Post-traumatic stress disorder in women and their partners, following severe post-partum hemorrhage: A study protocol for a prospective cohort study

Abstract

Background: Post-traumatic stress disorder is a Trauma- and Stressor-Related Disorder resulting from exposure to an event that is considered as traumatic. It is recognized in relation to traumatic childbirth that both patient, partner and health-care provider can develop a post-traumatic stress disorder. The most important risk factors in women are depression during the pregnancy, fear of childbirth, severe pre-eclampsia, preterm premature rupture of membranes, and severe neonatal complications. The prevalence rate in women in Western countries is estimated between 1 and 3%. The prevalence in partners witnessing childbirth is unknown. Post-traumatic stress disorder in relation to severe post-partum haemorrhage, in either women or partners, has not been extensively researched yet. Methods/design: This is a prospective cohort study in a hospital setting, with the objective to evaluate whether women and their partners have a higher risk to develop a post-traumatic stress disorder or symptoms, following a severe post-partum hemorrhage of 2.0 l or more, compared to a control group. The primary outcome variable is diagnosis of post-traumatic stress disorder. Secondary outcome variables are post-traumatic symptoms according to the post-traumatic stress disorder criteria, psychiatric co-morbidities and seeking psychological help. A total of at least 130 women and 130 partners, must be included according to power calculations. Patients, partners and controls are selected in eight hospitals through complication registers. They are asked to complete a digital questionnaire four to six weeks after delivery, to screen for a post-traumatic stress disorder or symptoms. Participants with scores above cut off values are asked to participate in a telephone interview. For secondary outcomes, risk factors will be evaluated by multivariable analysis. Discussion: This study is designed to give insight into the frequency of post-traumatic stress disorder and post-traumatic stress symptoms following a severe post-partum hemorrhage, both in patients and their partners. We strive to minimize the non-response bias, a common problem in this type or research, through early and active participant recruitment. Trial registration: NL50273.100.14.

Keywords:

• PTSD
• PPH
• DSM-5
• hemorrhages
• post-partum
• traumatic birth
• stress
• psychotrauma
• partner

Public Interest Statement

Post-traumatic stress disorder is a Trauma- and Stressor-Related Disorder resulting from exposure to an event that is considered as traumatic. It is recognized in relation to traumatic childbirth that both patient, partner and health-care provider can develop a post-traumatic stress disorder. The most important risk factors in women are depression during the pregnancy, fear of childbirth, severe pre-eclampsia, preterm premature rupture of membranes, and severe neonatal complications. The prevalence rate in women in Western countries is estimated between 1 and 3%. The prevalence in partners witnessing childbirth is unknown. Post-traumatic stress disorder in relation to severe post-partum haemorrhage, in either women or partners, has not been extensively researched yet.

Competing Interests

The authors declare no competing interest.

Acknowledgements

We thank prof. dr M. Olff, who provided the questionnaires.

Authors’ contributions

K.W.F. Scheepstra and M.E. van Steijn designed this study and will collect data. All authors were involved in writing the protocol and had final approval of the submitted and published versions.

Additional information

Funding

This work was supported by the WPOG and Teaching Hospital, OLVG.

Notes on contributors

Karel Willem Frank Scheepstra

Karel Willem Frank Scheepstra is a physician assistant training to psychiatrist at the Academic Center in Amsterdam. He is a member of the Capture group, (childbirth and psychotrauma research group), a multidisciplinary research group focusing on research involving psycho trauma in patients, their partners and caregivers.