Minouk E van Steijn, Karel W F Scheepstra, Tjitske R Zaat, Diana E van Rooijen, Claire A I Stramrood, Lea M Dijksman, Arijaan W Valkenburg-van den Berg, Welmoed Wiltenburg, Joris A M van der Post, Miranda Olff, Maria G van Pampus
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引用次数: 13
摘要
目的:探讨重度产后出血(PPH)是否为创伤后应激障碍(PTSD)的危险因素。严重的PPH可以作为创伤性事件来经历。创伤后应激障碍会对心理健康产生负面影响。了解分娩期间PTSD的危险因素为早期干预提供了机会，这可能会预防PTSD的发展。材料和方法:在这项前瞻性研究中，我们比较了两组参与者;出血量≥2000 mL的女性(重度PPH，患者)和出血量≤500 mL的女性(对照组)。参与者在分娩后4到6周使用PCL-5进行PTSD筛查。阳性筛查后进行CAPS-5诊断PTSD。结果:我们纳入了187例PPH患者和121例对照组。PPH患者的中位PCL-5评分(5.0)高于对照组(4.0,p = 0.005)。13例PPH患者(7.0%)和2例对照组(1.7%)的PCL-5得分≥32分，表明可能存在PTSD (OR 4.45, 95% CI 0.99-20.06, p = 0.035)。PPH患者在CAPS-5量表上符合PTSD临床诊断标准的人数明显多于对照组(n = 10,5.6% vs n = 0,0.0%;p = 0.007)。结论:重度PPH患者发生PTSD的风险显著增加，与临床相关。建议妇科医生和助产士在产后随访时筛查PTSD，以防止对心理健康产生长期负面影响。临床试验注册:NL50273.100.14。
Severe postpartum hemorrhage increases risk of posttraumatic stress disorder: a prospective cohort study.
Purpose: To evaluate whether severe postpartum hemorrhage (PPH) is a risk factor for posttraumatic stress disorder (PTSD). Severe PPH can be experienced as a traumatic event. PTSD leads to negative mental health effects. Knowing risk factors for PTSD during childbirth offers opportunities for early interventions, which may prevent the development of PTSD.
Materials and methods: In this prospective study, we compared two groups of participants; women with ≥2000 mL of blood loss (severe PPH, patients) and women with ≤500 mL of blood loss (controls). Participants were screened for PTSD using the PCL-5 four to six weeks after delivery. Positive screening was followed by the CAPS-5 to diagnose PTSD.
Results: We included 187 PPH patients and 121 controls. Median PCL-5 scores were higher for PPH patients (5.0) than controls (4.0, p = 0.005). Thirteen PPH patients (7.0%) and two controls (1.7%) scored ≥32 on the PCL-5, indicative of probable PTSD (OR 4.45, 95% CI 0.99-20.06, p = 0.035). Significant more PPH patients than controls met criteria for a clinical diagnosis of PTSD on the CAPS-5 (n = 10, 5.6% vs n = 0, 0.0%; p = 0.007).
Conclusions: There is a significant and clinically relevant increased risk for developing PTSD after severe PPH. Gynecologists and midwives are advised to screen for PTSD at postpartum follow-up visits to prevent long-term negative mental health effects.
期刊介绍：
The Journal of Psychosomatic Obstetrics and Gynecology was founded in 1982 in order to provide a scientific forum for obstetricians, gynecologists, psychiatrists and psychologists, academic health professionals as well as for all those who are interested in the psychosocial and psychosomatic aspects of women’s health. Another of its aims is to stimulate obstetricians and gynecologists to pay more attention to this very important facet of their profession.
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