Froeliger Alizée, Deneux-Tharaux Catherine, Loussert Lola, Madar Hugo, Sentilhes Loïc
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.
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.
Am J Obstet Gynecol. 2024 Nov;231(5):543.e1-543.e36. doi: 10.1016/j.ajog.2024.03.011. Epub 2024 Mar 16.
The prevalence and risk factors of posttraumatic stress disorder after cesarean delivery, outside high-risk contexts, remain unclear.
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.
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.
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.
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.
在非高风险情况下，剖宫产术后创伤后应激障碍的患病率及危险因素仍不明确。
本研究旨在评估剖宫产的普通女性人群产后2个月时创伤后应激障碍的患病率及危险因素。
这是一项针对剖宫产术后氨甲环酸预防产后出血（TRAAP2）试验的前瞻性辅助队列研究，于2018年至2020年在27家法国医院开展，纳入预计在妊娠≥34周临产前或临产时进行剖宫产的女性。随机分组后，前瞻性收集剖宫产及产后失血的特征。分娩后2个月，通过两份自填式问卷（事件影响量表修订版和创伤事件量表）评估创伤后应激障碍概况（创伤后应激障碍症状的存在情况）和初步诊断（与创伤后应激障碍一致的诊断筛查阳性）。采用逆概率加权法估计校正后的创伤后应激障碍患病率，以考虑无应答情况。根据因变量类型，通过多变量逻辑回归或线性回归模型分析潜在危险因素与创伤后应激障碍之间的关联。
4431名女性中，共有2785名返回了事件影响量表修订版问卷，2792名返回了创伤事件量表（应答率分别为62.9%和63.0%）。创伤后应激障碍概况的患病率为9.0%（95%置信区间，7.8%-10.3%），初步诊断的患病率为1.7%（95%置信区间，1.2%-2.4%）。与创伤后应激障碍概况风险较高相关的特征包括孕前易患因素（年轻、高体重指数和非洲出生的移民）以及剖宫产相关的产科因素（引产术后剖宫产[校正比值比，1.81；95%置信区间，1.14-2.87]、产后出血[校正比值比，1.61；95%置信区间，1.04-2.46]和产后住院期间的高强度疼痛[校正比值比，1.90；95%置信区间，1.17-3.11]）。与新生儿立即进行皮肤接触的女性患创伤后应激障碍的风险较低（校正比值比，0.66；95%置信区间，0.46-0.98），而产后第2天对分娩有不良记忆的女性风险较高（校正比值比，3.20；95%置信区间，1.97-5.12）。事件影响量表修订版和创伤事件量表得出了一致的结果。
剖宫产的女性中，约每11人中有1人在产后2个月时有创伤后应激障碍症状。一些产科干预措施和剖宫产管理的组成部分可能会影响这种风险。
