title: Postnatal morbidity after childbirth and severe obstetric morbidity.
abstract: OBJECTIVE
  To identify the impact of pregnancy and childbirth, and severe obstetric morbidity on outcome 6 to 12 months postpartum.
  
  
  METHODS
  Questionnaire assessment of postnatal outcome in a cohort study.
  
  
  METHODS
  South East Thames, UK.
  
  
  METHODS
  All women resident in South East Thames and delivering between 1st March 1997 and 28th February 1998.
  
  
  METHODS
  Questionnaire study of a cohort of women who experienced a severe obstetric morbidity during pregnancy or labour (cases), compared with a cohort of women who did not (controls).
  
  
  METHODS
  Assessment of postnatal depression risk [Edinburgh Postnatal Depression Scale (EPDS)], general health [Short Form 36 (SF-36)], sexual activity and use of health services between 6 and 12 months postpartum.
  
  
  RESULTS
  There were 331 cases and 1339 controls out of 48,262 deliveries. Six to 12 months after delivery, 77 (23.3%) of cases and 272 (20.5%) of the controls were at risk of postnatal depression (P = 0.25; 95% CI for difference -2.2% to 7.9%), 43.1% of cases were having problems with sexual relations compared with 18.7% of controls (P < 0.001; 95% CI for difference 8.9% to 21.9%). There was evidence of poorer general health in cases. Some 31.5% of cases attended outpatients in the first six months and 9.4% required emergency admission to hospital compared with 17.0% (P < 0.001; 95% CI for difference 9.1% to 19.9%) and 3.7% (P < 0.001; 95% CI for difference 2.4% to 9.0%), respectively, in controls.
  
  
  CONCLUSIONS
  Both control pregnancy and childbirth and severe obstetric morbidity are associated with significant postnatal morbidity. A severe obstetric morbid event significantly influences women's sexual health and wellbeing and increases health services utilisation. Prevention and appropriate management of severe obstetric morbid events may reduce these outcomes.
authors.affiliation: Department of Public Health Medicine, GKT School of Medicine and Dentistry, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Waterstone
authors.forename: Charles
authors.initials: C
authors.lastname: Wolfe
authors.forename: Richard
authors.initials: R
authors.lastname: Hooper
authors.forename: Susan
authors.initials: S
authors.lastname: Bewley
mesh_terms: D016022:Case-Control Studies; D015331:Cohort Studies; D019052:Depression, Postpartum / Q000209:etiology; D005260:Female; D005313:Fetal Death; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires