Etat de stress post-traumatique deux mois après un accouchement par voie basse : une étude prospective multicentrique

International audienceObjective: To assess the prevalence of post-traumatic stress disorder (PTSD) and identify characteristics associated with it two months after singleton vaginal delivery at or near term. Methods: Ancillary cohort study of the TRAAP randomized controlled trial, conducted in fifteen French hospitals in 2015-2016. Women who underwent singleton vaginal delivery after 35 gestation weeks were enrolled. After randomization, characteristics of labor and delivery were prospectively collected, paying special attention to postpartum blood loss. PTSD profile and provisional diagnosis were assessed two months after childbirth by two self-administered questionnaires (IES-R and TES). Associations between potential risk factors and PTSD were analyzed by multivariate logistic or linear regression modeling depending on the type of the dependent variable. Results: Questionnaires were returned by 2740/3891 and 2785/3891 women for the IES-R and TES, respectively (70.4% and 71.6% response rate). Prevalences of PTSD profile and provisional diagnosis were respectively 5.1% (95%CI 3.6-5.2%; 141/2740) and 1.6% (95%CI 1.2-2.1%; 44/2740) with the IES-R, and 4.9% (95%CI 4.1-5.8%; 137/2785) and 0.4% (95%CI 0.2-0.8%; 9/2080) with the TES. Characteristics associated with a higher risk of PTSD in multivariate analysis were vulnerability factors - notably migrant status and psychiatric history (aOR 2.7 95%CI 1.4-5.2) - and obstetric factors - notably induced labor (aOR 1.5 95%CI 1.0-2.2), labor longer than 6 hours (aOR 1.7 95%CI 1.1-2.5), postpartum hemorrhage ≥1,000mL (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 scale. Conclusion: Around one of twenty women with vaginal delivery have post-traumatic stress disorder symptoms at two months. Psychiatric history, postpartum hemorrhage and bad memories of deliveries at day 2 were the main factors associated with a PTSD profile

Etat de stress post-traumatique 2 mois après un accouchement par césarienne : une étude prospective multicentrique

International audienceBackground: The prevalence and risk factors of posttraumatic stress disorder (PTSD) after cesarean delivery, outside high-risk contexts, remain unclear.Objective: To assess posttraumatic stress disorder prevalence and risk factors at 2 months postpartum among a general population of women with cesarean delivery.Study design: Prospective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, conducted in 27 French hospitals in 2018-2020 and enrolling women expected to undergo cesarean delivery before or during labor at 34 or more 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 PTSD symptoms) and provisional diagnosis (positive screening for diagnosis consistent with a PTSD) were assessed by 2 self-administered questionnaires (Impact of Event Scale Revised (IESR) and Traumatic of Event Scale (TES)). 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 all, 2785 of 4431 women returned the IES-R questionnaire and 2792 the TES (response rates of 62.9% and 63.0%). The prevalence of posttraumatic stress disorder profile was 9.0% (95% confidence interval (CI) 7.8-10.3%) and of provisional diagnosis 1.7% (95%CI 1.2-2.4%). Characteristics associated with a higher risk of posttraumatic stress disorder profile were prepregnancy vulnerability factors - young age, high BMI and Africa-born migrant – and cesarean-related obstetric factors - cesarean delivery after induced labor (adjusted odds ratio [aOR] 1.81, 95%CI 1.14-2.87), postpartum hemorrhage (aOR 1.61, 95%CI 1.04-2.46) and high intensity pain during the postpartum stay (aOR 1.90, 95%CI 1.17-3.11). Women who had immediate skin-to-skin contact with their newborn were at lower risk of posttraumatic stress disorder (aOR 0.66, 95%CI 0.46-0.98), and women with bad memories of delivery on day 2 postpartum at higher risk (aOR 3.20, 95%CI 1.97-5.12). The IES-R and the TES scales yielded consistent results. Conclusions: Around one in 11 women with cesarean deliveries had posttraumatic stress disorder symptoms at 2 months postpartum. Some obstetric interventions and components of cesarean management may influence this risk

Surgical treatment of postpartum haemorrhage: national survey of French residents of obstetrics and gynecology

Abstract Background Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and one of the leading causes of maternal mortality worldwide. Many medical treatments and interventions are available nowadays, but surgical treatment is sometimes required when less invasive methods are unsuccessful. This study aimed to assess the theoretical and practical knowledge of French residents of Obstetrics and Gynecology concerning the surgical treatment of postpartum haemorrhage. Study design We performed a questionnaire study for senior residents of Obstetrics and Gynecology in France (fourth and fifth year of training). An anonymous survey was sent by email. Between December 2013 and April 2014, a total of 370 residents responded. Result The response rate was 47.6% (176/370). Only 156 questionnaires were fully completed and included for analysis. In all, 74% (115/156) of residents reported not mastering sufficiently or at all the technique for bilateral ligation of uterine arteries, 79% (123/156) for uterine compression sutures, 95% (148/156) for ligation of the internal iliac arteries, and 78% (122/156) for emergency peripartum hysterectomy. More than half of respondents (55%, 86/156) stated that they had not mastered any of these techniques. Conclusion An alarmingly high number of French senior residents in Obstetrics and Gynecology report that they have not acquired the sufficient surgical skills during their training to be able to perform the surgeries required for the management of PPH