Posttraumatic stress disorder 2 months after induced vaginal delivery: A multicenter prospective study

OBJECTIVES: An increased risk of postpartum posttraumatic stress disorder (PTSD) has been reported in women who had labor induced. Knowledge of childbirth-related PTSD in this context remain poorly documented. Our aim was to assess the PTSD prevalence and identify characteristics associated with it after induced vaginal delivery at or near term. METHODS: This was an ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage Following a Vaginal Delivery (TRAAP) randomized controlled trial conducted in 15 French university hospitals in 2015-2016. We included women with induced labor followed by a singleton vaginal delivery after 35 weeks. The main outcome was PTSD profile assessed 2 months after childbirth by two self-administered screening questionnaires (Impact of Event Scale-Revised [IES-R] and the Traumatic Event Scale [TES]). Corrected prevalence of PTSD was estimated using inverse probability weighting for nonresponse. Associations with potential risk factors were assessed with multivariate logistic regression. RESULTS: Among the 3891 women in the TRAAP trial, 794/3891 (20.4%) had labor induced. Among 560/794 respondents (70.5%), the corrected prevalence of PTSD profile was 10.6% (95% confidence interval [CI] 8.1-13.7). Characteristics associated with a higher risk were psychosocial vulnerability factors (maternal birth in Africa and psychiatric history) and obstetric factors, including characteristics related to the labor induction (cervical ripening adjusted odds ratio [aOR], 2.0; 95% CI 1.1-3.6 and induction for fetal indication aOR, 2.6; 95% CI, 1.2-5.5), postpartum hemorrhage (PPH) ≥1000 mL (aOR, 4.9; 95% CI, 1.8-13.3), and bad memories of delivery at day 2 postpartum (aOR, 3.6; 95% CI, 1.5-10.3). CONCLUSION: Approximately one in 10 women had PTSD symptoms 2 months after induced vaginal delivery. Beyond psychosocial vulnerability, subgroups at higher risk included specific aspects of labor induction.