Background
Defining postpartum haemorrhage
Defining maternal morbidity - women’s physical and emotional health problems
Methods
Aim and objectives
To determine the prevalence of women’s emotional health problems following a postpartum haemorrhage up to 3 months, >3 months and ≤6 months, and >6 months and ≤12 months postpartum; and
To determine the prevalence of women’s physical health problems following a postpartum haemorrhage up to 3 months, >3 months and ≤6 months, and >6 months and ≤12 months postpartum.
Outcomes
Inclusion and exclusion criteria
Search and selection strategy
Key words | Search terms/String |
---|---|
Postnatal period | TI postnatal OR AB postnatal OR TI post natal OR AB post natal OR TI post-natal OR AB post-natal OR TI postpartum OR AB postpartum OR TI post partum OR AB post partum OR TI post-partum OR AB post-partum OR TI “postnatal period” OR AB “postnatal period” OR TI “post natal period” OR AB “post natal period” OR TI “post-natal period” OR AB “post-natal period” OR TI “postpartum period” OR AB “postpartum period” OR TI “post partum period” OR AB “post partum period” OR TI “post-partum period” OR AB “post-partum period” OR TI puerperium OR AB Puerperium OR TI peripartum OR AB peripartum OR TI peri partum OR AB peri partum OR TI peri-partum OR AB peri-partum OR TI “peripartum period” OR AB “peripartum period” OR TI “peri partum period” OR AB “peri partum period” OR TI “peri-partum period” OR AB “peri-partum period” OR TI peripartum period OR AB peripartum period |
Postpartum haemorrhage | TI PPH OR AB PPH OR TI postpartum haemorrhage OR AB postpartum haemorrhage OR TI post partum haemorrhage OR AB post partum haemorrhage OR TI post-partum haemorrhage OR AB post-partum haemorrhage OR TI postpartum hemorrhage OR AB postpartum hemorrhage OR TI post partum hemorrhage OR AB post partum hemorrhage OR TI post-partum hemorrhage OR AB post-partum hemorrhage OR TI obstetric haemorrhage OR AB obstetric haemorrhage OR TI obstetric hemorrhage OR AB obstetric hemorrhage OR TI major obstetric haemorrhage OR AB major obstetric haemorrhage OR TI major obstetric hemorrhage OR AB major obstetric hemorrhage OR TI massive haemorrhage OR AB massive haemorrhage OR TI massive hemorrhage OR AB massive hemorrhage OR TI massive obstetric haemorrhage OR AB massive obstetric haemorrhage OR TI massive obstetric hemorrhage OR AB massive obstetric hemorrhage OR TI severe haemorrhage OR AB severe haemorrhage OR TI severe hemorrhage OR AB severe hemorrhage OR TI severe obstetric haemorrhage OR AB severe obstetric haemorrhage OR TI severe obstetric hemorrhage OR AB severe obstetric hemorrhage OR TI severe blood loss OR AB severe blood loss |
Women’s emotional and physical health problems | TI women’s health OR AB women’s health OR TI womens health OR AB womens health OR TI woman’s health OR AB woman’s health OR TI womans health OR AB womans health OR TI health outcome OR AB health outcome OR TI health outcomes OR AB health outcomes OR TI adverse outcome OR AB adverse outcome OR TI adverse outcomes OR AB adverse outcomes OR TI pregnancy outcome OR AB pregnancy outcome OR TI pregnancy outcomes OR AB pregnancy outcomes OR TI puerperal disorder OR AB puerperal disorder OR TI puerperal disorders OR AB puerperal disorders OR TI maternal morbidity OR AB maternal morbidity OR TI maternal morbidities OR AB maternal morbidities OR |
TI mental health OR AB mental health OR TI mental disorder OR AB mental disorder OR TI mental disorders OR AB mental disorders OR TI mental disease OR AB mental disease OR TI mental diseases OR AB mental diseases OR TI emotional wellbeing OR AB emotional wellbeing OR TI emotional well being OR AB emotional well being OR TI emotional well-being OR AB emotional well-being OR TI emotional health OR AB emotional health OR TI postnatal depression OR AB postnatal depression OR TI post natal depression OR AB post natal depression OR TI post-natal depression OR AB post-natal depression OR TI postpartum depression OR AB postpartum depression OR TI post partum depression OR AB post partum depression OR TI post-partum depression OR AB post-partum depression OR TI postnatal distress OR AB postnatal distress OR TI post natal distress OR AB post natal distress OR TI post-natal distress OR AB post-natal distress OR TI postpartum distress OR AB postpartum distress OR TI post partum distress OR AB post partum distress OR TI post-partum distress OR AB post-partum distress OR TI postnatal stress OR AB postnatal stress OR TI post natal stress OR AB post natal stress OR TI post-natal stress OR AB post-natal stress OR TI perinatal mental health OR AB perinatal mental health OR TI perinatal mental health problems OR AB perinatal mental health problems OR TI peri natal mental health problems OR AB peri natal mental health problems Or TI perinatal mental health problem OR AB perinatal mental health problem OR TI peri natal mental health problem OR AB peri natal mental health problem OR TI postnatal anxiety OR AB postnatal anxiety OR TI post natal anxiety OR AB post natal anxiety OR TI post-natal anxiety OR AB post-natal anxiety OR TI postpartum anxiety OR AB postpartum anxiety OR TI post partum anxiety OR AB post partum anxiety OR TI post-partum anxiety OR AB post-partum anxiety OR OR TI postnatal anxieties OR AB postnatal anxieties OR TI post natal anxieties OR AB post natal anxieties OR TI post-natal anxieties OR AB post-natal anxieties OR TI postpartum anxieties OR AB postpartum anxieties OR TI post partum anxieties OR AB post partum anxieties OR TI post-partum anxieties OR AB post-partum anxieties OR TI postnatal psychosis OR AB postnatal psychosis OR TI post natal psychosis OR AB post natal psychosis OR TI post-natal psychosis OR AB post-natal psychosis OR TI postpartum psychosis OR AB postpartum psychosis OR TI post partum psychosis OR AB post partum psychosis OR TI post-partum psychosis OR AB post-partum psychosis OR | |
TI physical health OR AB physical health OR TI physical health problem OR AB physical health problem OR TI physical health problems OR AB physical health problems OR TI health problem OR AB health problem OR TI health problems OR AB health problems |
Data management processes
Quality assessment of included studies
Modified Newcastle Ottawa Scale (NOS) | Quality Assessment Tool – Modified Newcastle Ottawa Scale (NOS) | ||||||||
---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |
Representativeness of the exposed cohort (postpartum women) | Do the authors provide a definition of PPH? | Ascertainment of exposure | Assessment of outcome | Was the follow-up long enough for outcome to occur? (From birth up to 12 months postpartum or postnatal period defined) | Adequacy of follow-up | If necessary and/or appropriate provide details explaining decision on adequacy of follow-up | How many stars (a) does this paper receive? | Based on the overall quality, do you wish to include this paper? | |
Truly representativea | Yesa | Secure recorda | Independent blind assessmenta | Yesa | Complete follow-upa | ✓ = Yes, include | |||
Somewhat representativea | No | Record linkage/Questionnaire a | Record linkage/Questionnairea | No | Subjects lost to follow-up <20 %a | No = Exclude | |||
Selected group of users | Descriptive written self-report | Descriptive self-report | Subjects lost to follow-up >20 % | An overall rating of 3 or less implies weak quality and should be excluded | |||||
No clear description | No description | No description | No statement | ||||||
Not applicablea |
Data extraction management
Data analysis
Results
Results of search and selection strategy
Characteristics of included studies
Reference | Country | OECD country (at the time research was conducted) | Year of study | Study design | ICD-10 (2010) or similar definition of PPH used | Timing/severity/amount of PPH used in definition | Number and description of participants included | Data collection | Data reported and timing (HP, <1, ≥1 < 3, ≥3 < 6, ≥6 < 12, =12 months) | Quality assessment |
---|---|---|---|---|---|---|---|---|---|---|
Chauleur et al. (2008) [25] | France | Yes | 1999–2004 | P, C | Similar | Timing and severity not amount of bleeding | n = 32,463, Primigravida women (women in their first intended pregnancy) | D, MR | HP at <1, ≥1 < 3 | Strong |
Thompson et al. (2011) [27] | Australia and New Zealand | Yes | 2006–07 | P, C | Similar | √ | n = 206, Primiparous and Multiparous women who returned the 1st survey | MR, Q | HP at ≥1 < 3, ≥3 < 6 | Strong |
Bateman et al. (2010) [28] | United States | Yes | 1995–2004 | R, C | ICD-9 | √ | n = 25,654, Primiparous and Multiparous women who had a PPH | MR (national data) | HP at <1 | Moderate |
Liu et al. (2002) [30] | Canada | Yes | 1989–99 | R, C | ICD-9 | √ | n = 2,652,726, Primiparous and Multiparous women who gave birth during a 11 year period | MR (national data) | HP at ≥1 < 3 | Strong |
Naz et al. (2008) [31] | Pakistan | No | 2006 | P, C | Not stated | Severity of bleeding but not amount or timing | n = 705, Primiparous and Multiparous women who had a Primary PPH | MR | HP at <1 | Moderate |
Hoveyda and MacKenzie (2001) [36] | England | Yes | 1996–98 | R | Similar | Severity and timing of bleeding but not amount | n = 19,136, Primiparous and Multiparous women with Primary PPH, and those with Secondary PPH | MR | HP at <1 | Strong |
Results of methodological quality assessment
Results of data extraction
Definitions of PPH
Outcomes of PPH
References | Chauleur et al. (2008) [25] | Bateman et al. (2010) [28] | Naz et al. (2008) [31] | Hoveyda & MacKenzie (2001) [36] | Hoveyda & MacKenzie (2001) [36] |
---|---|---|---|---|---|
Number of participants | n = 317 | n = 25,654 | n = 50 | n = 657 (primary PPH) | n = 132 (secondary PPH) |
Reported Health Problems up to 1 month postpartum | |||||
Acute Renal Failure | 82 (0.32 %) | 2 (4 %) | |||
Acute Respiratory Failure | 105 (0.41 %) | ||||
Anaemia | 20 (40 %) | ||||
Anaemia + DIC | 5 (10 %) | ||||
Anaemia + DIC + ARF | 1 (2 %) | ||||
Coagulopathy / DIC | 445 (1.73 %) | 1 (2 %) | |||
Length of stay more than 7 days | 656 (2.56 %) | ||||
Perforation of the uterus | 3 (2.27 %) | ||||
Prolonged mechanical ventilation (>96 h) | 13 (0.05 %) | ||||
Secondary PPH | 33 (5.02 %) | ||||
Sepsis / Infection | 25 (0.1 %) | ||||
Shock + Anaemia | 2 (4 %) | ||||
Superficial venous thrombosis | 3 (0.9 %)a |
References | Thompson et al. (2011) [27] | Liu et al. (2002) [30] |
---|---|---|
Number of participants | n = 171 | n = 113,861 |
Reported Health problems ≥ 1 < 3 months postpartum | ||
Anxiety: State Trait Anxiety Inventory (median) | 10 | |
Depression: Edinburgh Postnatal Depression Scale > 12 | 19 (11 %) | |
Post-traumatic stress disorder: PCL > 44 | 9 (5 %) | |
Health Status: SF36 ‘somewhat worse than 1 year ago’ ago’ | 46 (26.9 %) | |
Health Status: SF36 ‘much worse than 1 year ago’ | 14 (8.2 %) | |
Physical problems: | ||
i. Painful perineum (vaginal births only) | 54/103 (52.5 %) | |
ii. Perineal infection (vaginal births only) | 6/104 (5.8 %) | |
iii. Pain at CS site (CS births only) | 53/65 (81.5 %) | |
iv. CS wound infection (CS births only) | 12/65 (18.5 %) | |
v. Uterine infection | 10 (5.9 %) | |
vi. Urinary tract infection | 11 (6.5 %) | |
vii. Stress urinary incontinence | 57 (33.5 %) | |
viii. Constipation | 81 (47.6 %) | |
ix. Incontinence of faeces | 10 (5.9 %) | |
x. Incontinence of flatus | 31 (18.5 %) | |
xi. Breast infection/ mastitis | 37 (21.8 %) | |
xii. Backache | 92 (54.7 %) | |
xiii. Headache (frequent) | 49 (29.2 %) | |
xiv. Physical exhaustion | 119 (71.2 %) | |
Re-admission Reasons: | 17 (10 %) | 4108 (3.6 %) |
i. Mastitis/Breast abscess | 4/17 | |
ii. Bleeding/Retained of products of conception | 3/17 | |
iii. Low haemoglobin/transfusion | 3/17 | |
iv. Problems with perineal stitches | 2/17 | |
v. Postnatal depression, hyperventilation, pleuritic pain, blood clot on liver, severe migraine, neonatal jaundice | 1/17 (each) |
References | Thompson et al. (2011) [27] |
---|---|
Number of participants | n = 171 |
Anxiety: State Trait Anxiety Inventory (median) | 10 |
Depression: Edinburgh Postnatal Depression Scale > 12 | 21 (13 %) |
Post-traumatic stress disorder: PCL > 44 | 5 (3 %) |
Health Status: SF36 ‘somewhat worse than 1 year ago’ | 51 (30.7 %) |
Health Status: SF36 ‘much worse than 1 year ago’ | 10 (6 %) |
Physical problems: | |
i. Painful perineum (vaginal births only) | 25/100 (25 %) |
ii. Perineal infection (vaginal births only) | 0 |
iii. Pain at CS site (CS births only) | 29/60 (48.3 %) |
iv. CS wound infection (CS births only) | 5/61 (8.2 %) |
v. Uterine infection | 4 (2.4 %) |
vi. Urinary tract infection | 6 (3.7 %) |
vii. Stress urinary incontinence | 42 (25.6 %) |
viii. Constipation | 39 (24 %) |
ix. Incontinence of faeces | 5 (3 %) |
x. Incontinence of flatus | 26 (16.1 %) |
xi. Breast infection/ mastitis | 22 (13.6 %) |
xii. Backache | 99 (60 %) |
xiii. Headache (frequent) | 51 (30.9 %) |
xiv. Physical exhaustion | 87 (52.7 %) |
Re-admission Reasons: | 4 (2 %) |
i. Bleeding/ Retained of products of conception | 2/4 |
ii. Post-natal depression | 1/4 |
iii. Cholecystitis | 1/4 |