title: Emotional and physical health outcomes after significant primary post-partum haemorrhage (PPH): a multicentre cohort study.
abstract: BACKGROUND
  Post-partum haemorrhage (PPH) rates are rising; however, data on the health impact on women are lacking.
  
  
  OBJECTIVE
  To describe the emotional and physical health outcomes for women following PPH.
  
  
  METHODS
  A cohort of 206 women with primary PPH of 1500 mL or more, and/or peripartum fall in haemoglobin concentration to 7 g/dL or less, and/or of 4 g/dL or less, was recruited from 17 Australian/New Zealand hospitals. Women completed questionnaires in the first week, and at two and four months post-partum. Obstetric details came from hospital records. Outcomes were anxiety; post-natal depression (PND); fatigue; post-traumatic stress disorder (PTSD); general health (SF-36); physical health problems; post-natal bleeding duration; hospital readmission.
  
  
  RESULTS
  Eighty-three percent completed the two-month and 81% the four-month questionnaires; 28% reported bleeding continuously for more than six weeks; 10% required hospital readmission within two months. Anxiety scores were in the medium range; 11 and 13% were at risk of PND at two and four months, respectively; median total fatigue scores were 17 at two and 15 at four months; 5% showed evidence of PTSD at two and 3% at four months; women scored highly in most SF-36 categories and showed improvements over time in all but general and mental health. Physical health concerns were comparable to those reported for general post-natal populations, with the exception of uterine infection (6% at two months).
  
  
  CONCLUSIONS
  In a cohort of women experiencing PPH, emotional and physical health outcomes were similar to those reported in general post-natal populations, with the exception of post-natal bleeding duration, uterine infection and hospital readmission.
authors.affiliation: Women's Hospitals Australasia, School of Clinical Medicine and Department of Obstetrics and Gynaecology, Australian National University Medical School, Canberra, Australian Capital Territory, Australia. jthompson@wcha.asn.au
authors.forename: Jane F
authors.initials: JF
authors.lastname: Thompson
authors.forename: Christine L
authors.initials: CL
authors.lastname: Roberts
authors.forename: David A
authors.initials: DA
authors.lastname: Ellwood
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology*; D001315:Australia; D015331:Cohort Studies; D019052:Depression, Postpartum / Q000209:etiology*; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D009520:New Zealand; D010359:Patient Readmission; D006473:Postpartum Hemorrhage / Q000503:physiopathology / Q000523:psychology*; D011247:Pregnancy; D060737:Reproductive Tract Infections / Q000209:etiology; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology*; D011795:Surveys and Questionnaires