Post-traumatic stress disorder following near-miss maternal morbidity

Background: Little is known on the psychological outcomes for women who experience near-miss maternal morbidity. The objective of this study is to determine if women who experience emergency peripartum hysterectomy (EPH), a type of near-miss maternal morbidity, are more likely to screen positive for post-traumatic stress disorder (PTSD) after childbirth compared to women who did not experience EPH. Methods: Using a retrospective cohort design, women were sampled through online communities. Women completed online screens for PTSD and depression, and provided sociodemographic, obstetric, psychiatric and psychosocial characteristics. We conducted bivariate frequencies and logistic regression analysis. We then validated findings by performing Monte Carlo simulation to increase the sample size, and propensity score matching to eliminate confounders, and re-running the logistic regression analysis. Results: 77 exposed women (experienced EPH) and 355 non-exposed women (no EPH) completed the survey. In the adjusted logistic regression model, women who experienced EPH were over 15 times more likely to screen positive for PTSD at the time of survey completion compared to women who did not experience EPH (adjusted Odds Ratio (aOR): 15.48; 95% confidence interval (CI) 6.23, 38.46). When women were asked to recall their psychological state at 6 months postpartum, the odds increased drastically (aOR: 55.82; 95% CI 19.65, 158.60). Following simulation and propensity score matching, odds ratios changed but the strength of the association persisted. Conclusion: After validating the data, the association of EPH and PTSD remained high and statistically significant, indicating a critical need for support services for these women following childbirth.