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Women's Health 2 > Complicated OB > Flashcards

Complicated OB Flashcards

1
Q

Ectopic pregnancy

  • define
  • risk
A
  • Developing blastocyst implants at a site other than endometrium
  • hemorrhage from ectopic preg is leading cause of preg related maternal death in first trimester
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2
Q

Ectopic Pregnancy

- risk factors

A
  • *anything that messes with the tube**
  • previous ectopic
  • tubal pathology/sx
  • prev genital infections
  • IUD
  • infertility
  • multiple sex partners
  • smoking
  • in-vitro fertilization
  • vaginal douching
  • extremes of age
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3
Q

Ectopic Pregnancy

- locations including MC

A
  • MC: fallopian tubes (70%)
  • cervix
  • ovary
  • cornea (where fallopian tube enters uterus, doesn’t stretch)
  • hysterotomy scar
  • abdomen
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4
Q

what is a heterotopic pregnancy?

A

rare - ectopic AND viable intrauterine pregnancy at the same time

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5
Q

Ectopic Pregnancy

- Dx

A

if pt presents with suspicious history and/or clinical picture:
- quantitative b-hCG
AND
- findings on high resolution TVUS

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6
Q

Ectopic Pregnancy

- hCG behavior

A
  • rises much slower in most (but not all) ectopic and nonviable IUP than in viable IUP
  • falling hCG is sign of failing pregnancy (regardless of its location)

*in 85% of viable IUP, concentrations rise by 66% Q48 hours during first 40 days

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7
Q

Sx that indicate ectopic preg until proven otherwise

A
  • positive preg test
  • abdominal/pelvic pain
  • +/- bleeding
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8
Q

Ectopic Pregnancy

- sx

A

Classic (ruptured and non-ruptured):

  • abd pain (99%)
  • amenorrhea (74%) bc pregnant…
  • vaginal bleeding (56%)
  • If hemodynamically unstable and/or acute abdomen - means lots of blood loss
  • may be able to palpate pelvic mass
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9
Q

Ectopic Pregnancy

- ddx

A
  • UTI
  • Kidney stones
  • diverticulitis
  • appendicitis
  • ovarian neoplasm
  • endometriosis
  • Leiomyomas
  • PID/endometriosis
  • preg-related: abortion, ruptured corpus luteal cysts, torsed ovary, degenerating fibroids
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10
Q

Ectopic Pregnancy

- medical management

A
  • Methotrexate
  • folic acid antagonist, inhibits DNA synthesis and cell reproduction, especially in proliferating cells
  • rapidly cleared by kidneys
  • dose based on surface area
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11
Q

Ectopic Pregnancy

- indications for sx management

A
  • hemodynamically unstable/ruptured
  • CI to methotrexate
  • Heterotropic pregnancy
  • poor medical candidate
  • desire for permanent sterilization
  • known tubal disease, planned in vitro fert for future pregnancy
  • failed medical therpay
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12
Q

Ectopic Pregnancy

- sx options

A

Laparoscopic vs. laparotomy

  • depends on many factors
  • laparoscopic is standard approach

Salpingostomy (open, remove, close) vs. salpingectomy (remove tube with ectopic)

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13
Q

Ectopic Pregnancy

- post sx f/u

A
  • ensure recover
  • follow hCG to ensure complete success (all the way to zero!)
  • can attempt conception once recovered and hCG is zero
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14
Q

Gestational Trophoblastic Disease

- overview

A
  • Proliferative disorder of trophoblastic cells
  • Maternal tumor arises from gestational tissue (not maternal)
  • Defined by beta-hCG
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15
Q

Gestational Trophoblastic Disease

- list the four types

A
  • Hydatidiform mole (complete or partial)
  • Persistent/invasive gestational trophoblastic neoplasia (GTN)
  • Choriocarcinoma
  • Placental site trophoblastic tumors
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16
Q

Gestational Trophoblastic Disease

- Risk factors

A
  • extremes of age
  • Hx of GTD
  • smoking >15 cig a day
  • Maternal blood AB, A, B (not O)
  • Nulliparity
  • Hx infertility
  • Use of OCP (very small risk)
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17
Q

Gestational Trophoblastic Disease

- Clinical sx

A
  • vaginal bleeding
  • enlarged uterus (rapid proliferation)
  • Theca lutein cysts
  • anemia
  • hyperemesis gravidarum (high level hCG)
  • hyperthyroid (hCG mimics TSH)
  • preeclampsia before 20 weeks gestation
  • vaginal passage of hydronic vesicles
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18
Q

Gestational Trophoblastic Disease

- complete vs. partial mole

A

Complete

  • complete set of chromosomes. 46XX (MC) or 46XY
  • more likely to be persistent and turn into cancer

Incomplete

  • triploid set of chromosomes (partially molar)
  • more likely to have actual fetus
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19
Q

Gestational Trophoblastic Disease

- management of Hydatidiform mole

A
  • Preoperative baseline hCG
  • Lab to rule out concomitant morbidity
  • D&C evacuation, send tissue to pathology to confirm dx
  • Serial hCG until 0
  • can attempt conception after hCG 0 for 12 months
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20
Q

Spontaneous Abortion

- Overview

A
  • preg that ends spontaneously before viable gestational age (20 weeks)
  • most common complication of early pregnancy
  • frequency decreases with increased gestational age
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21
Q

Spontaneous Abortion

- Risk Factors

A
  • age
  • previous SAB
  • smoking
  • cocaine
  • NSAIDs (high dose)
  • Caffeine (>200 mg a day)
  • Prolonged ovulation to implantation
  • prolonged time to pregnancy
  • low folate
  • BMI >18.5
  • Untx celiac dz
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22
Q

Spontaneous Abortion

- 5 Etiologies

A
  • Chromosomal abnl
  • Congenital abnl
  • Trauma (CVS and amniocentesis)
  • Host factors
  • Unexplained
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23
Q

Spontaneous Abortion

- Chromosomal abnormalities

A
  • 50% SAB
  • Most frequent
    Autosomal trisomies
    polyploidies
    Monosomy X
  • Most arise de novo, rarely d/t inherited karyotypic abnl
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24
Q

Spontaneous Abortion

- 5 Host factors

A
  • Maternal uterine abnl (uterine septum, submucosal leiomyoma, intrauterine adhesions)
  • Acute maternal infection (listeria, toxoplasmosis, CMV, rubella, herpes simplex, parvovirus B19)
  • Maternal (uncontrolled) endocrinopathies (Thyroid, Cushings, PCOS, DM, corpus luteum dysfunction)
  • Teratogens (drug, physical stress like fever, env chemicals)
  • Hypercoagulable state (SLE, antiphospholipid syndrome, thrombophilias)
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25
Q

Spontaneous Abortion

- Sx

A
  • amenorrhea
  • vaginal bleeding
  • pelvic pain
  • loss of fetal cardiac activity on US
  • cervix may or may not be dilated
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26
Q

Spontaneous Abortion

- List the 5 categories of

A
  • Missed
  • Complete
  • Incomplete
  • Threatened
  • Inevitable
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27
Q

Spontaneous Abortion

- Missed

A

had no idea, in for routine exam and pregnancy no longer viable
- no vaginal bleeding, cervical dilation, or cardiac activity

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28
Q

Spontaneous Abortion

- Complete

A
  • fetal tissue already gone
  • yes vaginal bleeding
  • no cervical dilation or cardiac activity
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29
Q

Spontaneous Abortion

- Incomplete

A
  • had sig bleeding, part of tissue still remains in uterus
  • yes vaginal bleeding and cervical dilation
  • no cardiac activity
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30
Q

Spontaneous Abortion

- Threatened

A
  • any vaginal bleeding in first trimester of pregnancy
  • yes vaginal bleeding and cardiac activity
  • no cervical dilation
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31
Q

Spontaneous Abortion

- Inevitable

A
  • hasn’t occurred yet but def will happen
  • Yes vaginal bleeding, cervical dilation
  • Yes/No cardiac activity
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32
Q

Spontaneous Abortion

- septic

A
  • fever, chills, other signs of infection
  • lower abd tenderness
  • boggy, tender uterus w/ dilated cervix
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33
Q

Spontaneous Abortion

- organisms that cause septic

A
  • staph aureus
  • gram neg bacilli
  • gram pos cocci
  • mixed
  • anaerobic orgs
  • fungi
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34
Q

Spontaneous Abortion

- management

A
  • Expectant: let it pass on its own, usually within first 2 weeks
  • Medical: expedite or control over when will occur. U
  • Surgical: suction D&C (dilation and curettage) or D&E (dilation and evacuation)
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35
Q

Spontaneous Abortion

- medical management uses what med

A

Misoprostol

- prostaglandins E1 analog

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36
Q

Spontaneous Abortion

- What must not forget to assess

A

RH status - will affect future pregnancies

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37
Q

Recurrent pregnancy loss (RPL)

- definition

A
  • three or more consecutive losses of clinically recognized pregnancies prior to 20 weeks gestation
  • Excludes ectopic, molar, biochemical pregnancies
  • can be primary (never have had live birth) or secondary (had normal first preg and now this)
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38
Q

Recurrent pregnancy loss (RPL)

- risk factors (6)

A
  • previous preg loss
  • uterine factors
  • immunologic factors
  • Endocrine factors
  • Genetic
  • Thrombophilia and fibrinolytic factors
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39
Q

Recurrent pregnancy loss (RPL)

- Uterine factors

A
  • impaired uterine distention or abnl implantation d/t decreased vascularity, increased inflammation, reduction in sensitivity to steroid hormones
  • fibroids (leiomyomas)
  • endometrial polyps
  • intrauterine adhesions (prior curettage)
  • uterine septum
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40
Q

Recurrent pregnancy loss (RPL)

- endocrine factors

A
  • poorly controlled DM
  • PCOS
  • Hyper- or hypothyroidism
  • HyperPRL
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41
Q

Recurrent pregnancy loss (RPL)

- evaluation first step

A
  • Extensive history and PE is paramount
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42
Q

Recurrent pregnancy loss (RPL)

- useful tests

A
  • karyotyping
  • uterine assessment
  • anticardiolipin abs and lupus anticoagulant
  • thyroid tests
  • PRL levels
  • hgb A1C
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43
Q

Placental Infections

- Two vulnerable portals

A
  • fetal membranes overlying cervix: direct access to pathogens ascending from vagina and cervix
  • Placental intervillous space and fetal villi - hematogenous access
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44
Q

Placenal Infections

- Chorioamnionitis overview

A
  • inflammation of chorion and or amnion

- can be sx or silent

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45
Q

Placenal Infections

- Chorioamnionitis sx

A
  • preterm labor
  • preterm premature rupture of membranes
  • prolonged labor
  • neonatal infection
46
Q

Placenal Infections

- Chorioamnionitis microbiology

A

Often polymicrobial

  • GBS
  • E. coli
  • Ureaplasma
  • Fusobacterium
  • Mycoplasma
  • anaerobes
47
Q

Placenal Infections

- Chorioamnionitis dx

A

Maternal fever (38C) AND 2 of the following:

  • maternal leukocytosis (>15k)
  • maternal tachycardia (>100)
  • fetal tachycardia (>160)
  • uterine tenderness
  • amniotic fluid has foul odor
48
Q

Placenal Infections

- Chorioamnionitis risk factors (7)

A
  • nulliparity
  • spontaneous labor
  • longer length of labor, esp if membranes are ruptured (rate doubles after 24 hours)
  • meconium-stained amniotic fluid
  • internal fetal/uterine monitoring
  • presence of genital tract pathogens (GC…)
  • Multiple vaginal examinations
49
Q

Placenal Infections

- Chorioamnionitis tx

A
  • initiate abx

- expedite delivery

50
Q

Vaginal bleeding during pregnancy

- overview

A
  • common event at all stages of pregnancy
  • almost always maternal, not fetal
  • disruption of decidual blood vessels or discrete cervical/vaginal lesions
51
Q

Vaginal bleeding during pregnancy

- 1st Trimester

A
  • 20-40% all women
  • light, heavy, intermittent, constant, painless, painful
    Four major causes:
  • ectopic pregnancy
  • miscarriage
  • Implantation of pregnancy
  • cervical/vaginal/uterine pathology
52
Q

Vaginal bleeding during pregnancy

- 2nd and 3rd trimester

A 
- less common
major causes:
- bloody show assoc. with cervical insufficiency
- placenta previa
- abrupt placenta
- uterine rupture
- vasa previa
- cervical/vaginal/uterine pathology
53
Q

Placenta previa

A
  • placent covers the cervix
  • can be complete or partial
  • ok as long as 2 cm away from edge
  • not painful, just locate of placenta
54
Q

Abruptio placenta

A
  • painful

- blood gets in between placenta and uterus

55
Q

Vasa previa

A
  • blood vessels are over cervix

- very bad

56
Q

Vaginal bleeding during pregnancy

- evaluation

A
  • complete hx and PE

- AVOID DIGITAL VAGINAL EXAM if you don’t know where the placenta is

57
Q

Vaginal bleeding during pregnancy

- prognosis

A

depends on gestational age

58
Q

Vaginal bleeding during pregnancy

- management

A

Depends on

  • gestational age
  • cause of bleeding
  • severity of bleeding
  • fetal status
59
Q

Vaginal bleeding postpartum

- post partum hemorrhage (PPH) overview

A
  • true emergency
  • major cause of morbidity
  • leading cause of admission to ICU in OB
  • Most preventable cause of maternal mortality
  • 1-5% deliveries
  • 10% recurrent in subsequent pregnancies
60
Q

Vaginal bleeding postpartum

- Post partum hemorrhage definitions

A
  • excessive bleeding that makes the pt sx or hypovolemic
  • > 500 cc vaginal
  • > 1000 cc C-section
  • > 1500 cc cesarean hysterectomy
61
Q

Vaginal bleeding postpartum

- postpartum hemorrhage: what is very helpful vital sign

A
  • pulse: tachycardia will occur before falling BP
  • > 120 is a problem
  • > 140 is a major problem
62
Q

Vaginal bleeding postpartum

- What controls uterine bleeding post delivery

A
  • contraction of myometrium constricts blood flow

- local decidual hemostatic factors aid in hemostasis

63
Q

Vaginal bleeding postpartum

- 4 causes of postpartum hemorrhage

A
  1. Uterine atony (MC, 80%)
  2. Trauma
  3. Coagulation defects
  4. Retained products of conception
64
Q

postpartum hemorrhage

- uterine atony

A

Uterus is tired:

  • overdistention (twins, big baby)
  • Uterine infection
  • Drugs (mg relaxes muscle)
  • Uterine fatigue dt prolonged labor
  • Uterine inversion
65
Q

postpartum hemorrhage

- complications

A
  • Morbidity: shock, renal failure, ARDS

- Sheehan’s syndrome

66
Q

postpartum hemorrhage

- management

A
  • Tx like any other trauma/hemorrhage
  • Non-operative and operative combos:
  • restore circulator volume
  • restore tissue O2
  • Reverse/prevent coagulopathy
67
Q

Hypertensive disorders

- Intro

A
  • MC med complication of pregnancy
  • 2nd MC cause of maternal mortality
  • 5-10% incidence
68
Q

Hypertensive disorders

- variation of presentation (4)

A
  1. Gestational hypertension
  2. Preeclampsia
  3. Chronic hypertension (preexisting)
  4. chronic HTN and preeclampsia
69
Q

Hypertensive disorders

- pathophys

A
  • do NOT know cause
  • likely involves both maternal and fetal factors
  • abnl in placental vasculature early in preg
  • circulating antiangiogenic factors that cause maternal endothelial dysfunction
  • environmental factors
  • paternal (more likely if paternal mother had preeclampsia!)
70
Q

Hypertensive disorders

- mild preeclampsia bp and proteinuria

A
  • BP >140/90 mmHG

- Proteinuria >300 mg/dL/24 hours

71
Q

Hypertensive disorders

- severe preeclampsia bp and proteinuria

A
  • BP > 160/110

- Proteinuria >5000

72
Q

Hypertensive disorders

- gestational HTN

A

elevated BP without proteinuria

73
Q

Hypertensive disorders

- severe preeclampsia sx

A
  • Oliguria (<500 cc/24 hours)
  • Cerebral/visual disturbances (blindness or scotomota)
  • pulmonary edema
  • RUQ/epigastric pain
  • impaired liver fn
  • thrombocytopenia
  • fetal growth restriction
74
Q

scotomota

A

spots of blindness

75
Q

Hypertensive disorders

- HELLP syndrome

A
  • severe subset of severe preeclampsia
  • Dx requires three:
    Hemolysis (LDH >600)
    Elevated LFTs (2x nl)
    Low platelets (<100K)
76
Q

Hypertensive disorders

- preeclampsia risk factors

A

SO MANY

  • nulliparity
  • hx preeclampsia
  • extremes of age
  • fam hx
  • chronic HTN
  • chronic renal dz
  • thrombophilia
  • vascular/CT disease
  • DM
  • multiple gestation
  • high BMI

** Smoking is NOT a risk factor

77
Q

Hypertensive disorders

- Preeclampsia dx

A
  • have a high index of suspicion
  • Lab (CBC, CMP, Uric acid, LDH, quantitative urine protein)
  • Increased antepartum fetal surveillance (US, amniotic fluid index, non-stress testing)
78
Q

Hypertensive disorders

- preeclampsia managment

A
  • variable, depends on situation
  • assess maternal status for end-organ damage
  • Control blood pressure (<160/105)
79
Q

Hypertensive disorders

- preeclampsia antihypertensive meds

A
  • Alpha-methyl dopa (aldomet)
  • Hydralazine (Apresoline)
  • Labetalol
  • Nifedipine (Procardia, Adatta) 1st line
80
Q

Hypertensive disorders

- preeclampsia seizure prophylaxis

A
  • IV Mg (can be toxic so monitor)

- Phenytoin is alt option, requires continuous heart monitoring

81
Q

Hypertensive disorders

- eclampsia

A
  • Have had a seizure
  • Administer Mg
  • for persistent convulsions: diazepam or lorazepam, sodium amobarbital
  • fetal resuscitation is via maternal resuscitation
  • delivery is only treatment
82
Q

Diabetes in Pregnancy

- types

A
  • Pregestational DM (T1 or T2 before preg)

- Gestational DM

83
Q

Diabetes in Pregnancy

- overview

A
  • Pregnancy is a state of insulin resistant and hyperinsulinemia
  • maternal insulin resistant is nl. Starts in the second trimester and peaks in third.
  • Results from increased placental secretion of diabetogenic hormones (GH, CRH, hCS/human placental lactose, progesterone)
  • HCS plays major role in maternal insulin resistance, peaking at 30 weeks gestation
84
Q

Diabetes in Pregnancy

- Diagnosis of overt DM

A
  • Fasting glucose >125
  • A1C >6.4%
  • Random glucose >199
85
Q

Diabetes in Pregnancy

- Dx of Gestational DM

A
  • test at 24-28 weeks
  • 1 hour OGTT >135
  • confirm with 3 hour OGTT
86
Q

Diabetes in Pregnancy

- complications of gDM

A
  • preeclampsia
  • hydramnios (big with gDM and small with T1DM)
  • fetal macrosomia (big baby)
  • fetal organomegaly
  • birth trauma (bc big baby)
  • operative delivery
  • perinatal mortality (stillbirth)
  • Neonatal respiratory problems and metabolic complications
87
Q

Diabetes in Pregnancy

- fetal/neonatal complications of pre-gestational DM

A
  • congenital malformations
  • spontaneous abortion
  • macrosomnia (big baby)
  • polyhydramnios
  • preterm baby
  • perinatal mortality (stillbirth)
  • neurodevelopment outcomes
88
Q

Diabetes in Pregnancy

- maternal complications of pre-gestational DM

A

same issues as DM in general

- retinopathy, nephropathy, etc.

89
Q

Diabetes in Pregnancy

- general management

A
  • nutrition
  • exercise (increases sensitivity to insulin)
  • Glucose monitoring (A1C pre-preg 6-7%)
  • Antenatal fetal testing
  • Assessment of fetal growth
  • Timing of delivery (early if poor glycemic control, 37-39 weeks)
  • Intrapartum glycemic control
90
Q

Diabetes in Pregnancy

- glycemic control

A
  • via diet and exercise
  • A1C 6-7%
  • Oral meds: sulfonylurea is standard, metformin is an option
  • Insulin: studies show better outcomes vs. oral meds.
91
Q

Diabetes in Pregnancy

- postpartum management

A
  • avoid hypoglycemia!
  • F/u 4-6 weeks for 2 hour OGTT to r/o undiagnosed DM
  • Pregestational DM return to primary care or endocrinologist for continued management
92
Q

PTL and PPROM

- define

A
  • PTL: preterm labor

- PPROM: preterm premature rupture of the membranes

93
Q

PTL and PPROM

- overview

A
  • leading cause of infant mortality in US
  • relationship between neonatal mortality and gestational age is nonlinear
  • <37 weeks is preterm
  • 12% of births preterm in 2009
94
Q

PTL and PPROM

- Risk factors

A
  • stress
  • occupational fatigue
  • excessive/impaired uterine distention (twins!)
  • cervical factors
  • infection
  • placental pathology
  • fetal congenital anomalies
95
Q

PTL

- preterm labor definition

A

painful uterine contractions that lead to cervical dilation

contraction WITHOUT cervical change is NOT preterm labor

96
Q

PTL

- evaluation

A
  • History (characterize the sx)
  • PE (cervical exam)
  • Determine gestational age
  • Labs: urine culture, GBS, gonorrhea/chlamydia, fetal fibronectin (not used much anymore), drug screen?
  • US
  • +/- cervical length
97
Q

PTL

- management

A
  • Give steroids, even if not sure if in labor!! Reduces morbidity and mortality related to preterm birth
  • Abx for GBS prophylaxis
  • Tocolytic drugs for up to 48 hours to delay delivery, allow glucocorticoids to achieve max benefit
  • Abx if positive gonorrhea/chlamydia
98
Q

GBS prophylaxis

A
  • Ampicillin or penicillin
  • if PCN allergic, do culture

if GBS unknown, treat if there are risk factors:

  • Rupture > 18 hours
  • preterm <37 weeks
  • GBS bacturia
  • previous GBS sepsis in another infant
99
Q

PTL

- Antenatal glucocorticoid administration

A
  • Administer between 24 and 33 completed weeks of gestation

- Betamethasone and dexamethasone

100
Q

PTL

- Benefits of antenatal glucocorticoid administration

A

Reduces:

  • neonatal respiratory distress**
  • intraventricular hemorrhage
  • retinopathy of pregnancy
  • necrotizing enterocolitis
101
Q

PTL

- tocolytics

A
  • Magnesium sulfate: decreases rates of cerebral palsy
  • Procardia (CCB)
  • Indomethacin (cyclooxygenase inhibitor, <32 weeks only to avoid fetal kidney damage)
  • Terbutaline (beta-adrenergic receptor agonist): not used much anymore
102
Q

PPROM

  • overview
  • definition
A
  • treat just like PTL except also give abx
  • PROM is membrane rupture prior to onset of uterine contractions
  • PPROM is PROM <37th week
  • management of PPROM is controversial!
103
Q

PPROM

- evaluation

A
  • Hx
  • PE (cervical exam)
  • Determine gestational age
  • Labs: urine culture, GBS, gonorrhea/chlamydia, fetal fibronectin, drug screen?
  • US +/- cervical length
  • Sterile speculum exam: nitrazine, ferning test (looks like snowflake bc salty), pooling of fluid coming out cervix
104
Q

PPROM

- management overview

A
  • similar to PTL +/- tocolytics AND admin of latency abx (latent refers to period btwn breaking of membrane and delivery)
  • expedite delivery in cases of overt infection
  • Vaginal or cesarean route of delivery
105
Q

PPROM

- latency abx

A
  • ampicillin and erythromycin IV X 2D

- amoxicillin and erythromycin PO X 5D

106
Q

Postpartum blues

- overview

A
  • transient condition characterized by mild, often rapid, mood swings from elation to sadness, irritability, anxiety, decreased concentration, insomnia, tearfulness, crying spells
  • 40-80% of women within 2-3 days of delivery
  • resolves in 2 weeks
    MAKE THIS NORMAL
107
Q

Postpartum blues and depression

- Risk factors

A
  • Hx of depression
  • depressive sx during pregnancy
  • Fam hx of depression
  • Stress around child care
  • Psychosocial impairment at work, relationships, leisure
  • Postpartum blues = increased risk of postpartum depression
108
Q

Postpartum blues

- treatment

A
  • usually resolves over time with support and reassurance

- seek med attn if persist >2 weeks

109
Q

Postpartum depression

- overview

A
  • often unrecognized bc similar to dx of normal puerperium changes (time 6 weeks after delivery)
  • 5% prevalence (maybe way higher)
110
Q

Postpartum depression

- diagnosis

A

SIG E CAPS

  • sleep
  • interest
  • guilt
  • energy
  • concentration
  • appetite
  • psychomotor retardation
  • suicidal
  • 5+ sx, present most of the day nearly every day for min 2 consecutive weeks.
  • One sx must be either depressed mood or loss in interest or pleasure
111
Q

Postpartum depression

- management

A
  • address psychosocial and biologic factors
  • Psychosocial therapy (mild to mod sx)
  • light therapy
  • Pharm for severe sx. Sertraline (least in breastmilk) or paroxetine, or anything that has worked in the past :)
  • avoid bentos
  • Severe: electroconvulsive therapy
  • Hormone therapy

Women's Health 2 (9 decks)

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