The prevalence and risk factors of posttraumatic stress disorder after cesarean delivery, outside high-risk contexts, remain unclear. This study aimed to assess posttraumatic stress disorder prevalence and risk factors at 2 months postpartum among a general population of women with cesarean delivery. This was a prospective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, conducted in 27 French hospitals from 2018 to 2020, enrolling women expected to undergo cesarean delivery before or during labor at ≥34 weeks of gestation. After randomization, characteristics of the cesarean delivery and postpartum blood loss were prospectively collected. Two months after childbirth, posttraumatic stress disorder profile (presence of posttraumatic stress disorder symptoms) and provisional diagnosis (positive screening for diagnosis consistent with a posttraumatic stress disorder) were assessed by 2 self-administered questionnaires (Impact of Event Scale - Revised and Traumatic Event Scale). The corrected posttraumatic stress disorder prevalence was estimated with inverse probability weighting to take nonresponse into account. Associations between potential risk factors and posttraumatic stress disorder were analyzed by multivariate logistic or linear regression modeling according to the type of dependent variable. In total, 2785 of 4431 women returned the Impact of Event Scale - Revised questionnaire and 2792 the Traumatic Event Scale (response rates of 62.9% and 63.0%). The prevalence of posttraumatic stress disorder profile was 9.0% (95% confidence interval, 7.8%–10.3%) and of provisional diagnosis 1.7% (95% confidence interval, 1.2%–2.4%). Characteristics associated with a higher risk of posttraumatic stress disorder profile were prepregnancy vulnerability factors (young age, high body mass index, and African-born migrant) and cesarean delivery–related obstetrical factors (cesarean delivery after induced labor [adjusted odds ratio, 1.81; 95% confidence interval, 1.14–2.87], postpartum hemorrhage [adjusted odds ratio, 1.61; 95% confidence interval, 1.04–2.46] and high-intensity pain during the postpartum stay [adjusted odds ratio, 1.90; 95% confidence interval, 1.17–3.11]). Women who had immediate skin-to-skin contact with their newborn were at lower risk of posttraumatic stress disorder (adjusted odds ratio, 0.66; 95% confidence interval, 0.46–0.98), and women with bad memories of delivery on day 2 postpartum were at higher risk (adjusted odds ratio, 3.20; 95% confidence interval, 1.97–5.12). The Impact of Event Scale - Revised and the Traumatic Event Scale yielded consistent results. Approximately 1 in 11 women with cesarean deliveries had posttraumatic stress disorder symptoms at 2 months postpartum. Some obstetrical interventions and components of cesarean delivery management may influence this risk.

中文翻译：

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剖宫产后 2 个月创伤后应激障碍：一项多中心前瞻性研究

在高风险环境之外，剖腹产后创伤后应激障碍的患病率和危险因素仍不清楚。本研究旨在评估普通剖腹产妇女人群产后 2 个月时创伤后应激障碍的患病率和危险因素。这是一项预防剖宫产后产后出血的氨甲环酸 (TRAAP2) 试验的前瞻性辅助队列研究，于 2018 年至 2020 年在法国 27 家医院进行，纳入了预计在妊娠 ≥ 34 周的分娩前或分娩过程中进行剖腹产的妇女。随机分组后，前瞻性收集剖宫产和产后失血的特征。分娩后两个月，通过 2 份自填问卷（事件影响量表 - 修订版和创伤事件影响量表）评估创伤后应激障碍概况（是否存在创伤后应激障碍症状）和临时诊断（与创伤后应激障碍诊断一致的阳性筛查）规模）。校正后的创伤后应激障碍患病率是通过逆概率加权来估计的，以考虑无反应。根据因变量的类型，通过多元逻辑回归或线性回归模型分析潜在危险因素与创伤后应激障碍之间的关联。总共，4431 名女性中有 2785 名返回了事件影响量表 - 修订调查问卷，2792 名女性返回了创伤事件量表（答复率为 62.9% 和 63.0%）。创伤后应激障碍患病率为 9.0%（95% 置信区间，7.8%–10.3%），临时诊断患病率为 1.7%（95% 置信区间，1.2%–2.4%）。与创伤后应激障碍较高风险相关的特征是孕前脆弱性因素（年轻、高体重指数和非洲出生的移民）和剖腹产相关产科因素（引产后剖宫产[调整后的比值比，1.81； 95% 置信区间，1.14–2.87]、产后出血[调整后的比值比，1.61；95% 置信区间，1.04–2.46] 和产后住院期间的高强度疼痛[调整后的比值比，1.90；95% 置信区间，1.17] –3.11]）。与新生儿进行直接肌肤接触的女性患创伤后应激障碍的风险较低（调整后的优势比为 0.66；95% 置信区间为 0.46–0.98），而对产后第 2 天分娩记忆不佳的女性则患创伤后应激障碍的风险较低。风险较高（调整后的比值比，3.20；95% 置信区间，1.97–5.12）。事件影响量表 - 修订版和创伤事件量表产生了一致的结果。大约十分之一的剖腹产妇女在产后 2 个月出现创伤后应激障碍症状。一些产科干预措施和剖宫产管理的组成部分可能会影响这种风险。