Search Results for: Linee guida sull’emorragia postpartum

Circulation, Volume 150, Issue Suppl_1, Page A4143094-A4143094, November 12, 2024. Background:Peripartum cardiomyopathy (PPCM) is defined as a dilated form of cardiomyopathy that occurs within the last month of pregnancy and up to 5 months postpartum. The etiology is likely multifactorial and viral infections may account for up to a third of PPCM cases. We aimed to examine the impact of concurrent COVID-19 infection on in-hospital outcomes of women with PPCM.Methods:National Inpatient Sample was queried to identify women admitted with PPCM with COVID-19 (group A) between the years 2020-2021 and without (group B) concurrent COVID-19 infection between the years 2016-2019.Results:A total of 19135 women were admitted with PPCM between the years 2016-2021, of whom 420 (2%) had concurrent COVID-19 infection. Group A PPCM followed a seasonal pattern with peak incidence in fall (43%) followed by winter (31%), spring (13%) and summer (13%) [p=0.002]. Group A was more often Hispanic (20.3% -vs- 10.8%, p

Circulation, Volume 150, Issue Suppl_1, Page A4143849-A4143849, November 12, 2024. Background:Maternal mortality in the United States continues to rise, with hypertensive disorders of pregnancy (HDP) playing a significant role in adverse outcomes. Patients of color have worse outcomes compared to their White counterparts. Data in non-pregnant patients suggests community health workers (CHWs) can help mitigate disparities and improve HDP outcomes. Does exposure to a CHW improve patient education about HDP and satisfaction and are these findings different between Black and non-Black patients?Methods:This was a prospective survey study that enrolled patients delivering at the University of Chicago (UCM). Patients with HDP are automatically enrolled in a standardized postpartum hypertension education program (STAMPP-HTN) where they receive education and a blue tooth compatible blood pressure monitor. Patients who did not record their blood pressures were contacted by a CHW and surveyed about their experience. Results were compared between Black and Non-Black patients using a Wilcoxon Rank Sum, X2or Fisher’s Exact test, as appropriate.Results:There were 32 survey responses from 22 respondents and 15 patients with complete baseline data, 6 of whom were Black and 9 of whom were non-Black. There were no differences in age, insurance status, or pregnancy outcomes between groups. Additionally, of the 32 survey responses, there were no significant differences in experiences with a CHW between Black and non-Black patients. Table 1 outlines the impact of CHW on patient’s education and attitude towards HDP. Most patients found that CHW involvement increased the amount of time they checked their blood pressure (76%) with no difference between races (p=0.23). Overall, 84% patients (strongly agreed or agreed) that their CHW knows the important issues about their healthcare.Conclusion:The incorporation of a CHW program into a pre-existing postpartum hypertension program was overall well-received by patients with no racial disparity. The program increased the patient’s understanding of HDP and lead to a better follow up of their blood pressures values. Further work is needed to determine how this program impacts long-term patient’s outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4140800-A4140800, November 12, 2024. Introduction:Peripartum cardiomyopathy (PPCM) is the leading cause of late postpartum pregnancy-related death and often precipitates acute heart failure and cardiogenic shock. Limited contemporary data exists on long-term outcomes among PPCM patients who develop cardiogenic shock (PPCM-CS), especially those who require extra-corporeal membrane oxygenation (ECMO).Methods:This retrospective cohort study identified patients with PPCM-CS from January 2012-January 2024, using EHR-based data from academic medical centers across the US (TriNetX, Inc.). The primary outcome was all-cause mortality over a 180-day follow-up period. Secondary outcomes included acute kidney injury (AKI), new-onset atrial fibrillation (AF), ventricular tachycardia/fibrillation (VT/VF), mechanical circulatory support (MCS), and heart transplantation (HT). The outcomes were reported in the overall population and among those requiring ECMO support.Results:We identified 856 females (mean age 36 ± 12 years; 41% White, 41% Black individuals) with PPCM-CS (Table). During a mean follow-up of 144 ± 63 days, all-cause mortality occurred in 17.9%. There were high incidences of AKI (53.7%), AF (19.4%), and VT/VF (29.3%) (Fig 1). 8.1% of patients successfully underwent HT. There was substantial MCS use, with percutaneous ventricular assist device (pVAD) used in 8.7% and intra-aortic balloon pump (IABP) used in 11.0%. Among those requiring ECMO (N=97, 11.3%), there was high all-cause mortality (26.8%). The concomitant use of pVAD and IABP was 14.4% and 15.5%, respectively. 14.4% of ECMO-supported patients underwent successful HT.Conclusion:This study provides insights into long-term clinical outcomes among patients with PPCM-CS, highlights those requiring ECMO support. Further investigation is needed for early disease recognition and to establish optimal utilization of MCS to improve outcomes in PPCM-CS.

Circulation, Volume 150, Issue Suppl_1, Page A4139708-A4139708, November 12, 2024. Background:Racial and ethnic disparities exist in cardiovascular health (CVH) in pregnancy. While social determinants of health (SDOH) affect CVH, the extent to which SDOH assessed in early pregnancy explain racial and ethnic differences in CVH postpartum remains to be defined.Objective:This study examines the relative contribution of SDOH in early pregnancy to racial and ethnic differences in maternal CVH 2-7 years after delivery.Methods:This is a secondary analysis of the prospective nulliparous pregnancy outcomes study: Monitoring Mothers-to-be Heart Health Study (nuMoM2b-HHS) cohort. The outcome was maternal CVH defined using the American Heart Association’s Life’s Essential 8 (LE8) framework, which included body mass index, blood pressure, lipids, fasting glucose, diet, physical activity, sleep health, and smoking status, and calculated as a score of 0-100. We used the Blinder-Oaxaca decomposition to quantify the statistical contributions of differences in demographic (age and nativity), socioeconomic status ([SES], education, income, insurance, and health literacy), and psychosocial (resilience, social support, anxiety, depression, and stress) factors in early pregnancy to differences in mean postpartum CVH between the two largest self-identified minoritized racial and ethnic groups (non-Hispanic [NH] Black and Hispanic) and NH White individuals.Results:Of 4,161 assessed pregnant individuals, 17.7% identified as Hispanic, 15% as Black, and 67.3% as White. After adjusting for demographic, SES, and psychosocial factors, the average CVH score in White individuals was 12.2 (SE 1.2) points higher (better) than in Black individuals and 3.3 (SE 0.8) points higher than in Hispanic individuals (Figure, all p

Circulation, Volume 150, Issue Suppl_1, Page A4145391-A4145391, November 12, 2024. INTRODUCTION:Pregnancy is marked by cardiovascular and hemodynamic changes to enable normal placental-fetal growth but may also predispose women to adverse outcomes including hypertensive disorders. Studies have assessed the plasma proteome of hypertension, but proteomic biomarkers of maternal blood pressure (BP) through pregnancy and postpartum remain unexplored.OBJECTIVES:Explore the 1sttrimester (TM) maternal plasma proteome in relation to systolic (S) and diastolic (D) BP in the 1stand 3rdthird TM, and 3 months postpartum.METHODS:We obtained baseline, 1stTM plasma samples from n=435 women from an antenatal multiple micronutrient vs iron-folic acid supplement trial in rural NW Bangladesh (West et al JAMA 2014). Phlebotomy occurred

Circulation, Volume 150, Issue Suppl_1, Page A4142422-A4142422, November 12, 2024. Background:Patent Foramen Ovale (PFO) is a common cardiac anomaly that persists into adulthood in approximately 25% of the population. Although often clinically silent, PFOs can lead to complications in pregnancy, such as paradoxical strokes. Here, we present a case of a pregnant patient with a cryptogenic stroke attributed to PFO, highlighting the complex decision-making involved in her management.Case Description:A 37-year-old woman, G2P1001 at 9 weeks gestation, presented to her ophthalmologist with 2 days of decreased vision in her left eye. She was diagnosed with branch retinal artery occlusion and underwent laser embolization. Subsequently, she was sent to the hospital for an expedited work-up. The patient was started on aspirin upon presentation. MRI of the brain and MR angiography of the head and neck were unremarkable, and lower extremity duplex studies were normal. Transthoracic echocardiography revealed a PFO with a mild interatrial septal aneurysm. Hypercoagulable work-up revealed low protein S free antigen and a positive anticardiolipin IgM, both difficult to interpret during pregnancy. Given the high-risk morphology of the PFO, there was concern for a paradoxical stroke. The RoPE Score was calculated to be 9, indicating an 88% chance that the stroke was due to the PFO. She was then initiated on enoxaparin daily and discharged with outpatient follow-up. The rest of the coagulable work-up was unrevealing. Repeat protein S levels were still low but considered normal for pregnancy. It was determined that the patient did not have genetic thrombophilia but was hypercoagulable due to pregnancy. After interdisciplinary discussions, the patient underwent PFO closure at 15 weeks gestation. Post-procedure, she was transitioned to aspirin and a three-month course of clopidogrel. Enoxaparin was resumed post-clopidogrel up until one month before delivery, when subcutaneous heparin was initiated. She successfully delivered at 39 weeks, after which enoxaparin was resumed and continued for 6 weeks postpartum. Repeat protein S testing 12 weeks postpartum was normal, and aspirin was discontinued.Conclusion:This case of a pregnant patient with stroke highlights the importance of prompt screening for PFO and tailored management to prevent recurrence. It underscores the importance of thorough evaluation and interdisciplinary collaboration in treatment planning and demonstrates the safety and effectiveness of PFO closure during pregnancy.

Circulation, Volume 150, Issue Suppl_1, Page A4141212-A4141212, November 12, 2024. Background:Premature coronary artery disease (CAD) is increasing, especially in young women. There is currently no data regarding the cardiovascular and obstetrical risk of pregnancy in patients with premature CAD.Objective:This study aims to describe the cardiovascular, obstetrical and fetal outcomes in pregnant patients with premature CAD.Methods:Using the AFIJI cohort of individuals with premature CAD (Appraisal of risk Factors in young Ischemic patients Justifying aggressive Intervention), we compared the cardiovascular outcomes of women aged < 40 years-old who experienced pregnancy versus those who did not. Major adverse cardiovascular events (MACE) including death, myocardial infarction, ischemic stroke, or unplanned revascularization were analyzed using a Cox model with pregnancy as a time-dependent variable. A secondary analysis described obstetrical and fetal outcomes in pregnant women with premature CAD vs. pregnant women of the French National maternal and fetal cohort (n=11992).Results:Among women with premature CAD in the AFIJI cohort (N = 120), 50 were aged < 40 years among whom 24 experienced pregnancy. Aspirin was the only treatment continued during pregnancy. We observed an association between pregnancy and an increased risk of cardiovascular events (aHR 3.87, IC95% 1.41-10.63, p < 0.01) adjusted for age and tobacco use. When comparing with the French National database, pregnant women with premature CAD had higher rates of preeclampsia (20.8% vs. 2.3%), pregnancy-induced hypertension (37.5% vs. 2%), threat of premature birth (20.8% vs. 4.8%), postpartum hemorrhage (12.5% vs. 3%) and fetal death (8.7% vs. 0.8%).Conclusion:Pregnancy in women with premature coronary artery disease is associated with a higher risk of major adverse cardiovascular events and significant more obstetrical complications. These findings highlight the need for careful monitoring and management of pregnant patients with a prior history of CAD to mitigate these risks.

Circulation, Volume 150, Issue Suppl_1, Page A4147241-A4147241, November 12, 2024. Background:Prior studies suggest that angiogenic markers measured during pregnancy may be associated with higher future systolic blood pressure. Furthermore, prior work suggests postpartum body mass index (BMI) influences progression to chronic hypertension among women who experience hypertensive disorders of pregnancy. However, no studies to date have investigated the relationship between levels of angiogenic markers during pregnancy and the future development of obesity among non-obese pregnant women.Methods:We included participants in a longitudinal pregnancy biorepository at Brigham and Women’s Hospital (Boston, MA) who had available levels of sFlt-1 (soluble fms-like tyrosine kinase receptor-1) and PlGF (placental growth factor) measured in the third trimester and who continued to follow with primary care in one of the Mass General Brigham institutions up to December 2019, with available covariate and outcome data. We excluded participants with a pre-pregnancy history of obesity (BMI ≥30 kg/m2). The ratio of sFlt-1/PlGF in the third trimester was examined by tertiles. Adjusted mixed effects models were used to test group differences in BMI trends during follow-up.Results:Among 590 participants included, the mean (SD) first-trimester BMI was 24 (3) kg/m2, and the mean age at delivery was 32 (6) years. Maternal age at delivery and first-trimester BMI were similar across sFlt-1/PlGF tertiles, but participants in the higher tertiles tended to have a slightly lower gestational age at delivery (Table 1). During a median follow-up of 9 years, 173 participants (29%) developed obesity during follow-up. Participants in the second and third tertiles had steeper increases in BMI (+0.22 and +0.24 kg/m2, respectively) compared to those in the first tertile (+0.18 kg/m2; p

Circulation, Volume 150, Issue Suppl_1, Page A4140494-A4140494, November 12, 2024. Background:Primary care after pregnancy is recommended, especially for individuals with recent adverse pregnancy outcomes (APOs, such as preeclampsia or gestational diabetes), who are at increased risk for future heart disease. Health-related social needs (HRSNs) are recognized barriers to care, yet their pregnancy-related prevalence and associations with care are unknown. We sought to (1) describe the pregnancy-related prevalence of HRSNs, and (2) assess associations between pregnancy-related HRSNs and subsequent linkage to primary care.Methods:We analyzed electronic health record data for individuals with prenatal care and delivery (2018-2021) at our urban safety-net hospital. HRSNs were assessed via a routine screener, and we summarized individual responses during pregnancy through 6 weeks post partum as: any positive, all negative, or never screened. Postpartum linkage to primary care was defined as a completed primary care visit after 6 weeks through 1 year post partum. We analyzed the prevalence of HRSNs and their associations with linkage to primary care, using adjusted log-linked binomial regression models. In stratified models we assessed for effect modification by APO history and other variables.Results:Of 4941 individuals in our sample, 53% identified as Black non-Hispanic and 21% as Hispanic, 68% were publicly insured, and 93% completed ≥1 HRSN screening. Nearly 1 in 4 screened positive for any HRSN, most often food insecurity (14%) or housing instability (12%), and 53% linked to primary care. Compared with those who screened negative for all HRSNs (n=3491), linkage to primary care was similar among those who screened positive for any HRSNs (n=1079; adjusted risk ratio, aRR 1.04, 95% confidence interval, CI: 0.98-1.10) and lower among those never screened (n=371; aRR 0.77, 95% CI: 0.68-0.86). We found no evidence of effect modification by APO history, race/ethnicity, insurance, language, or Covid-19 pandemic exposure.Conclusions:In this diverse postpartum sample, we identified a 24% prevalence of pregnancy-related HRSNs and 53% subsequent linkage to primary care. Linkage to primary care was not associated with HRSN screening result (positive versus negative) but was significantly negatively associated with being missed by HRSN screening. Further research is needed to better understand HRSN screening practices and who is missed by screening, and to identify modifiable barriers to postpartum primary care especially after APOs.

Circulation, Volume 150, Issue Suppl_1, Page A4143844-A4143844, November 12, 2024. A 35-year-old gravida 1, para 0 with biventricular heart failure (LVEF 25%), nonischemic cardiomyopathy, history stroke, history of left ventricular thrombus, class III obesity, and chronic kidney disease who had been followed by Cardio-Obstetrics throughout her pregnancy presented at 34 weeks gestation for planned induction of labor. Upon presentation, she underwent assessment with a pulmonary artery catheter (PAC) and was noted to be in cardiogenic shock with elevated biventricular filling pressures and low cardiac index necessitating hemodynamic stabilization followed by primary cesarean section.The patient was admitted to the cardiac ICU for medical optimization prior to delivery. Home medications including isosorbide dinitrate, metoprolol, and hydralazine were continued. The patient was briefly placed on inotropic support with dobutamine, which was discontinued due to ectopy. After PAC-guided IV diuresis, anticoagulation transition from enoxaparin to heparin, and twice daily fetal monitoring via non-stress test, a multidisciplinary team, including cardiology, maternal fetal medicine, cardiac anesthesia, and cardiothoracic surgery assembled for the C-section. Following pre-delivery cannulation for potential ECMO support, the patient underwent C-section and elective salpingectomy under epidural anesthesia with delivery of a healthy neonate.Post-delivery, the patient was monitored in the ICU, focusing on fluid management, anticoagulation transition to warfarin, and titration of heart failure medications, as the patient did not plan to breastfeed. After discharge, she was scheduled for a 2-week postpartum visit including echocardiogram, EKG, and NT-proBNP.Discussion:Given the patient’s acute decompensation and fluid overload, medical optimization was essential prior to delivery. However, stabilization was expected to be temporary due to ongoing physiologic changes of pregnancy. Her limited mobility and concern for multiorgan compromise, such as new oxygen dependency and rising creatinine, made a prolonged induction of labor unfeasible. Due to concern for maternal intolerance of labor, unstable fetal lie, fetal distress due to decreased perfusion, and an increased likelihood of emergency C-section, a primary C-section was recommended as a safer option. The successful delivery of a healthy neonate and post-operative maternal stabilization highlights the importance of a multidisciplinary approach in managing complex cardio-obstetric cases.

Circulation, Volume 150, Issue Suppl_1, Page A4142487-A4142487, November 12, 2024. Introduction:The US maternal mortality rate is rising, with cardiovascular disease being the main cause of death. Acute myocardial infarction in particular (most commonly ST-elevation myocardial infarction (STEMI)) is associated with excess mortality. There have been no recent large, population-based studies estimating the current incidence of postpartum STEMI or identifying its risk factors.Research Question:Given the increasing risk of postpartum STEMI and the consequences of such a diagnosis we sought to identify recent incidence of postpartum STEMI and understand its predictors.Goal:The purpose of this study was to describe the incidence and risk factors of acute postpartum STEMI in the USA.Methods:This study was performed using MarketScan Commercial Claims and Encounters Data. Patient selection was from all deliveries resulting in a live birth between 2017 and 2020 with claims data available for 12 months prior and 6 months following delivery data. For all births, STEMI within 6 months was noted and the following risk factors were collected: age, hypertension (HTN), thrombophilia, anemia, diabetes mellitus (DM), and smoking. We then performed multivariate logistic regression models to estimate odds ratio (95% confidence interval) for STEMI adjusted for the aforementioned risk factors.Results:327,570 delivery cases were identified, of which 3330 (1%) had a STEMI in the time from hospital admission to 6 months postpartum. Most STEMIs occurred close to the time of delivery: 2823 (84.8%) cases within 24 hours of delivery and an additional 132 within 1 week, 80 within 2 weeks, and 52 within 4 weeks (cumulative totals of 89.4%, 91.8%, and 93.3% respectively). The following factors had a significant, independent, positive correlation with STEMI: age ≥40 (OR 1.6 [95% CI 1.4-1.9]), DM (OR 1.6 [95% CI 1.5-1.7]), HTN (OR 1.6 [95% CI 1.5-1.7]), and smoking (OR 1.5 [95% CI 1.3-1.8]). These are shown in Figure 1.Conclusion:Although rare, postpartum STEMI is associated with high morbidity and mortality and is occurring at an increasing rate. While maternal age is not modifiable, HTN, smoking and DM are, and more should be done to address these risk factors in those who are, or plan to become, pregnant.

Circulation, Volume 150, Issue Suppl_1, Page A4140795-A4140795, November 12, 2024. Background:Cardiovascular disease (CVD) remains a leading cause of maternal mortality in the United States, comprising 26.5% of pregnancy-related deaths.Objective:We aim to evaluate trends in CVD during pregnancy and maternal, obstetric, and fetal outcomes in pregnant women with CVD in the Kaiser Permanente Northern California (KPNC) integrated healthcare system.Methods:This is a retrospective cohort study of adult KPNC members with moderate or greater valvular heart disease, cardiomyopathy, congenital heart disease, or ischemic heart disease during pregnancy from 2010-2021. Bivariate analyses and multivariable logistic regression were used to evaluate associations between demographic and clinical risk factors and maternal outcomes in pregnant patients with CVD.Results:Of 320,902 pregnancies, 763 (0.24%) were identified with clinically significant CVD. The prevalence of CVD increased from 0.19% to 0.24% over the decade, predominantly due to an increase in prevalence of women with congenital heart disease. Mean gestational age at delivery was 36.7 weeks with 19.5% experiencing preterm delivery. Cesarean section, pre-eclampsia or eclampsia, and postpartum hemorrhage rates were 29.5%, 20.8%, and 13.1%, respectively. Fetal loss beyond the first trimester occurred in 7.1% pregnancies.Adverse maternal cardiac outcomes occurred in 12.6% of patients with clinically significant CVD, with the most common outcome being hospitalizations for congestive heart failure. Age, diabetes, parity, BMI, prior heart failure, prior CVD, lower LVEF, and systemic valvular regurgitation were significant predictors of adverse maternal events.Conclusions:The incidence of CVD during pregnancy increased between 2010-2021, largely driven by an increase in pregnancies among women with congenital heart disease. Rates of adverse maternal cardiac outcomes, pregnancy loss greater than 20 weeks, and maternal mortality in this cohort were similar to those previously reported in other large registries. High rates of pre-eclampsia or eclampsia and postpartum hemorrhage were noted in this cohort. Understanding risk factors for adverse outcomes in a contemporary, diverse setting can help refine cardio-obstetric risk assessment and preconception counseling.

Circulation, Volume 150, Issue Suppl_1, Page A4141249-A4141249, November 12, 2024. Background:Hypertensive disorders of pregnancy (HDP) is a leading cause of pregnancy-related mortality in the United States and an important risk factor for postpartum cardiovascular disease (CVD). Previous animal data suggested that FSTL3 expression may be pathogenic in the development of cardiovascular dysfunction. The incidence of CVD during pregnancy has been increasing over time, which highlights the need to identify biomarkers that affect the development of the disease. We therefore hypothesized that peripartum FSTL3 levels would be associated with postpartum cardiovascular dysfunction and maternal morbidity.Methods:Pregnant patients age ≥ 18 years and singleton < 41 weeks with preeclampsia or superimposed preeclampsia who delivered at the University of Chicago between May 2017 and November 2020 were included in this observational cohort study. The primary outcome was cardiovascular dysfunction defined as postpartum hypertension, cardiomyopathy (confirmed with echocardiography and cardiology consult), and pulmonary edema (confirmed with chest radiography). The secondary outcome was severe maternal morbidity. Categorical data were assessed with chi-square or Fisher’s Exact test. The association between FSTL3 levels and postpartum CV dysfunction was assessed using multivariable logistic regression.Results:Our study included 408 patients, of which 212 were diagnosed with HDP. The median age was 28 years old (IQR 23, 33), the median BMI was 33.4 (IQR 28.6, 39.3), and the majority were African American (67.1%). Elevated FSTL3 levels were associated with postpartum CV dysfunction (OR 1.02 [95% CI: 1.01, 1.04]; p < 0.001). After multivariable adjustment for delivery gestational age, maternal age, BMI, nulliparous, HDP, smoking, and diabetes, the association between FSTL3 and CVD persisted (p = 0.02). Table 1 outlines the association between FSTL3 and maternal/neonatal outcomes.Conclusion:This study demonstrates that the biomarker FSLT3 predicts postpartum cardiovascular dysfunction and is associated with maternal morbidity. Our findings suggest that FSLT3 may facilitate the development of CVD and that therapeutic strategies targeting FSLT3 may affect the course of postpartum cardiovascular dysfunction.

Objectives
The present study aimed to evaluate whether body mass index (BMI) and body fat percentage (BFP) could be used to predict pregnancy outcomes in patients with gestational diabetes mellitus (GDM).

Design
Retrospective cohort study.

Setting
Wenzhou Medical University Affiliated Second Hospital (Zhejiang Province, China). Clinical data were collected from electronic medical records.

Participants
Data from 683 patients with GDM admitted to the Wenzhou Medical University Affiliated Second Hospital between January 2019 and December 2021 were retrospectively analysed.

Outcome measures
Pregnancy outcomes.

Results
The results showed that pregnant women with BFP ≥33% were more prone to abnormal amniotic fluid volume, abnormal blood pressure and anaemia (p

Objective
This study explored the experiences of women who have undergone emergency caesarean section (EmCS) and how they perceived anxiety and depression to impact their quality of life.

Design
A qualitative study grounded in the biopsychosocial model was conducted among Ghanaian women diagnosed with anxiety and depression following EmCS. Semistructured interviews were used to collect data on the psychosocial impact of EmCS on women’s lives. Thematic analysis was used to identify key themes from the interviews, using Nvivo V.14 Software.

Setting
A hospital in Effutu Municipality, Central Region of Ghana. Data were collected from August 2022 to September 2023.

Participants
The study included 25 Ghanaian women who had undergone an EmCS, had clinically diagnosed and treated anxiety and/or depression and had recovered within the last 6 months. Women with pre-existing mental health conditions were excluded.

Results
The major themes identified from the thematic analysis of results included emotional distress, daily life challenges and disrupted social relationships.

Conclusions
There is an urgent need for targeted mental health interventions and culturally sensitive postpartum support to address the psychological needs of women following EmCS in Ghana.