Psychotraumatic Impact of Severe Postpartum Hemorrhage
N. Smaoui, A. Jedidi, I. Gassara, R. Feki, H. Hkim, M. Maalej, N. Charfi, M. Maalej, S. Omri, L. ZouariIntroduction
Postpartum hemorrhage (PPH) remains one of the leading causes of maternal morbidity and mortality worldwide, particularly in low- and middle-income countries. Beyond its physical consequences, severe PPH can represent a highly traumatic event for mothers, potentially leading to long-term psychological sequelae. In recent years, growing attention has been given to the association between obstetric complications and post-traumatic stress disorder (PTSD), yet data from North African and Tunisian contexts remain scarce.
Objectives
The objective of this study was to determine the prevalence of post-traumatic stress disorder (PTSD) among women who experienced severe postpartum hemorrhage (PPH).
Methods
A cross-sectional, descriptive, and analytical study was conducted between January and December 2024 among 49 participants who presented with severe PPH. Their deliveries took place in the Gynecology-Obstetrics Department of Hedi Chaker University Hospital in Sfax between 2017 and 2023.
PTSD was assessed using the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5), with a diagnostic threshold set at a score ≥ 31.
Statistical analysis was performed using SPSS-26 software.
Results
The mean age of participants at the time of delivery complicated by PPH was 31.16 ± 5.86 years (min = 19, max = 47). More than 95% of participants belonged to low and middle socio-economic classes (n=47), and more than two-thirds came from rural areas (n=33).
Gestational age ranged from 35 to 42 weeks, with 81.63% of deliveries carried to term (n=40), and 45% of deliveries (n=22) performed by cesarean section.
PPH required invasive management in 23 participants (46.9%), including 4 (8.16%) who underwent hemostatic hysterectomy. Additionally, 18 participants (36.7%) were admitted to intensive care.
PTSD assessment revealed a mean PCL-5 score of 31.81 ± 18.54 (min = 4, max = 71). Overall, 22 participants (44.9%) met the DSM-5 diagnostic criteria for PTSD.
Analysis of PCL-5 dimensions showed mean scores of 7.98 ± 5.59 for re-experiencing (min = 0, max = 18), 3.78 ± 2.53 for avoidance (min = 0, max = 8), 9.84 ± 8.53 for negative alterations in cognition and mood (min = 0, max = 28), and 9.61 ± 4.83 for hyperarousal (min = 0, max = 22).
Conclusions
Severe PPH is associated with an increased risk of PTSD. Systematic assessment of post-obstetric PTSD is essential to ensure appropriate and preventive management.
Disclosure of Interest
None Declared