Prevalence of Postpartum Post-Traumatic Stress Disorder Following Postpartum Haemorrhage: A Systematic Review and Meta-Analysis

Background: Postpartum haemorrhage (PPH) is not only an important cause of maternal death during the perinatal period but also an important cause of postpartum mental-related diseases. The overall prevalence of Postpartum Post-Traumatic Stress Disorder (PP-PTSD) in the community sample was 4% (95%CI: 2.77–5.71), but the incidence of PP-PTSD caused by PPH has not been reported by meta-analysis and systematic review. Methods: Eleven network databases were systematically searched, including 4 Chinese databases and 7 international databases. The Medical Subject Headings (MeSH) thesaurus combined with Boolean operator, studies were searched from the inception of each database to December 1, 2024. All the retrieved articles were screened according to the inclusion and exclusion criteria, and finally, the studies included in this study. A random effects model was used to pool weighted estimates of PP-PTSD prevalence. Subgroup analysis and meta-regression were used to find possible sources of heterogeneity. In addition, sensitivity analysis and publication bias were used to evaluate the stability and bias of the included studies. Statistical analysis was performed by R software. Results: A total of 15 studies were included in this systematic review and meta-analysis, with a total of 1530 postpartum women who experienced PPH, of whom 265 were diagnosed with PP-PTSD. The pooled prevalence estimate of PP-PTSD after PPH was found to be 19% (95% CI 11–28). The results of the subgroup analysis showed significant differences in the prevalence of screening PP-PTSD tools (P < 0.05). The meta-regression results showed that screening PP-PTSD tools and the definition of PPH may be the source of heterogeneity in this meta-analysis. Sensitivity analysis showed that the pooled estimated prevalence of PP-PTSD was stable, and there was no clear publication bias in the included studies. Discussions: The pooled prevalence of PP-PTSD in postpartum women experiencing PPH was about 19%, which was significantly higher than that in the general postpartum women. However, only 15 studies were included in our meta-analysis, and even fewer could be included in subgroup analyses, which may have limited the pool of the estimated prevalence. But this finding also suggests that attention should be paid not only to maternal PPH treatment during the perinatal period but also to the high risk of PPH leading to PP-PTSD after delivery. Other: The study protocol was also registered with PROSPERO (the International Prospective Register of Systematic Reviews) under the registration ID CRD42024618460. And no funding of any kind was received for this meta-analysis.