Severe postpartum hemorrhage increases risk of posttraumatic stress disorder: a prospective cohort study

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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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.

Original languageEnglish
Pages (from-to)335-345
Number of pages11
JournalJournal of Psychosomatic Obstetrics and Gynaecology
Issue number4
Early online date17 Mar 2020
Publication statusPublished - 2021

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