesia information sessions provided by anesthetic nurses: impact on satisfaction and anxiety of parturient women a prospective sequential study. BMC Anesthesiol 2022; 22:105. [PMID: 35413841 PMCID: PMC9002221 DOI: 10.1186/s12871-022-01647-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Information on epidural analgesia delivered to parturient women is frequently incomplete, making it difficult for expectant mothers to make an appropriate choice for their delivery. We assessed the impact of a multimodal information session on epidural analgesia delegated to anesthetic nurses on new-mothers' satisfaction. METHODS We performed a prospective sequential study including parturient women who gave birth with epidural analgesia. During the first period, information on epidural analgesia was delivered by anesthetists during the scheduled anesthesia consultation, according to French standard-of-care. Then, a dedicated information session about epidural analgesia provided by anesthetic nurses was implemented. The primary endpoint was the satisfaction of women with the quality of information received. Main secondary endpoints were knowledge of women about epidural analgesia, anxiety before epidural catheter placement, and satisfaction with delivery. RESULTS 259 and 298 women were included during the first and second periods respectively, among whom 178 and 188 were analyzed. Information on epidural analgesia delivered by anesthetic nurses was associated with improvement of new-mothers' satisfaction with information received (9 (8-10) vs. 10 (9-10) - p < 0.001). Moreover, information delivered by anesthetic nurses was associated with decreased anxiety before epidural catheter placement (4 (1-8) vs. 3 (1-6) - p = 0.006) and increased satisfaction with delivery (8 (7-10) vs. 9 (8-10) - p = 0.01). Women's knowledge on epidural analgesia was durably increased when information was delivered by anesthetic nurses compared to conventional information by anesthetists. After adjustment, the only variable associated with both new mothers' satisfaction with information and delivery was the information session taught by anesthetic nurses. CONCLUSIONS Information sessions on epidural analgesia delivered by anesthetic nurses was associated with improved satisfaction of women with their delivery. Such information sessions may be used in maternity wards to improve new-mothers' childbirth experience.
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Affiliation(s)
- Quentin Cherel
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Julien Burey
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Julien Rousset
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Anne Picard
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Dimitra Mirza
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Christina Dias
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Hélène Jacquet
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Paule Mariani
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Nathalie Raffegeau
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Isabelle Saupin
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Marie Bornes
- Service de gynécologie-obstétrique, Hôpital Tenon, Sorbonne Université, APHP, DMU ORIGYNE, 4 rue de la Chine, 75020, Paris, France
| | - Nathanaël Lapidus
- Département de Santé Publique, Hôpital Saint-Antoine, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, APHP, Sorbonne Université, 184 rue du Faubourg St Antoine, 75012, Paris, France
| | - Christophe Quesnel
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Marc Garnier
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France.
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16
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Risk factors for operative vaginal delivery after a previous instrumental delivery. J Gynecol Obstet Hum Reprod 2022; 51:102382. [DOI: 10.1016/j.jogoh.2022.102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022]
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17
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Antoniou E, Tzanoulinou MD, Stamoulou P, Orovou E. The Important Role of Partner Support in Women's Mental Disorders During the Perinatal Period. A Literature Review. MAEDICA 2022; 17:194-200. [PMID: 35733735 PMCID: PMC9168558 DOI: 10.26574/maedica.2022.17.1.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The arrival of a newborn is often a happy event in a woman's life. However, many women experience perinatal distress such as anxiety disorders and depression during pregnancy or postpartum period. Although the positive interpersonal relationships of women with their wider environment seem to be a support network, research shows that support provided by partners is a very important protective factor in reducing mental health disorders in both prenatal and postnatal period in a woman's life. for this reason, more research needs to be done in the field of perinatal distress in order to clarify the causes that lead to mental disorders and to strengthen the partner's role in the management of perinatal mental disorders of women.
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Affiliation(s)
- Evangelia Antoniou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | | | - Pinelopi Stamoulou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Eirini Orovou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
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18
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Mei Z, Wu X, Zhang X, Zheng X, Li W, Fan R, Yu H, Zhang S, Gu Y, Wang X, Xia Y, Meng G, Shen J, Niu K. The occurrence and risk factors associated with post-traumatic stress disorder among discharged COVID-19 patients in Tianjin, China. Brain Behav 2022; 12:e2492. [PMID: 35064764 PMCID: PMC8865157 DOI: 10.1002/brb3.2492] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a serious mental health condition that is triggered by a terrifying event. We aimed to investigate the occurrence and risk factors of PTSD among discharged COVID-19 patients. METHODS This study included 144 discharged COVID-19 patients. PTSD was assessed by using validated cut-offs of the impact of event scale-revised (IES-R, score ≥25). All patients completed a detailed questionnaire survey, and clinical parameters were routinely measured in the hospital. Binary logistic regression models were applied to identify factors associated with PTSD. RESULTS Of the 144 participants with laboratory-confirmed COVID-19, the occurrence of PTSD was 16.0%. In multivariable analyses, age above 40 years (adjusted OR [95% CI], 5.19 [2.17-12.32]), female sex (adjusted OR [95% CI], 7.82 [3.18-18.21]), current smoker (adjusted OR [95% CI], 6.72 [3.23-15.26]), and ≥3 involved pulmonary lobes (adjusted OR [95% CI], 5.76 [1.19-15.71]) were significantly associated with a higher risk of PTSD. Conversely, history of hypertension and serum hemoglobin levels were significantly associated with a lower risk of PTSD with adjusted ORs (95% CI) of 0.37 (0.12-0.87) and 0.91 (0.82-0.96), respectively. CONCLUSION Old age, gender (being female), current smoking, bacterial pneumonia, and ≥3 involved pulmonary lobes were associated with an increased occurrence of PTSD among discharged COVID-19 patients.
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Affiliation(s)
- Zaoxian Mei
- Department of Tuberculosis, Tianjin Haihe Hospital, Tianjin Institute of Respiratory Diseases, No.890 JinGu Road, Jinnan District, Tianjin, 300350, China
| | - Xiaohui Wu
- Tianjin Key Laboratory on Technologies Enabling Development of Clinical, Therapeutics and Diagnostics, College of Pharmacy, Tianjin Medical University, No.22 Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Xueli Zhang
- Department of Tuberculosis, Tianjin Haihe Hospital, Tianjin Institute of Respiratory Diseases, No.890 JinGu Road, Jinnan District, Tianjin, 300350, China
| | - Xingjie Zheng
- Department of Tuberculosis, Tianjin Haihe Hospital, Tianjin Institute of Respiratory Diseases, No.890 JinGu Road, Jinnan District, Tianjin, 300350, China
| | - Wenxin Li
- Department of Tuberculosis, Tianjin Haihe Hospital, Tianjin Institute of Respiratory Diseases, No.890 JinGu Road, Jinnan District, Tianjin, 300350, China
| | - Rui Fan
- Department of Tuberculosis, Tianjin Haihe Hospital, Tianjin Institute of Respiratory Diseases, No.890 JinGu Road, Jinnan District, Tianjin, 300350, China
| | - Hongwei Yu
- Department of Tuberculosis, Tianjin Haihe Hospital, Tianjin Institute of Respiratory Diseases, No.890 JinGu Road, Jinnan District, Tianjin, 300350, China
| | - Shunming Zhang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, No.22 Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Yeqing Gu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, No.22 Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Xuena Wang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, No.22 Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Yang Xia
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, No.22 Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Ge Meng
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, No.22 Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Jun Shen
- Department of Tuberculosis, Tianjin Haihe Hospital, Tianjin Institute of Respiratory Diseases, No.890 JinGu Road, Jinnan District, Tianjin, 300350, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, No.22 Qixiangtai Road, Heping District, Tianjin, 300070, China
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19
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Posttraumatic Stress Disorder Symptoms 2 Months After Vaginal Delivery. Obstet Gynecol 2022; 139:63-72. [PMID: 34856568 DOI: 10.1097/aog.0000000000004611] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the prevalence of posttraumatic stress disorder (PTSD) symptoms and identify characteristics associated with it 2 months after singleton vaginal delivery at or near term. METHODS We conducted an ancillary cohort study of the TRAAP (TRAnexamic Acid for Preventing postpartum hemorrhage after vaginal delivery) randomized controlled trial in 15 French hospitals in 2015-2016. Women who had singleton vaginal delivery after 35 weeks of gestation were enrolled. After randomization, characteristics of labor and delivery were prospectively collected and paid special attention to postpartum blood loss. Posttraumatic stress disorder profile and provisional diagnosis were assessed 2 months after childbirth by two self-administered questionnaires: the IES-R (Impact of Event Scale-Revised) and the TES (Traumatic Event Scale). Associations between potential risk factors and PTSD symptoms were analyzed by multivariable logistic or linear regression modeling, depending on the type of dependent variable. RESULTS Questionnaires were returned by 2,740 of 3,891 women for the IES-R and 2,785 of 3,891 women for the TES (70.4% and 71.6% response rate). The prevalence of PTSD symptoms was 4.9% (95% CI 4.1-5.8%; 137/2,785) with the TES, and the prevalence of PTSD provisional diagnosis was 1.6% (95% CI 1.2-2.1%; 44/2,740), with the IES-R and 0.4% (95% CI 0.2-0.8%; 9/2,080) with the TES. Characteristics associated with a higher risk of PTSD in multivariable analysis were vulnerability factors - notably migrant status and history of psychiatric disorder (adjusted odds ratio [aOR] 2.7 95% CI 1.4-5.2) - and obstetric factors - notably induced labor (aOR 1.5 95% CI 1.0-2.2), being labor longer than 6 hours (aOR 1.7 95% CI 1.1-2.5), postpartum hemorrhage of 1,000 mL or more (aOR 2.0 95% CI 1.0-4.2), and bad memories of delivery at day 2 postpartum (aOR 4.5 95% CI 2.4-8.3) as assessed with the IES-R. Results were similar with the TES. CONCLUSION Approximately 1 of 20 women with vaginal delivery have PTSD symptoms at 2 months postpartum. History of psychiatric disorder, postpartum hemorrhage, and bad memories of deliveries at day 2 were the main factors associated with a PTSD profile.
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20
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van Steijn ME, Scheepstra KWF, Zaat TR, van Rooijen DE, Stramrood CAI, Dijksman LM, Valkenburg-van den Berg AW, Wiltenburg W, van der Post JAM, Olff M, van Pampus MG. Severe postpartum hemorrhage increases risk of posttraumatic stress disorder: a prospective cohort study. J Psychosom Obstet Gynaecol 2021; 42:335-345. [PMID: 32180491 DOI: 10.1080/0167482x.2020.1735343] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
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.
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Affiliation(s)
- Minouk E van Steijn
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, the Netherlands.,Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Karel W F Scheepstra
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Tjitske R Zaat
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Claire A I Stramrood
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lea M Dijksman
- Department of Epidemiology and Statistics, St Antonius Hospital, the Netherlands
| | | | - Welmoed Wiltenburg
- Department of Obstetrics and Gynecology, Westfriesgasthuis, the Netherlands
| | - Joris A M van der Post
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Maria G van Pampus
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, the Netherlands
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21
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Shander A, Javidroozi M, Sentilhes L. Reply to: Prophylactic tranexamic acid at delivery: if not now, when? Int J Obstet Anesth 2021; 49:103234. [PMID: 34810054 DOI: 10.1016/j.ijoa.2021.103234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/14/2021] [Accepted: 10/24/2021] [Indexed: 11/19/2022]
Affiliation(s)
- A Shander
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ, USA.
| | - M Javidroozi
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ, USA
| | - L Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
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22
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Martinez-Vázquez S, Rodríguez-Almagro J, Hernández-Martínez A, Delgado-Rodríguez M, Martínez-Galiano JM. Obstetric factors associated with postpartum post-traumatic stress disorder after spontaneous vaginal birth. Birth 2021; 48:406-415. [PMID: 33909303 DOI: 10.1111/birt.12550] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study aimed to determine whether there is an association between clinical practices carried out during spontaneous vaginal birth (SVB), or clinical situations that arise during vaginal birth, and the incidence of post-traumatic stress disorder (PTSD). METHODS A cross-sectional study with 839 puerperal women in Spain was conducted. The Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) was administered online. The relationship between the risk of postpartum PTSD and various intrapartum complications was studied in addition to practices or procedures performed during the intrapartum period. RESULTS PTSD (PPQ scores ≥19) was identified in 8.1% (68) of the women who participated. Among the risk factors for PTSD was a concerning intrapartum FHR tracing (adjusted OR: 2.24, 95% CI: 1.07-4.66). Other intrapartum practices also put women at risk of PTSD, including the administration of an enema (aOR: 7.01, 95% CI: 2.14-23.01), being required to stay lying down throughout the labor and birth (aOR: 5.75, 95% CI: 3.25-10.19), artificial amniorrhexis without consent (aOR: 2.28, 95% CI: 1.31-3.97), administration of synthetic oxytocin without consent (aOR: 2.18, 95% CI: 1.26-3.77), fundal pressure during pushing (aOR: 3.14, 95% CI: 1.72-5.73), repeated vaginal examinations performed by different people (aOR: 4.84, 95% CI: 2.77-8.47), and manual removal of the placenta without anesthesia (aOR: 3.45, 95% CI: 1.81-6.58). CONCLUSIONS Various intrapartum clinical practices, all related to dehumanized treatment, and intrapartum complications, were associated with an increased risk of PTSD. There is a need to eradicate obstetric mistreatment and to increase access to evidence-informed, respectful care in Spain. Care practitioners need to better appreciate their roles in preventing PTSD.
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Affiliation(s)
| | - Julián Rodríguez-Almagro
- Department of Nursing, Faculty of Nursing of Ciudad Real, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Antonio Hernández-Martínez
- Department of Nursing, Faculty of Nursing of Ciudad Real, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Miguel Delgado-Rodríguez
- Department of Health Sciences, University of Jaen, Jaén, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Juan Miguel Martínez-Galiano
- Department of Nursing, University of Jaen, Jaén, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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23
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Donate-Manzanares M, Rodríguez-Cano T, Rodríguez-Almagro J, Hernández-Martínez A, Santos-Hernández G, Beato-Fernández L. Mixed-method study of women's assessment and experience of childbirth care. J Adv Nurs 2021; 77:4195-4210. [PMID: 34297861 DOI: 10.1111/jan.14984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/24/2021] [Accepted: 07/11/2021] [Indexed: 11/28/2022]
Abstract
AIM To examine women's evaluations of quality of care from their perspectives. BACKGROUND Assessing women's satisfaction with the quality of care they receive during childbirth is an important component of care quality that should be analysed. Evidence suggests that childbirth experience has an important impact on women's health. Therefore, taking into account the perceptions of women about quality is a means to improve care. However, studies examining care quality in this setting remain scarce. DESIGN Mixed-methods explanatory sequential design. METHODS A national survey with a sample of 1082 participants, and 15 semi-structured interviews. Data collection occurred between January 2017 and January 2019. Quantitative data were obtained through a validated scale, the Quality from the Patient's Perspective-Intrapartal questionnaire, whose score can range from 1 (minimum satisfaction) to 4 (maximum satisfaction). Semi-structured interviews were conducted for qualitative data. Descriptive statistics, group comparison and qualitative content analysis were included in data analysis. RESULTS The mean score on the QPP-I tool was high (3.13; SD 0.74). Variables that had the most influence on the experience were type of birth, type of perineal trauma, admission of the baby, time since birth, home-birth, parity and duration of labour. Data from the qualitative interviews identified five themes that explained women's experiences with the quality of care. Previous expectations influence the emotions they have regarding the experience. Relationships with professionals and their social skills are fundamental for the evaluation of quality. The separation of the newborn appears as a factor that worsens the appreciation of women. Good pain management and continuity of care by specialists are also named as key elements of the quality of care. CONCLUSION Findings demonstrate that experience with childbirth care is of utmost importance for women. They also show the indisputable need to listen to their opinions and assessments when lines of improvement of quality are identified. IMPACT This study provides information that can improve the care that women receive during their childbirths. Using their opinions will make them feel an active part of the system and in this way, we will be closer to achieve excellence in our services.
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Affiliation(s)
| | - Teresa Rodríguez-Cano
- Servicio de Psiquiatría del Hospital General Universitario de Ciudad Real, Calle Obispo Rafael Torija, Ciudad Real, Spain
| | - Julián Rodríguez-Almagro
- Facultad de Enfermería de Ciudad Real, Campus de Ciudad Real, Calle de Camilo José Cela, Ciudad Real, Spain
| | - Antonio Hernández-Martínez
- Facultad de Enfermería de Ciudad Real, Campus de Ciudad Real, Calle de Camilo José Cela, Ciudad Real, Spain
| | - Gloria Santos-Hernández
- Servicio de Obstetricia y Ginecología del Hospital Virgen de la Salud de Toledo, Toledo, Spain
| | - Luis Beato-Fernández
- Servicio de Psiquiatría del Hospital General Universitario de Ciudad Real, Calle Obispo Rafael Torija, Ciudad Real, Spain
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24
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Ma G, Gao L, Li Q, Zhao X. Efficacy of intrauterine Bakri balloon tamponade combined with ascending uterine artery ligation on postpartum hemorrhage. Am J Transl Res 2021; 13:4995-5002. [PMID: 34150084 PMCID: PMC8205799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To observe the efficacy of intrauterine Bakri balloon tamponade (IBBT) combined with ascending uterine artery ligation (AUAL) in the treatment of postpartum hemorrhage (PPH) due to uterine inertia after cesarean section. METHODS A total of 92 patients with PPH due to uterine inertia after cesarean section were divided into a study group (n=46) and a control group (n=46) in accordance with the random number table. The control group was treated with IBBT alone, while the study group was treated with IBBT combined with AUAL. The clinical efficacies, hemorrhage, surgical duration, hospital stay, hemorrhage rate after removal of tamponade, recurrence rate of PPH, changes in coagulation function and quality of life were compared between the two groups. RESULTS The overall response rate (ORR) in the study group was 95.65%, remarkably higher than that of 80.43% in the control group (P < 0.05). The study group had a lesser amount of hemorrhage at 2 h and 24 h after surgery, a longer surgical duration, a shorter hospital stay, and lower hemorrhage rate after removal of tamponade and recurrence rate of PPH than the control group (P < 0.05). After treatment, prothrombin time, activated partial thromboplastin time and fibrinogen in the study group were markedly higher than those in the control group (P < 0.05). Compared with those before treatment, the scores of quality of life in the two groups were elevated at 3 months after treatment (P < 0.05), and the scores of quality of life in the study group were higher than those in the control group at 3 months after treatment (P < 0.05). CONCLUSION IBBT combined with AUAL can effectively alleviate hemorrhage and improve coagulation function and quality of life of patients with PPH due to uterine inertia after cesarean section, exhibiting a definite efficacy and a high safety profile.
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Affiliation(s)
- Guangna Ma
- Department of Obstetrics, Tai'an City Central Hospital Tai'an 271000, Shandong Province, China
| | - Li Gao
- Department of Obstetrics, Tai'an City Central Hospital Tai'an 271000, Shandong Province, China
| | - Qinwen Li
- Department of Obstetrics, Tai'an City Central Hospital Tai'an 271000, Shandong Province, China
| | - Xudong Zhao
- Department of Obstetrics, Tai'an City Central Hospital Tai'an 271000, Shandong Province, China
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25
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Ertan D, Hingray C, Burlacu E, Sterlé A, El-Hage W. Post-traumatic stress disorder following childbirth. BMC Psychiatry 2021; 21:155. [PMID: 33726703 PMCID: PMC7962315 DOI: 10.1186/s12888-021-03158-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/04/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Childbirth experience could be complicated and even traumatic. This study explored the possible risk factors for post-traumatic stress disorder following childbirth (PTSD-FC) in mothers and partners. METHODS Through a cross-sectional online survey biographical, medical, psychological, obstetrical and trauma history data were collected. The PTSD-FC, postnatal depression, social support, and perceived mother-infant bond in 916 mothers and 64 partners were measured through self-reported psychometric assessments. RESULTS Our findings highlight the possible impact of several risk factors such as emergency childbirth, past traumatic experiences and distressing events during childbirth on PTSD-FC. The difficulties in mother-infant bond and the postpartum depression were highly associated with the total score of PTSD-FC symptoms for mothers. While for partners, post-partum depression was highly associated with the total score of PTSD-FC. CONCLUSIONS Our study demonstrated significant links between psychological, traumatic and birth-related risk factors as well as the perceived social support and the possible PTSD following childbirth in mothers and partners. Given that, a specific attention to PTSD-FC and psychological distress following childbirth should be given to mothers and their partners following childbirth.
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Affiliation(s)
- Deniz Ertan
- Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France
- La Teppe, Tain l'Hermitage, France
| | - Coraline Hingray
- Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
| | - Elena Burlacu
- CHRU de Tours, Centre Régional de Psychotraumatologie CVL, Tours, France
| | - Aude Sterlé
- CHRU de Tours, Centre Régional de Psychotraumatologie CVL, Tours, France
| | - Wissam El-Hage
- CHRU de Tours, Centre Régional de Psychotraumatologie CVL, Tours, France.
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.
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26
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Nutrient Requirements during Pregnancy and Lactation. Nutrients 2021; 13:nu13020692. [PMID: 33670026 PMCID: PMC7926714 DOI: 10.3390/nu13020692] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 01/03/2023] Open
Abstract
A woman's nutritional status during pregnancy and breastfeeding is not only critical for her health, but also for that of future generations. Nutritional requirements during pregnancy differ considerably from those of non-pregnant women. Thus, a personalized approach to nutritional advice is recommended. Currently, some countries recommend routine supplementation for all pregnant women, while others recommend supplements only when necessary. Maternal physiological adaptations, as well as nutritional requirements during pregnancy and lactation, will be reviewed in the literature examining the impacts of dietary changes. All of these data have been studied deeply to facilitate a discussion on dietary supplement use and the recommended doses of nutrients during pregnancy and lactation. The aim of this review is to evaluate the knowledge in the scientific literature on the current recommendations for the intake of the most common micronutrients and omega-3 fatty acids during pregnancy and lactation in the United States, Canada, and Europe. Taking into account these considerations, we examine minerals, vitamins, and omega-3 fatty acid requirements. Finally, we conclude by discussing the potential benefits of each form of supplementation.
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27
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Cardaillac C, Delga B, Thubert T, Labat JJ, Levesque A, Winer N, Riant T, Ploteau S. Description and classification of postpartum chronic pain: A multicentric prospective study. J Gynecol Obstet Hum Reprod 2020; 49:101769. [PMID: 32461069 DOI: 10.1016/j.jogoh.2020.101769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION To classify persistent perineal and pelvic postpartum pain using the classification usually employed in chronic pelvic pain. MATERIAL AND METHOD Prospective observational study including all women who have consulted an algologist or gynecologist at one of the six French centers for a chronic pain (superior or equal to 3 months) spontaneous linked by the mother with her childbirth were included. During semi-directed interviews, a questionnaire regarding sociodemographic factors and detailed questions about pain were collected. Then, pelvic and perineal pain were classified into 7 pain syndromes: pelvic sensitization (Convergences PP criteria), complex regional pain syndrome (Budapest criteria), pudendal or cluneal neuralgia (Nantes criteria), neuroma, thoraco-lumbar junction syndrome, myofascial pain (muscle trigger zone), fibromyalgia (American College of Rheumatology criteria). The principal objective of this study is to assess the prevalence of each painful disorder. The secondary aims were the description of socio-demographic factors and clinical characteristics of this population, identify the related symptoms and the impact on daily function associated with the chronic pelvic or perineal postpartum pain. RESULTS 40 women with chronic pelvic or perineal pain spontaneously linked with childbirth were included. 78 % experienced pain for more than 12 months. A large majority had a vaginal birth (95 %) with perineal suture (90 %) and severe acute pain within the first week postpartum (62 %). Postpartum pain impacted participant's sexual activity (80 %), micturition (28 %) and defecation (38 %). In the sample, 17 cases of neuroma, 6 patients with pudendal or cluneal neuralgia, 13 patients with pelvic sensitization and 2 cases of fibromyalgia were identified. Complex regional pain syndrome was diagnosed in 8 patients, and myofascial pain in 11 women, and only 1 patient had thoraco-lumbar junction syndrome. Neuropathic pain was found in 31 participants (77.5 %) according to DN4 criteria. DISCUSSION The classification scheme proposed in this study may be a very useful tool to investigate postpartum pelvic and perineal pain and to propose a treatment.
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Affiliation(s)
- Claire Cardaillac
- Department of Gynecology-Obstetrics and Reproductive Medecine, 38 Boulevard Jean Monnet, 44000, Nantes, France; Pelvic Pain Center, Nantes, France
| | - Bérénice Delga
- Department of Gynecology-Obstetrics and Reproductive Medecine, 38 Boulevard Jean Monnet, 44000, Nantes, France
| | - Thibault Thubert
- Department of Gynecology-Obstetrics and Reproductive Medecine, 38 Boulevard Jean Monnet, 44000, Nantes, France
| | | | | | - Norbert Winer
- Department of Gynecology-Obstetrics and Reproductive Medecine, 38 Boulevard Jean Monnet, 44000, Nantes, France
| | - Thibault Riant
- Pelvic Pain Center, Nantes, France; Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine De Sienne, Nantes, France
| | - Stéphane Ploteau
- Department of Gynecology-Obstetrics and Reproductive Medecine, 38 Boulevard Jean Monnet, 44000, Nantes, France; Pelvic Pain Center, Nantes, France.
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Goutaudier N, Ayache R, Aubé H, Chabrol H. Traumatic anticipation of childbirth and disordered eating during pregnancy. J Reprod Infant Psychol 2020; 38:243-258. [PMID: 32189512 DOI: 10.1080/02646838.2020.1741525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND While research on Fear Of Childbirth (FOC) during pregnancy is on the rise, research regarding pretraumatic stress reactions is lacking. Moreover, less is known regarding negative anticipation of childbirth and Eating Disorders (ED). This study aims at identifying typologies of women in the prepartum period based on FOC and pretraumatic stress symptoms and investigating whether or not the identified profiles differ on levels of bulimic symptoms and Drive for Thinness (DT). PARTICIPANTS AND METHODS a sample of 213 pregnant women completed questionnaires assessing FOC, pretraumatic stress, DT and bulimic symptoms. RESULTS four clusters based on pretraumatic stress and FOC symptoms were identified: one characterised by traumatic symptoms, one showing moderated FOC symptoms, one with high symptomatology and one with low symptoms. Higher ED symptoms were found in women with both FOC and pretraumatic stress symptoms, and in the cluster showing elevated pretraumatic stress symptomatology. CONCLUSIONS To our knowledge, this is the first study focusing on anticipated traumatic reactions and ED in pregnant women. While some women evidenced FOC and pretraumatic stress symptoms, two different clusters, one with FOC and one with pretraumatic stress, were found. These findings suggest that, while sharing similarities, these constructs are different.
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Affiliation(s)
- Nelly Goutaudier
- Centre de Recherches sur la Cognition et l'Apprentissage -UMR CNRS 7295, Université de Poitiers , Poitiers, France
| | - Raphael Ayache
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse Jean-Jaurès , Toulouse, France
| | - Hélène Aubé
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse Jean-Jaurès , Toulouse, France
| | - Henri Chabrol
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse Jean-Jaurès , Toulouse, France
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Correlation between Kind of Cesarean Section and Posttraumatic Stress Disorder in Greek Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051592. [PMID: 32121561 PMCID: PMC7084417 DOI: 10.3390/ijerph17051592] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/20/2020] [Accepted: 02/27/2020] [Indexed: 11/22/2022]
Abstract
A birth experience with cesarean section (CS) can be a cause of the development of post-traumatic stress disorder after a cesarean (PTSD-AC) or profile PTSD, for a percentage of women. So far, there is no data on the frequency of PTSD-AC in Greece and this syndrome is often associated with other mental disorders of the postpartum period. The purpose of this research is to associate the kind of CS with PTSD-AC for Greek mothers and the combination of factors that make them less resistant to trauma. A sample of ahundred and sixty-six mothers who gave birth with emergency cesarean section (EMCS) and elective cesarean section (ELCS) at a Greek University hospital have consented to participate in the two phases of the survey, in the 2nd day postpartum and a follow-up in the 6th week postpartum. Medical/demographic data and a life events checklist (LEC-5) with Criterion A and post-traumatic stress checklist (PCL-5) were used to diagnose PTSD and PTSD Profile. Out of166 mothers enrolled, 160 replied to the follow-up (96.4%), ELCS 97 (97%) and EMCS 63 (95%). Twenty (31.7%) EMCS had PTSD and nine (14.3%) had Profile. One (1%) ELCS had PTSD and 4 (4.1%) had Profile. This survey shows a high prevalence rate of PTSD after EMCS with additional risk factors of preterm labor, inclusion in the Neonatal Intensive Care Unit (NICU), a lack of breastfeeding, and a lack of support from the partner.
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Perinatal Posttraumatic Stress Disorder: A Review of Risk Factors, Diagnosis, and Treatment. Obstet Gynecol Surv 2019; 74:369-376. [DOI: 10.1097/ogx.0000000000000680] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Beck CT, Casavant S. Synthesis of Mixed Research on Posttraumatic Stress Related to Traumatic Birth. J Obstet Gynecol Neonatal Nurs 2019; 48:385-397. [PMID: 30958993 DOI: 10.1016/j.jogn.2019.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To synthesize mixed-research results (quantitative and qualitative) on posttraumatic stress in women who experienced traumatic births. DATA SOURCES PubMed, Scopus, and PsycINFO databases. STUDY SELECTION Quantitative and qualitative studies were included if they were published in English from January 1, 2009, through December 31, 2018, and focused on posttraumatic stress in the postpartum period related to traumatic childbirth. DATA EXTRACTION The final sample consisted of 59 studies: 4 qualitative and 55 quantitative. Both authors independently appraised each study using the Critical Appraisal Skills Programme. Quantitative studies were synthesized by narrative synthesis and vote counting, and qualitative studies were synthesized by content analysis. DATA SYNTHESIS In the included studies, prevalence rates of elevated posttraumatic stress ranged from 0.8% to 26%. Significant predictors of posttraumatic stress that occurred before childbirth and those that were birth related were identified. Reports of six intervention studies to decrease posttraumatic stress symptoms after traumatic births were included. These interventions focused on postnatal debriefing, expressive writing, online cognitive behavioral therapy, a brief cognitive intervention, and the implementation of the nine instinctive stages of the infant during the first hour after birth. We created four themes from the findings of the qualitative studies: Distressing Symptoms, Detrimental Effect of Posttraumatic Stress on Women's Relationships With Their Infants and Partners, Critical Influence ofSupport, and Debriefing. CONCLUSION When a woman experiences posttraumatic stress related to a traumatic birth, the entire family unit is vulnerable. Findings from quantitative predictor studies can be used to develop an instrument to screen women for risk factors for posttraumatic stress related to birth trauma. Primary interventions are needed to prevent women from experiencing traumatic births.
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Donate-Manzanares M, Rodríguez-Cano T, Gómez-Salgado J, Rodríguez-Almagro J, Hernández-Martínez A, Barrilero-Fernández E, Beato-Fernández L. Quality of Childbirth Care in Women undergoing Labour: Satisfaction with Care Received and How It Changes over Time. J Clin Med 2019; 8:jcm8040434. [PMID: 30934940 PMCID: PMC6518019 DOI: 10.3390/jcm8040434] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 12/31/2022] Open
Abstract
(1) Background: To evaluate women’s satisfaction with the care received during childbirth undergoing labour and how this changes over time. (2) Methods: An observational, multicentre and longitudinal study in two public hospitals of Spain with a convenience sample of 248 women during the post-partum period. Satisfaction was evaluated using the Intrapartal-Specific Quality from the Patient’s Perspective questionnaire. Socio-demographic and clinical variables were considered. A bivariate analysis evaluated the relationship between satisfaction and the recorded variables to compare the hypotheses, and also to know if there were any significant differences between the scores obtained at the various evaluated time points (three days, 15 days, one year postpartum). The multivariate analysis by binary logistic regression helped complete the study about the variables related to the level of satisfaction; (3) Results: The mean scores for satisfaction at each time point were high, and they lowered with time. The bivariate analysis showed an association between satisfaction and the following variables: ‘mother’s place of birth’, ‘level of education’, ‘type of labour onset’, ‘type of birth’ and ‘type of perineal trauma’. For the multivariate analysis, women who gave birth vaginally, began labour spontaneously and had an epidural were more satisfied than those who did not; (4) Conclusions: Women seemed to obtain good levels of satisfaction with the care they received. Even so, based on continuously improved quality, we proposed some improvement measures, particularly regarding the physical environment and the information offered to patients. It is important to know at what time experience while giving birth should be evaluated as scores can lower with time as part of its normal evolution.
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Affiliation(s)
| | | | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, University of Huelva, 21071 Huelva, Spain.
- Safety and Health Posgrade Program, Universidad Espíritu Santo, Guayaquil 091650, Ecuador.
| | | | | | | | - Luis Beato-Fernández
- Department of Psychiatry, Hospital General Universitario, 13005 Ciudad Real, Spain.
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Reardon DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE Open Med 2018; 6:2050312118807624. [PMID: 30397472 PMCID: PMC6207970 DOI: 10.1177/2050312118807624] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022] Open
Abstract
The abortion and mental health controversy is driven by two different perspectives regarding how best to interpret accepted facts. When interpreting the data, abortion and mental health proponents are inclined to emphasize risks associated with abortion, whereas abortion and mental health minimalists emphasize pre-existing risk factors as the primary explanation for the correlations with more negative outcomes. Still, both sides agree that (a) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion; (b) the abortion experience directly contributes to mental health problems for at least some women; (c) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion; and (d) it is impossible to conduct research in this field in a manner that can definitively identify the extent to which any mental illnesses following abortion can be reliably attributed to abortion in and of itself. The areas of disagreement, which are more nuanced, are addressed at length. Obstacles in the way of research and further consensus include (a) multiple pathways for abortion and mental health risks, (b) concurrent positive and negative reactions, (c) indeterminate time frames and degrees of reactions, (d) poorly defined terms, (e) multiple factors of causation, and (f) inherent preconceptions based on ideology and disproportionate exposure to different types of women. Recommendations for collaboration include (a) mixed research teams, (b) co-design of national longitudinal prospective studies accessible to any researcher, (c) better adherence to data sharing and re-analysis standards, and (d) attention to a broader list of research questions.
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Posttraumatic stress disorder related to postpartum haemorrhage: A systematic review. Eur J Obstet Gynecol Reprod Biol 2018; 225:214-220. [PMID: 29747143 DOI: 10.1016/j.ejogrb.2018.04.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/10/2018] [Indexed: 11/23/2022]
Abstract
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.
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