Perinatal Posttraumatic Stress Disorder: A Review of Risk Factors, Diagnosis, and Treatment.

Abstract

Perinatal posttraumatic stress disorder (P-PTSD) occurs in approximately 3% to 15% of women in the postpartum period. It is often underrecognized, poorly characterized, and undertreated. If untreated, it can lead to maternal and infant morbidity. The aim of this review article is to discuss P-PTSD as it relates to the obstetrician gynecologist, focusing specifically on identifying perinatal risk factors, P-PTSD diagnostic tools, and treatment options. PubMed, PsycINFO, Cochrane Library, and Scopus were searched on MeSH terms and free text for terms related specifically to P-PTSD. Because of the lack of data on treatment specifically for the perinatal population, a second search for general PTSD treatment guidelines was conducted and incorporated into this review. Risk factors have been identified in the literature in 4 major categories: obstetric, psychiatric, social, and subjective distress during delivery. Two diagnostic tests, the general PTSD diagnostic tool, the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the specific diagnostic tool, the Perinatal Post-Traumatic Stress Disorder Questionnaire, can both be helpful for the clinician to diagnose patients who may have P-PTSD. Individual trauma-focused psychotherapy is first line for treatment of P-PTSD. Immediate debriefing interventions and non-trauma-focused psychotherapy has not been shown to be helpful. If trauma-focused psychotherapy is not available or not preferred, selective serotonin reuptake inhibitors and non-trauma-focused psychotherapy can be used. When designing and carrying out the program, the beginning of the intervention and adherence should be considered. To increase adherence, the program should be attractive and it should meet the participants' needs. Identifying and treating P-PTSD have important implications for maternal and neonatal health. Few treatment studies exist for P-PTSD specifically, so combining P-PTSD research with current guidelines for PTSD is necessary to inform clinical practice.