Background
A | Stressor |
---|---|
□ The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others. | |
□ The person's response involved intense fear, helplessness, or horror | |
B
|
Intrusive recollection (1 or more)
|
□ Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. | |
□ Recurrent distressing dreams of the event | |
□ Acting or feeling as if the traumatic event were recurring | |
□ Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. | |
□ Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event | |
C
|
Avoidant/numbing (3 or more)
|
□ Efforts to avoid thoughts, feelings, or conversations associated with the trauma | |
□ Efforts to avoid activities, places, or people that arouse recollections of the trauma | |
□ Inability to recall an important aspect of the trauma | |
□ Markedly diminished interest or participation in significant activities | |
□ Feeling of detachment or estrangement from others | |
□ Restricted range of affect | |
□ Sense of foreshortened future | |
D
|
Hyper-arousal (2 or more)
|
□ Difficulty falling or staying asleep | |
□ Irritability or outbursts of anger | |
□ Difficulty concentrating | |
□ Hyper-vigilance | |
□ Exaggerated startle response | |
E
|
Duration
|
□ Duration of the disturbance (symptoms in B, C, and D) is more than one month | |
F
|
Functional significance
|
□ The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning |
Definition, incidence and prevalence of severe maternal morbidity
Scottish Confidential Audit’s criteria and definition [[27]] | |
---|---|
1
|
Major obstetric haemorrhage
|
Estimated blood loss ≥ 2500ml, or transfused 5 or more units of blood or received treatment for coagulopathy | |
2
|
Eclampsia
|
Seizure associated with antepartum, intrapartum or postpartum symptoms and signs of pre-eclampsia. | |
3
|
Renal or liver dysfunction
|
Acute onset of biochemical disturbance, urea > 15mmol/l, creatinine > 400mmol/l, AST/ALT > 200u/l. | |
4
|
Cardiac arrest
|
No detectable major pulse. | |
5
|
Pulmonary oedema
|
Clinically diagnosed pulmonary oedema associated with acute breathlessness and O2 saturation < 95%, requiring O2, diuretics or ventilation. | |
6
|
Acute respiratory dysfunction Requiring intubation or ventilation for > 60 minutes (not including duration of general anaesthetic). |
7
|
Coma Including diabetic coma. Unconscious for > 12 hours. |
8
|
Cerebro-vascular event
|
Stroke, cerebral/cerebellar haemorrhage or infarction, subarachnoid haemorrhage, dural venous sinus thrombosis. | |
9
|
Status epilepticus
|
Unremitting seizures in patient with known epilepsy. | |
10
|
Anaphylactic shock
|
An allergic reaction resulting in collapse with severe hypotension, difficulty breathing and swelling/rash. | |
11
|
Septicaemic shock
|
Shock (systolic blood pressure < 80 mm/Hg) in association with infection. No other cause for decreased blood pressure. Pulse of 120 beats/minute or more. | |
12
|
Anaesthetic problem
|
Aspiration, failed intubation, high spinal or epidural anaesthetic. | |
13
|
Massive pulmonary embolism
|
Increased respiratory rate (> 20/min), tachycardia, hypotension. Diagnosed as ‘high’ probability on V/Q scan or positive spiral chest CT scan. Treated by heparin, thrombolysis or embolectomy. | |
14
|
Intensive care admission/ Coronary care admission
|
Unit equipped to ventilate adults. Admission for one of the above problems or for any other reason. Include CCU admissions. | |
1
|
Severe preeclampsia
|
Blood pressure 170/110 mm Hg on two occasions 4 hours apart or > 170/110 mm Hg once plus ≥ 0.3 g in 24 hours proteinuria or ≥ + + on dipstick | |
OR | |
Diastolic blood pressure > 90 mm Hg plus proteinuria (as above) on one occasion plus one of the following signs/symptoms: Oliguria (< 30 ml/h for 2 hours), Visual disturbances (flashing lights or blurred vision), Epigastric/right upper quadrant pain or tenderness, Thrombocytopenia (< 100x109/l) Pulmonary oedema | |
2
|
Eclampsia
|
Convulsions during pregnancy or in the first 10 days postpartum together with at least two of the following features within 24 hours after the convulsions: Hypertension (≥ 170/110 mm Hg), Proteinuria (≥ + on random dipstick analysis or ≥ 0.3 g in 24 hours) | |
Thrombocytopenia (< 100x109/l), Increased aspartate aminotransferase (≥ 42 U/l) | |
3
|
HELLP syndrome
|
Haemolysis (abnormal peripheral smear or raised total bilirubin concentration (≥ 20.5 μmol/l)), raised liver enzyme activity (raised aspartate aminotransferase (≥ 70 U/l) or raised γglutamyltransferase (≥ 70 U/l), and low platelets (< 100x109/l)) | |
4
|
Severe haemorrhage
|
Estimated blood loss > 1500 ml, peripartum fall in haemoglobin concentration ≥ 40 g/l or acute transfusion of 4 or more units of blood | |
5
|
Severe sepsis
|
Sepsis is systemic response to infection manifested by two or more of: Temperature > 38°C or < 36°C (unless after prolonged caesarean), Heart rate > 100 beats/minute, Respiratory rate > 20/min or PaCO2 < 32 mmHg, White cell count > 17x109/l or < 4x109/l or > 10% immature forms, Plus bacteraemia (that is, positive blood cultures) or positive swab culture | |
Severe sepsis is sepsis associated with one of: Organ dysfunction—for example, acute renal failure, Hypoperfusion—for example, lactic acidosis, oliguria, or acute alteration in mental state, Hypotension—that is, systolic blood pressure < 90 mm Hg or drop of > 40 mm Hg in the absence of other causes of hypotension | |
6
|
Uterine rupture
|
Acute dehiscence of the uterus leading to the emergency delivery of the infant |
Methods
Inclusion and exclusion criteria
Topic | Inclusion criteria | Exclusion criteria |
---|---|---|
Research focus
| · The relationship between severe maternal morbidity that occurred during pregnancy until the end of the first week postpartum and the onset of PTSD/PTSD symptoms within 2 years postpartum | · Studies of PTSD/PTSD symptoms associated with miscarriage and abortion |
· Studies of PTSD/PTSD symptoms associated with medical procedure or medical intervention per se (e.g. caesarean section) without including severe maternal morbidity as a predictor of PTSD/PTSD symptoms | ||
· Other postnatal psychological and physical problems | ||
· Studies of PTSD/PTSD symptoms in pregnant women not associated with pregnancy related events but with others such as conflict, accidents or natural disasters | ||
· Studies examining the effects of pre-existing PTSD/PTSD symptoms on future pregnancies | ||
Population
| · Women who experienced (severe) maternal morbidity (eg. Major obstetric haemorrhage, pre-eclampsia/eclampsia, HELLP syndrome, admission to intensive/special care unit) | Childbearing women in general (of whom, women who experienced severe maternal morbidity not distinguishable) |
Setting/countries
| · No restriction made | · None |
Study type/design
| · Observational studies | · Descriptive studies with no comparison group |
· Experimental studies with relevant data | · Qualitative studies | |
· Systematic reviews which examined the relationship between severe maternal morbidity and subsequent postnatal PTSD/PTSD symptoms | · Letter, commentary, news or short communications | |
· Repeated findings originated from same study | ||
Language
| · English | · Non-English |
Publication
| · Published and grey literature | · None |
Time frame
| · Studies published from 1970 | · Studies published before 1970 |
Data extraction
Results
Overview of selected studies
Authors | Country | Design | Site | Size† (follow-up) | Resp. Rate† % | Time of recruit-ment | Criteria | Maternal morbidity type (Data source) | PTSD | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Inclusion | Exclusion | Time postnatal | Tool | Admini-stration | |||||||||
Adewuya et al. 2006 | Nigeria | Cross-sectional | Multi. clinic. (n=5) | 876 | 95 a
| Postnatal | Women attending 6 week postnatal & infant immunisation clinic | None | Hospital admission in pregnancy Manual removal of placenta | Self-report | 6 wks | M.I.N.I. | Interview |
Ayers 1999 (PhD thesis) | UK | Pros. cohort | Single hospital | 245 (201) | 70 -83 c (46–56 a) | Antenatal | Gestational age 16≤, ≤ 36 wks at recruitment Good English | ElCS Poor English Other research participation Moving out No fixed address Psychiatric inpatient | Blood loss Delivery complication | Clinical records | 1 week 6 weeks 6 mths | IES PSS-SR | Postal |
Baecke et al. 2009 | Netherlands | Retro. cohort | Single hospital | 169 | 48-76 b or c
| Postnatal | Pregnancy complicated by preeclampsia and control groups | Multiple pregnancy | Pre-term preeclampsia Term preeclampsia | Clinical records | 6 -18 mths | IES | Postal |
Cohen et al. 2004 | Canada | Pros. cohort | Multi. hospital (n=6) | 198 | 60-87 b or c
| Postnatal | Age≥18 Understand English Delivered a full-term Singleton infant | Poor English Child for adoption Risk of baby (multiple infant, premature, congenanomaly, NICU, death) | maternal complications (PPH, uterine infection UTI, or retained placenta etc.) | Not clear | 6-8 wks | DTS | Interview (telephone) |
Creedy 1999 (PhD thesis) | Australia | Pros. cohort | Multi. hospital (n=4) | 499 (141) | 73 b
| Antenatal | Age≥18 3rd trimester pregnancy Understand English No major prenatal complication No medical problems healthy full-term infant | Risk of baby (premature, stillbirth) Pregnancy with high risk for birth complications | Delivery complication (PPH, anaemia, infection, severe post-delivery pain or manual removal of placenta etc) | Self-report | 4-6 wks 3–4 mths | IES PSS- | Interview (telephone) |
Engelhard et al. 2002‡
| Netherlands | Retro. cohort | Single hospital | 113 | 51-90 b
| Postnatal | Pregnancy complicated by preeclampsia and control groups Primiparas | Age<18, Illiterate in Dutch Intrauterine fetal death | Pre-term preeclampsia Term preeclampsia | Clinical records | ≤ 2 yrs | PSS-SR | Postal |
Hoedjes et al., 2001 | Netherlands | Pros. cohort | Multi. hospital (n=4) | 128 (137) | 50-54 a or b
| Postnatal | Age≥18 Pregnancy complicated by preeclampsia speaking Dutch | -- | Mild preeclampsia: Severe preeclampsia | Clinical records | 6 wks 12 wks | SRIP | Postal |
Lev-Wiesel et al. 2009 | Israel | Pros. cohort | Single hospital | 1071 | 96 c or d
| Antenatal | Women >= 5 mths pregnant at the time of recruitment | Women under psychiatric treatment | High-risk pregnancy Delivery complications (CS, preterm delivery or fetal distress etc) | Clinical records Self-report | 1 mth 6 mths | PSS-I | Interview (face-to-face/ telephone) |
Sorenson & Tschetter 2010 | US | Cross-sectional | Commu-nity | 71 | 75 c (53 b) | Postnatal | Listed in phone book Having 'landline' phone numbers | All others who did not meet inclusion criteria | Birth complication: | Not stated | 6-7 mths | PTCS | Interview (telephone) |
Stramrood et al. 2010 | Netherlands | Pros. cohort | Single hospital & single midwifery practice | 175 (137) | 71-91c
| Antenatal | Women hospitalised with preeclampsia or PPROM | Critically ill, multiple pregnancy, A history of intrauterine fetal death, Alcohol/drug dependence Pre-existing medical conditions (eg. diabetes, hypertension, cardiovascular, renal diseases) | Preeclampsia PPROM | Clinical records | 6 wks 15 mths | PSS-SR | Interview |
Stramrood et al. 2011 | Netherlands | Cross-sectional | Multi. Hospital (n=3) Midwifery practice (n=4) | 428 | 47 a or b
| Postnatal | Women delivered 2 to 6 months prior to study with >=16 weeks of gestation | -- | Pregnancy complications (pre-eclampsia, HELLP, antenatal blood loss or intrauterine death etc) Delivery complications (PPH, manual placenta removal or ICU etc) | Self-report | 2-6 mths | TES-B | Web-based |
Methodological quality
Representativeness and generalisability
Exposure to maternal morbidity
Measures of PTSD
Tool | DTS | IES | PSS-SR | PTCS | SRIP | TES-B |
---|---|---|---|---|---|---|
No. of items
| 17 | 15 | 17 | 15 | 22 | 17 |
Response scale
| 5 point Likert | 4 point Likert | 4-point Likert | 5-point Likert | 4 point Likert | 4 point Likert |
Validity
| ||||||
- Sensitivity
| 0.69 | 1.00 | 0.62 | Not yet | 0.86 | Not yet |
- Specificity
| 0.95(cut-off of 40on sum score) | 0.78(cut-off of 19on sum score) | 1.00 | established | 0.71 | established |
Reliability
| ||||||
- Internal consistency
| 0.99 | 0.78 (intrusions)0.82 (avoidance) | 0.91 | 0.93 | 0.90-0.94 | 0.84 |
- Test-retest
| 0.86 | 0.89 (intrusions) 0.79 (avoidance) | 0.74 | -- | 0.60-0.97 | -- |
Reporting period
| Past week | Past week | Past two weeks | Not available | Past four weeks | Past four weeks |
Specify stressor of interest
| Yes | Yes | Yes | Not available | No | Yes |
DSM-IV criteria
| B, C, D | B, C | B, C, D | Not available | B, C, D | A, B, C, D, E, F |
Is there difference in prevalence/incidence of PTSD (profile/symptoms) between women who experienced severe maternal morbidity and those who did not?
Study | N* | Instrument | Time of Assessment | PTSD profile & symptoms (%) | |
---|---|---|---|---|---|
Women with complication | Women without (less) complication | ||||
Baecke et al. 2009 | 169 | IES | 6 – 18 mths |
PTSD symptoms
| |
44%: Preterm preeclampsia | 41%: Preterm, no complication | ||||
11%: Term preeclampsia | 11%: Term, uneventful | ||||
Cohen et al. 2004 | 198 | DTS | 8 – 10 wks |
PTSD profile
| |
0%: Maternal complication (2+) | 0%: Maternal complication (0–1) | ||||
PTS
| |||||
59%: Maternal complication (2+) | 30%: Maternal complication (0–1) | ||||
Engelhard et al. 2002 | 113 | PSS-SR | Within 2 yrs |
PTSD profile
| |
28%: Preterm preeclampsia | 28%: Preterm, no complication | ||||
17%: Term preeclampsia | 0%: Term, uneventful | ||||
Hoedjes et al. 2011 | 128 | SRIP | 6 wks |
PTSD profile
| N/A |
9%: severe & mild preeclampsia | |||||
11%: severe preeclampsia | |||||
3%: mild preeclampsia | |||||
137 | 12 wks |
PTSD profile
| |||
5%: severe & mild preeclampsia | |||||
7%: severe preeclampsia | |||||
0%: mild preeclampsia | |||||
Stramrood et al. 2010a | 163 | PSS-SR | 6 wks |
PTSD profile
| |
11%: Preeclampsia | 3% Term, uneventful | ||||
17%: PPROM | |||||
137 | 15 mths |
PTSD profile
| |||
11%: Preeclampsia | 0% Term, uneventful | ||||
3%: PPROM |
Is there a statistical relationship between severe maternal morbidity and PTSD (profile/symptoms), and if so, how strong is that relationship?
Study | N | Method | Results (in case of ORs: risk vs. reference) | ||||||
---|---|---|---|---|---|---|---|---|---|
Adewuya et al., 2006 | 876 | Stepwise multiple regressions | M.I.N.I | PTSD | 6 wks | Admission due to pregnancy complication: yes vs. no | Adjusted OR: 11.9 †
| (95%CI: 6.4–22.1) | |
Mode of delivery | |||||||||
- Instrumental vs. spontaneous vaginal | Adjusted OR: 7.9 †
| (95%CI: 3.9–16.2) | |||||||
- EmCS vs. spontaneous vaginal | Adjusted OR: 7.3 †
| (95%CI:3.5–15.2) | |||||||
- ElCS vs. spontaneous vaginal | Adjusted OR: 2.0 | (95%CI: 0.4–8.9) | |||||||
Mode of placental removal: manual vs. normal | Adjusted OR: 5.0 †
| (95%CI: 2.4–10.1) | |||||||
Perceived control in childbirth: LAS < 40 vs. > 40 | Adjusted OR: 5.1 †
| (95%CI: 2.7–9.5) | |||||||
Ayers, 1999 | 220 | Mann Whitney Spearman's correlation | IES | Intrusions (sub-sum score) | 6 wks | Delivery complication: presence vs. absence | ns | ||
Amount of blood loss | ns | ||||||||
Kruskal-Wallis | Type of delivery (eg. EmCS) | ns | |||||||
Partial correlation (removing an effect of PTSD symptoms in pregnancy) | Appraising birth as traumatic | Partial correlation β=.20 ** (one tailed) | |||||||
Different from how women wanted to be | Partial correlation β=.17* | ||||||||
201 | 6 mths | Delivery complication: presence vs. absence | ns | ||||||
Amount of blood loss | ns | ||||||||
Type of delivery (eg. EmCS) | ns | ||||||||
Appraising birth as traumatic | Partial correlation β=.19 ** (one tailed) | ||||||||
Different from how women wanted to be | Partial correlation β=.22** | ||||||||
220 | Avoidance (sub-sum score) | 6 wks | Delivery complication: presence vs. absence | ns | |||||
Amount of blood loss | ns | ||||||||
Type of delivery (eg. EmCS) | ns | ||||||||
Appraising birth as traumatic | Partial correlation β=.23 ** (one tailed) | ||||||||
Different from how women wanted to be | Partial correlation β=.35*** | ||||||||
201 | 6 mths | Delivery complication: presence vs. absence | Unadjusted U=2553 * | ||||||
Amount of blood loss | ns | ||||||||
Type of delivery (eg. EmCS) | ns | ||||||||
Appraising birth as traumatic | Partial correlation β=.24 *** (one tailed) | ||||||||
Different from how women wanted to be | Partial correlation β=.29 *** | ||||||||
Baecke et.al, 2009 | 169 | Method for ORs: not stated | IES | PTSD symptoms | 6-18 mths | Preterm preeclampsia vs. Term, uneventful | (Adjusted?) OR: 6.2†
| (95%CI: 2.5-15.8) | |
Preterm preeclampsia vs. Term preeclampsia | (Adjusted?) OR: 6.2†
| (95%CI: 1.3-30.1) | |||||||
Preterm, no complication vs. Term, uneventful | (Adjusted?) OR: 5.5†
| (95%CI: 2.0-15.2) | |||||||
Cohen et al., 2004 | 184 | Multivariable logistic regression | DTS | Postpartum stress (high/low) | 8-10 wks | Maternal complications: 2+ vs. 0-1 | Adjusted OR: 4.0†
| (95%CI: 1.3-12.8) | |
Depression during pregnancy: yes vs. no | Adjusted OR: 18.9†
| (95%CI: 5.8-62.4) | |||||||
History of traumatic events: 2+ vs. 0–1 | Adjusted OR: 3.2†
| (95%CI: 1.2-8.3) | |||||||
Born in Canada vs. Not born in Canada | Adjusted OR: 3.2†
| (95%CI: 1.3-8.1) | |||||||
Income (Canadian $) | |||||||||
- lowest (<$32,000) vs. high (>$8000) | Adjusted OR: 0.1†
| (95%CI: 0.02-0.5) | |||||||
- middle ($32,000-80,000) vs. high (>$8000) | Adjusted OR: 0.4†
| (95%CI: 0.2-0.8) | |||||||
Creedy et al., 1999 | 499 | Simple regression | IES | PTSD symptom severity (sum score) | 4-6 wks | Preparedness for labour and delivery | ns | ||
Stepwise multiple regressions | Maternal complications | ns | |||||||
EmCS | Adjusted β=.20*** | ||||||||
Forceps delivery | Adjusted β=.17*** | ||||||||
Vacuum delivery | Adjusted β=.14** | ||||||||
Post-delivery pain | Adjusted β=.16*** | ||||||||
Neonatal complications | Adjusted β=.10* | ||||||||
Hierarchical multiple regression |
Final model (Accounted for 21% of variance)
| ||||||||
Perception of maternity care (step 1) | Adjusted β=.-32*** | ||||||||
Obstetric intervention (step 2) | Adjusted β=.26*** | ||||||||
141 | Multiple regression | 3 mths |
Final model (Accounted for 24% variance)
| ||||||
Preparedness for labour and delivery | Adjusted β=.-16* | ||||||||
Obstetric intervention | Adjusted β=.15* | ||||||||
Perception of maternity care | Adjusted β=.42*** | ||||||||
Engelhard et.al, 2002 | 113 | Hierarchical multiple regression | PSS-SR | PTSD symptom severity | Within 2 yrs |
Final mode (Accounted for 61% of the variance)
| |||
Gestational age at admission (step 1) | ns | ||||||||
Peritraumatic distress (step 2) | ns | ||||||||
Peritraumatic dissociation (step 2) | Adjusted β=.27** | ||||||||
Negative interpretations (step 3) | Adjusted β=−.40* | ||||||||
Thought suppression (step 3) | Adjusted β=−.25* | ||||||||
Hoedjes et al., 2011 | 149 | Logistic regression for each variable (adjusting only for assessment time – 6 and 12 weeks postpartum using GEE‡) | SRIP | PTSD profile (yes/no) | 6-12 wks | Severity of preeclampsia: severe vs. mild | Unadjusted OR: 5.0* | (95%CI: 0.6–38.8) | |
Mode of delivery: CS vs. vaginal | Unadjusted OR: 8.4* | (95%CI: 1.1–65.5) | |||||||
Age | Unadjusted OR: 0.6* | (95%CI: 0.4–0.7) | |||||||
Gestational age at delivery | Unadjusted OR: 0.8* | (95%CI: 0.7–1.0) | |||||||
Intrusions (yes/no) | Severity of preeclampsia: severe vs. mild | Unadjusted OR: 5.5* | (95%CI: 1.6–18.7) | ||||||
Mode of delivery: CS vs. vaginal | Unadjusted OR: 4.3* | (95%CI: 1.7–10.6) | |||||||
Admission to NICU: yes vs. no | Unadjusted OR: 5.9* | (95%CI: 2.4–15.0) | |||||||
Perinatal death: yes vs. no | Unadjusted OR: 7.1* | (95%CI: 1.8–27.8) | |||||||
Age | Unadjusted OR: 0.8* | (95%CI: 0.7–0.9) | |||||||
Gestational age at delivery | Unadjusted OR: 0.9* | (95%CI: 0.8–0.9) | |||||||
Birth weight | Unadjusted OR: 0.5* | (95%CI: 0.3–0.8) | |||||||
Avoidance (yes/no) | Mode of delivery: CS vs. vaginal | Unadjusted OR: 3.9* | (95%CI: 1.1–13.9) | ||||||
Admission to NICU: yes vs. no | Unadjusted OR: 4.3* | (95%CI: 1.2–15.6) | |||||||
Age | Unadjusted OR: 0.7* | (95%CI: 0.6–0.8) | |||||||
Gestational age at delivery | Unadjusted OR: 0.9* | (95%CI: 0.8–0.9) | |||||||
Birth weight | Unadjusted OR: 0.4* | (95%CI: 0.2–1.0) | |||||||
Hyperarousal (yes/no) | Severity of preeclampsia: severe vs. mild | Unadjusted OR: 3.0* | (95%CI: 1.2–7.9) | ||||||
Mode of delivery: CS vs. vaginal | Unadjusted OR: 2.6* | (95%CI: 1.2–5.7) | |||||||
Admission to NICU: yes vs. no | Unadjusted OR: 2.8* | (95%CI: 1.3–5.8) | |||||||
Perinatal death: yes vs. no | Unadjusted OR: 6.6* | (95%CI: 1.1–39.6) | |||||||
Age | Unadjusted OR: 0.9* | (95%CI: 0.8–1.0) | |||||||
Gestational age at delivery | Unadjusted OR: 0.9* | (95%CI: 0.8–1.0) | |||||||
Birth weight | Unadjusted OR: 0.6* | (95%CI: 0.4–0.8) | |||||||
Lev-Wiesel et al, 2009 | 1071 | Linear multiple regression | PSS-I | PTSD symptoms severity | 6 mths |
Final model (Accounted for 41% of the variance)
| |||
(sum score) | Subjective pain and distress during delivery | Adjusted β=.51*** | |||||||
PTS during pregnancy | Adjusted β=.04 | ||||||||
Delivery complications | Adjusted β=.04 | ||||||||
Depression during pregnancy | Adjusted β=.15*** | ||||||||
History of traumatic events | Adjusted β=.08** | ||||||||
High risk pregnancy | Adjusted β=.03 | ||||||||
Sorenson & Tschetter, 2010 | 71 | Point-biserial correlation coefficient | PTCS | Posttraumatic childbirth stress (low/high) | 6–7 mths | Maternal complications: yes vs. no | Unadjusted rpbs = 0.28 †
| ||
Infant complications: yes vs. no | Unadjusted rpbs = 0.25 †
| ||||||||
Stramrood et al, 2010 | 175 | Hierarchical multiple regression | PSS-SR | PTSD symptoms severity | 6 wks |
Final model (Accounted for 39% of the variance)
| |||
A history of depression (step 1) | Adjusted β=.23** | ||||||||
BDI scores during pregnancy (step 1) | Adjusted β=.33*** | ||||||||
Death of infant (step 2) | Adjusted β=.29*** | ||||||||
Hospital admission of the infant (step 2) | ns | ||||||||
Birth weight (step 2) | ns | ||||||||
Diagnosis of the mother (PE vs PPROM) (step 2) | ns | ||||||||
CS (step 2) | ns | ||||||||
Stramrood et al, 2011 | 428 | Hierarchical multiple regression | TES-B | PTSD symptoms severity (sum score) | 2 to 6 mths |
Final model (Accounted for 41% of the variance)
| |||
Country of origin (step 1) | Adjusted β=.004 | ||||||||
Primiparity (step 1) | Adjusted β=.06 | ||||||||
Preeclampsia/HELLP syndrome (step 1) | Adjusted β=.08 | ||||||||
Hypertension (step 1) | Adjusted β=.04 | ||||||||
Preterm delivery (step 1) | Adjusted β=.04 | ||||||||
Secondary/tertiary care (step 2) | Adjusted β=−.09 | ||||||||
Hospital delivery (step 2) | Adjusted β=−.05 | ||||||||
Induction of labour (step 2) | Adjusted β=−.02 | ||||||||
Instrumental vaginal delivery (step 2) | Adjusted β=−.08 | ||||||||
Unplanned caesarean section (step 2) | Adjusted β=.11** | ||||||||
Postpartum haemorrhage (>1L) (step 2) | Adjusted β=.06 | ||||||||
Manual placenta removal (step 2) | Adjusted β=.04 | ||||||||
Perinatal death (step 2) | Adjusted β=.06 | ||||||||
N(I)CU admittance (infant) (step 2) | Adjusted β=.05 | ||||||||
ICU admittance (mother) (step 2) | Adjusted β=.03 | ||||||||
Fear of childbirth (high) (step 3) | Adjusted β=.02 | ||||||||
Delivery worse than expected (step 3) | Adjusted β=.01 | ||||||||
Intensity of pain (high) (step 3) | Adjusted β=.11* | ||||||||
Sense of Coherence (low) (step 3) | Adjusted β=.53*** |