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Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4877 (Published 21 August 2013) Cite this as: BMJ 2013;347:f4877

Re: Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States

All the potential causes of postpartum haemorrhage e.g. inverted uterus, uterine atony, retained placenta, rupture uterus and coagulopathies should be ruled out by stringent inclusion and exclusion criteria. Authors have taken atony uterus only and inpatient post partum haemorrhage only thus excluding other causes. However, the other causes of atonic uterus (Large uterus like in multiple pregnancy, polyhydramnios, large baby or macrosomia such as in diabetics) should have been excluded before reaching a conclusion on effect of SRI.

Since SRI (serotonin reuptake inhibitors) increase bleeding events, then these may have increased risk during periods (menorrhagia) and during antenatal period (antipartum haemorrhage or APH), history of which should also be culled out.

Competing interests: No competing interests

25 August 2013
Neeru Gupta
Scientist E
KK Jani
Indian Council of Medical Research
Ansari Nagar, New Delhi-110029