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Obs and gynae > Labour and puerperium > Flashcards

Labour and puerperium Flashcards

1
Q

What is induction of labour

A

Start labour artificially

Needed in 20% of pregnancies

When safer to deliver baby than keep in utero

Can be to optimise maternal health

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2
Q

What are the indications for induction of labour

A

Prolonged gestation

Premature rupture of membranes

Maternal health problems

Fetal growth restriction

Intrauterine fetal death

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3
Q

When should induction of labour be used in prolonged gestation

A

Uncomplicated pregnancies, offer between 40+0 and 40+14

Prolonged gestation associated with fetal compromise and stillbirth

If mother declines induction, increased monitoring after 42 weeks

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4
Q

When should induction of labout be used in premature rupture of membranes

A

If >37 weeks
- Offer induction of labour or expectant management for 24 hours

If 34-37 weeks
- Time induction based on risk vs benefit

If < 34 weeks
- Delay induction (unless have fetal compromise)

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5
Q

What maternal health problems should lead to consideration for induction of labour

A

Hypertension

Pre-eclampsia

Diabetes

Obstetric cholestasis

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6
Q

What are the absolute contraindications for induction of labour

A

Cephalopelvic disproportion

Major placenta praevia

Vasa praevia

Cord prolapse

Transverse lie

Active primary genital herpes

Previous classical C-section

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7
Q

What are the relative contraindications for induction of labour

A

Breech presentation

Triplet(+) pregnancy

2+ previous low transverse C-sections

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8
Q

What are the methods of induction of labour

A

Vaginal prostaglandins

Amniotomy

Membrane sweep

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9
Q

How are vaginal prostaglandins used in the induction of labour

A

Primary method

Ripen cervix

Help with uterine contractions

Maximum 1 cycle per day (1 pessary, or 1 tablet/gel repeated after 6 hours)

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10
Q

What is amniotomy

A

Artificially rupture membranes using amnihook

Get release of prostaglandins, hope to start labour

Only when cervix is ripe

Can be given alongside syntocinon

Not first line (unless prostaglandins contraindicated) - risk of uterine hyperstimulation

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11
Q

What is a membrane sweep

A

Not a formal method of induction

Gloved finger through cervix, aim to separate membrane and release prostaglandins

Increases chances of spontaneous labour

Nulliparous: offer at 40 and 41 weeks

Multiparous: offer at 41 weeks

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12
Q

What methods of monitoring are used during induction of labour

A

Bishop score

CTG (if using oxytocin, use CTG throughout)

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13
Q

What is a Bishop score

A

Assessment of cervical ripening based on vaginal examination

Used before and during induction

> 7 = cervix favourable (high chance of response)

<4 = unlikely to progress naturally, will need prostaglandin induction

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14
Q

What are the complications of induction of labour

A

Failure of induction (offer more prostaglandins or C-section)

Uterine hyperstimulation (manage with tocolytic (anti-contraction) agents)

Cord prolapse

Infection

Pain (more severe than with natural labour)

Increased need for further intervention

Uterine rupture

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15
Q

What is operative vaginal delivery and what are the methods used

A

Use of instruments to aid delivery

Up to 3 pulls with one instrument, then switch to a different one

Ventouse

Forceps

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16
Q

How is ventouse used in operative vaginal delivery

A

Low risk of maternal complications

Attach cup to fetal head using vacuum, apply traction with each contraction

Electrical pump, or kiwi (used to rotate fetus)

Lower success rate, less maternal perineal injury, less pain, more cephalhematoma, more subgaleal haematoma, more fetal retinal haemorrhage

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17
Q

How are forceps used in operative vaginal delivery

A

Lower risk of fetal complications

2 blades, go around fetal had, apply traction with contractions

Higher rates of 3rd/4th degree tears, not ideal for rotation, no need for maternal effort

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18
Q

What are the maternal indications for operative vaginal delivery

A

Inadequate progress

  • 2 hours of pushing in nulliparous
  • 1 hour of pushing in multiparous

Exhaustion

Medical conditions where active pushing should be limited (intracranial pathology, congenital heart defects, severe hypertension)

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19
Q

What are the fetal indications for operative vaginal delivery

A

Suspected fetal compromise in 2nd stage of labour (abnormal CTG/bloods)

Clinical concern (significant antepartum haemorrhage…)

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20
Q

What are the absolute contraindications for operative vaginal delivery

A

Unengaged fetal head (singleton)

Incompletely dilated cervix (singleton)

True cephalo-pelvic disproportion

Breech and face presentation

Preterm (<34 weeks) - for ventouse

Fetus high risk of coagulation disorders - for ventouse

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21
Q

What are the relative contraindications for operative vaginal delivery

A

Non-reassuring fetal status with head above pelvic floor

Delivery of twin 2, where head has not engaged or cervix has re-formed

Prolapse of umbilical cord when cervix is fully dilated

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22
Q

What are the pre-requisites for instrumental delivery

A

Fully dilated

Ruptured membranes

Cephalic presentation

Defined fetal position

Fetal head at least at ischial spine

Empty bladder

Adequate pain relief

Adequate maternal pelvis

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23
Q

What are the fetal complications of operative vaginal delivery

A

Neonatal jaundice

Scalp lacerations

Cephalhaematoma

Subgaleal haematoma

Facial bruising

Facial nerve damage

Skull fractures

Retinal haemorrhage

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24
Q

What are the maternal complications of operative vaginal delivery

A

3rd/4th degree vaginal tears

VTE

Incontinence

PPH

Shoulder dystocia

Infection

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25
Q

What is premature rupture of membranes

A

ROM at least 1 hour before onset of labour

At >37 weeks

In 10-15% pregnancies

Minimum risk to mother and baby

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26
Q

What is pre-term premature rupture of membranes

A

Rupture of membranes at <37 weeks

2% pregnancies

High rates of maternal and fetal compromise

40% of pre-term pregnancies

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27
Q

What is the pathophysiology of PROM/P-PROM

A

Early weakening and rupture of membranes due to:

  • Early activation of normal physiological process (high apoptotic markers and enzymes)
  • Infection
  • Genetic predisposition
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28
Q

What are the risk factors for PROM/P-PROM

A

Smoking (especially at <28 weeks)

Previous PROM/P-PROM

Vaginal bleeding during pregnancy

Lower genital tract infection

Invasive procedures (amniocentesis…)

Polyhydramnios

Multiple pregnancies

Cervical insufficiency

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29
Q

What are the clinical features of PROM/P-PROM

A

Typical history of ‘waters breaking’

Non-specific symptoms: gradual leaking, change in vaginal discharge

Fluid pooling in posterior fornix on speculum examination

Avoid digital vaginal examination until woman is in labour

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30
Q

What are the differential diagnoses for PROM/P-PROM

A

Urinary incontinence

Normal vaginal secretions of pregnancy

Increased sweat/moisture around perineum

Increased cervical discharge

Vesicovaginal fistula

Loss of mucus plug

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31
Q

What investigations are used in PROM/P-PROM

A

High vaginal swab (look for GBS)

Actim-PROM (swab to look for insulin like growth factor binding protein 1 in vaginal fluid)

Amnisure (swab to look for alpha microglobulin 1)

Nitrazine test (pH of vaginal fluid)

Ferning test (fern pattern on slides)

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32
Q

What is the management of PROM/P-PROM at <34 weeks

A

Aim to get to 34 weeks

Monitor for signs of choramnionitis

Avoid sexual intercourse

Prophylactic erythromycin for 10 days

Corticosteroids

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33
Q

What is the management of PROM/P-PROM at 34-36 weeks

A

Induce labour once steroids have been given

Monitor for signs of choramnionitis

Avoid sexual intercourse

Prophylactic erythromycin for 10 days

Penicillin during labour if GBS found

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34
Q

What is the management of PROM/P-PROM at >36 weeks

A

Induce labour within 24-48 hours

Monitor for signs of choramnionitis

Penicillin during labour if GBS found

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35
Q

What are the complications of PROM/P-PROM

A

Outcomes correlate with gestational age

Choramnionitis (inflammation of fetal membranes)

Oligohydramnios (more if <24 weeks)

Neonatal death (prematurity, sepsis, pulmonary hypoplasia)

Placental abruption

Umbilical cord prolapse

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36
Q

When is an emergency caesarean section used

A

Failure to progress

Fetal compromise

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37
Q

What are the categories of emergency caesarean sections

A

Category 1

  • Immediate threat to life of mother or fetus
  • Birth within 30 mins

Category 2

  • Maternal/fetal compromise, not immediately life-threatening
  • Birth within 60-75 mins

Category 3

  • No maternal/fetal compromise, but need early delivery
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38
Q

What are the indications for caesarean section

A

Breech presentation

Malpresentation

Twins (twin 1 not cephalic)

Fetal compromise

Transmissible disease (poorly controlled HIV)

Primary genital herpes in 3rd trimester

Placenta praevia

Maternal diabetes

Previous major shoulder dystocia

Previous 3rd/4th degree tear

Maternal request

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39
Q

Benefits of caesarean section

A

Reduced risk of:

  • Perianal trauma
  • Pain
  • Urinary/anal incontinence
  • Uterovaginal prolapse
  • Late stillbirth
  • Early neonatal infection
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40
Q

What are the immediate complications of caesarean section

A

PPH (>1000 ml)

Wound haematoma

Intra-abdominal haemorrhage

Bladder/bowel trauma

Neonatal: transient tachypnoea of newborn, fetal lacerations

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41
Q

What are the intermediate complications of caesarean section

A

Infection (UTI, endometritis, respiratory)

VTE

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42
Q

What are the late complications of caesarean section

A

Urinary tract trauma

Subfertility

Negative psychological effects

Rupture/dehiscence of scar in next labour

Placenta praevia/accrete

Caesarean scar ectopic pregnancy

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43
Q

Risks and benefits of VBAC

A

Shorter hospital stay and recovery

Higher risk of uterine rupture

Risk of anal sphincter injury

Lower risk of maternal death

Good chances of success of future VBACs

Risk of respiratory difficulties/hypoxic ischaemic encephalopathy in neonate

Increased risk of stillbirth beyond 39 weeks

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44
Q

Risks and benefits of elective repeat caesarean section

A

Longer recovery

Small risk of uterine rupture

No risk of anal sphincter injury

Higher risk of maternal death

Subsequent pregnancies need to be caesarean

Higher risk of neonatal respiratory morbidity

Increased risk of placental problems

Increased risk of adhesions

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45
Q

What is uterine rupture, and what are the risk factors for it in VBAC

A

Full-thickness disruption of uterine muscle and overlying serosa

An obstetric emergency

Can get fetal hypoxia/large maternal haemorrhage

Risk factors in VBAC: previous C-section, induction of labour, obstruction of labour, multiple pregnancy, multiparity

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46
Q

How are VBAC deliveries managed

A

Deliver in hospital setting

Continuous CTG monitoring

Avoid induction where possible

Get guidance from seniors

After 39 weeks, recommendation is repeat C-section

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47
Q

What are the absolute contraindications for VBAC

A

Classical caesarean scar

Previous uterine rupture

Normal contraindications for vaginal birth

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48
Q

What are the relative contraindications for VBAC

A

Complex uterine scar

> 2 previous lower segment C-sections

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49
Q

What is shoulder dystocia

A

When fetal shoulder gets impacted after delivery of the head

An obstetric emergency

Anterior shoulder on maternal pubic symphysis/posterior shoulder on sacral promontory

50
Q

What is the pathophysiology of shoulder dystocia

A

Impaction of shoulder

Delayed delivery = hypoxia of fetus

Can get brachial plexus injury when applying traction

51
Q

What are the pre-labour risk factors for shoulder dystocia

A

Previous shoulder dystocia

Macrosomia

Diabetes

BMI >30

Induction of labour

52
Q

What are the intrapartum risk factors for shoulder dystocia

A

Prolonged 1st stage of labour

Secondary arrest (initial good progress, then stop due to malposition)

Prolonged second stage of labour

Oxytocin augmentation

Assisted vaginal delivery

53
Q

What are the clinical features of shoulder dystocia

A

Difficulty delivering fetal head/chin

Failure of restitution (fetus stays in OA position)

Turtle-neck sign (head retracts slightly into pelvis)

54
Q

What are the immediate management steps for shoulder dystocia

A

Call for help

Advise mother to stop pushing (can worsen impaction)

Avoid downward traction of head

Do not apply fundal pressure (can cause uterine rupture)

Consider episiotomy (does not relieve obstruction, but makes manoeuvres easier)

55
Q

What are the first line manoeuvres used for shoulder dystocia

A

McRoberts manoeuvre

  • Hyperflexion of hips (knees to chest)
  • Stop pushing
  • Get widening of pelvic outlet

Suprapubic pressure

  • Sustained or rocking pressure
  • Puts pressure behind anterior shoulder to disimpact it from pubic symphysis
56
Q

What are the second line (internal) manoeuvres used in shoulder dystocia

A

Posterior arm
- Insert hand, grab fetal arm and pull to delivery

Internal rotation (corkscrew)

  • Apply pressure in front of one shoulder and behind the other
  • Move baby into oblique position

If not working, repeat with patient on all 4s (widens pelvic outlet)

57
Q

What is the post-delivery management for shoulder dystocia

A

Active management of 3rd stage of labour (increased risk of PPH)

PR examination (exclude 3rd degree tears)

Debrief mother and partner (can be traumatic)

Consider physiotherapy review before discharge

Paediatric review (for brachial plexus injury, humeral fracture, hypoxic brain injury)

58
Q

What is an umbilical cord prolapse

A

Umbilical cord comes through cervix with/before presenting part of fetus

High mortality rates for babies

Obstetric emergency

59
Q

What are the 2 types of cord prolapse

A

Occult (incomplete) prolapse
- Cord descends alongside presenting part (not beyond it)

Overt (complete) prolapse
- Cord descends past presenting part

60
Q

What is cord presentation in umbilical cord prolapse

A

Presence of umbilical cord between presenting part and cervix

With or without intact membranes

61
Q

Which babies is umbilical cord prolapse more common in

A

Pre-term babies (more likely to be breech and have congenital defects)

62
Q

How does umbilical cord prolapse cause fetal hypoxia

A

Occlusion

  • Presenting part presses onto umbilical cord
  • Occlusion of blood flow to fetus

Arterial vasospasm

  • Exposure of umbilical cord to cold atmospheres
  • Get umbilical arterial vasospasm
  • Reduced blood flow to fetus
63
Q

What are the risk factors for umbilical cord prolapse

A

Breech presentation

Unstable like (if >37 weeks, consider admission until delivery)

Artificial rupture of membranes

Polyhydramnios

Prematurity

64
Q

What are the clinical features of umbilical cord prolapse

A

Always consider if have non-reassuring fetal heart rate and absent membranes (strong link to fetal bradycardia)

Confirm via external/PV examination

65
Q

What are the differential diagnoses for umbilical cord prolapse

A

If have PV bleeding or blood-stained liquor with rupture of membranes, consider placental abruption/vasa praevia

66
Q

What is the management for umbilical cord prolapse

A

Call for help

Avoid handling cord (worsens vasospasms)

Manually elevate presenting part (reduce occlusion)

Encourage into left lateral/knee-chest position

Consider tocolysis (terbutaline) reduces uterine contractions

Delivery via emergency C-section

67
Q

What is eclampsia

A

Convulsions in pre-eclamptic woman in absence of neurological/metabolic causes

An obstetric emergency

High maternal and fetal mortality rate

Most seizures in post-partum period

68
Q

What are the moderate risk factors for eclampsia

A

Nulliparity

Age >40

BMI >35

Family history

Pregnancy interval >10 years

Multiple pregnancy

69
Q

What are the high risk factors for eclampsia

A

Chronic hypertension

HTN/pre-eclampsia/eclampsia in previous pregnancy

Pre-existing CKD

Diabetes

Autoimmune diseases (SLE, antiphospholipid syndrome…)

70
Q

What are the clinical features of eclampsia

A

New onset tonic-clonic seizures in presence of pre-eclampsia

Seizures lasting 60-75 seconds

Convulsions can cause fetal distress/bradycardia

71
Q

What are the signs/symptoms of end-organ damage in eclampsia

A

Frontal headaches

Hyper-reflexia

Nausea and vomiting

Generalised oedema

RUQ pain

Jaundice

Visual disturbances

Changes in mental age

72
Q

What are the maternal complications of eclampsia

A

HELPP syndrome

DIC

AKI

Adult respiratory distress syndrome

Cerebrovascular haemorrhage

Permanent CNS damage

Death

73
Q

What are the fetal complications of eclampsia

A

Intrauterine growth restriction

Prematurity

Infant respiratory distress syndrome

Intrauterine death

Placental abruption

74
Q

What are the differential diagnoses for eclampsia

A

Hypoglycaemia

Pre-existing epilepsy

Head trauma

Haemorrhagic stroke

Meningitis

Medication-induced

Brain tumour

Cerebral aneurysm

Septic shock

Ischaemic stroke

75
Q

What investigations are used for eclampsia

A

Bloods (FBC, U&ES, LFTS, clotting studies, blood glucose)

USS (rule out placental abruption)

CTG monitoring

Consider full neurological workup

76
Q

What are the main steps of management of eclampsia

A

Resuscitation

Cessation of seizures

Blood pressure control

Prompt delivery of baby and placenta

Monitoring

77
Q

What is involved in the cessation of seizures step of eclampsia management

A

Give magnesium sulphate

Assess patient for hypermagnesemia (hyperreflexia, respiratory depression)

Continuous fetal CTG monitoring

78
Q

What is involved in the blood pressure control step of eclampsia management

A

Give IV labetalol and hydralazine

Target mean arterial pressure <120

Continuous CTG monitoring

79
Q

What in-patient care is needed post-natally for eclampsia

A

Regular symptom review

Bloods 72 hours post-partum

Pre-conception counselling (minimise risks for future pregnancies)

Step-down to community

80
Q

What out-patient care is needed post-natally for eclampsia

A

Consider CT head (if neurological symptoms persist)

Measure blood pressure (daily for 2 weeks post-partum)

Follow-up at 6 weeks

81
Q

What is uterine rupture

A

Full-thickness disruption of uterine muscle and overlying serosa

Can extend to affect bladder/broad ligament

Significant maternal and fetal morbidity and mortality

82
Q

What are the main types of uterine rupture

A

Incomplete

  • Peritoneum overlying uterus is intact
  • Uterine contents remain in uterus

Complete

  • Peritoneum torn
  • Uterine contents in peritoneal cavity
83
Q

What are the risk factors for uterine rupture

A

Previous C-section (higher risk with vertical incision)

Previous uterine surgery

Induction/augmentation of labour

Obstruction of labour

Multiple pregnancy

Multiparity

84
Q

What are the signs and symptoms of uterine rupture

A

Sudden severe abdominal pain (persisting between contractions)

Shoulder tip pain

Vaginal bleeding

85
Q

What would you find on examination in uterine rupture

A

Regression of presenting part

Scar tenderness

Palpable fetal parts on abdominal examination

86
Q

What would fetal monitoring show in uterine rupture

A

Fetal distress

Absent heart sounds

87
Q

What are the differential diagnoses for uterine rupture

A

Placental abruption (woody uterus)

Placenta praevia (painless PV bleeding)

Vasa praevia (ruptured membranes, painless PV bleeding, fetal bradycardia)

88
Q

What investigations are used in uterine rupture

A

Intrapartum CTG monitoring

USS for diagnosis (abnormal fetal lie/presentation, haemoperitoneum, absent uterine wall)

89
Q

How is uterine rupture managed

A

Call for help

Resuscitate

Surgery (immediate C-section, repair/remove uterus)

90
Q

What is thought to be linked to amniotic fluid embolism

A

Strong uterine contractions

Excessive amniotic fluid

Disruption of uterine vessels

91
Q

What are the risk factors for amniotic fluid embolism

A

Multiple pregnancy

Increased maternal age

Induction of labour

Uterine rupture

Placenta praevia

Placental abruption

Cervical lacerations

Eclampsia

Polyhydramnios

C-section/instrumental delivery

92
Q

What are the clinical features of amniotic fluid embolism

A

Sudden onset

Hypoxia/respiratory arrest

Hypotension

Fetal distress

Seizures

Shock

Confusion

Cardiac arrest

DIC

93
Q

What are the differential diagnoses for amniotic fluid embolism

A

PE

Anaphylaxis

Sepsis

Eclampsia

Myocardial infarction

94
Q

What are the investigations and management for amniotic fluid embolism

A

Resuscitate

Bloods

ECG (ischaemic changes)

CXR

Arrange ITU admission

Manage DIC

Deliver baby (even if post-partum section)

95
Q

What is the definitive diagnosis for amniotic fluid embolism

A

On post-mortem

Fetal squamous cells and debris in pulmonary vasculature

96
Q

What is primary post-partum haemorrhage

A

Loss of >500mls of blood PV within 24 hours of delivery

97
Q

What are the 2 main types of primary post-partum haemorrhage

A

Minor PPH
- 500-1000 mls blood loss

Major PPH
- >1000 mls blood loss

98
Q

What are the 4 main groups of causes of primary PPH

A

Tone

Tissue

Trauma

Thrombin

99
Q

What is the significance of ‘tone’ in primary PPH

A

Uterine atony most common cause of PPH

Uterus not able to contract fully due to lack of tone

Risk factors: maternal profile (age >40, BMI >35, asian), uterine over-distension (multiple pregnancy, macrosomia…), induced/prolonged labour, placental problems (praevia, abruption, previous PPH)

100
Q

What is the significance of ‘tissue’ in primary PPH

A

Retention of placental tissue

Prevents uterus from contracting

101
Q

What is the significance of ‘trauma’ in primary PPH

A

Damage sustained during delivery (vaginal/cervical tears)

Risk factors: instrumental delivery, episiotomy, C-section)

102
Q

What is the significance of ‘thrombin’ in primary PPH

A

Vascular causes (placental abruption, hypertension, pre-eclampsia)

Coagulopathies (Von Willebrand’s disease, haemophilia, DIC, HELPP)

103
Q

What are the signs and symptoms of primary PPH

A

Bleeding PV

If large blood loss: dizziness, palpitations, shortness of breath

104
Q

What would you find on examination in primary PPH

A

Abdominal examination (signs of uterine rupture)

Speculum examination (sites of localised trauma)

Placenta (ensure placenta is complete)

105
Q

What investigations are needed in primary PPH

A

Bloods (FBC, coagulation profile, U&Es, LFTs)

Cross-match 4-6 units of blood

106
Q

What is the general method of managing primary PPH

A

TRIM

  • Teamwork
  • Resuscitation
  • Investigations and monitoring
  • Measures to arrest bleeding
107
Q

What is the definitive management for primary PPH due to uterine atony

A

Bimanual compression (apply pressure to abdomen with other hand)

Pharmacological

  • Syntocinon (synthetic oxytocin)
  • Ergometrine
  • Carboprost (prostaglandin analogue)
  • Misoprostol (prostaglandin analogue)

Surgical

  • Intrauterine balloon tamponade
  • Haemostatic sutures around uterus
  • Uterine/iliac artery ligation
  • Hysterectomy
108
Q

What is the definitive management for primary PPH due to ‘trauma’

A

Repair laceration

May need hysterectomy

109
Q

What is the definitive management for primary PPH due to ‘tissue’

A

IV oxytocin

Manual removal of placenta

Prophylactic antibiotics

110
Q

What is the definitive management for primary PPH due to ‘thrombin’

A

Correct coagulation abnormalities with blood products

111
Q

What are the methods of preventing primary PPH

A

Active management of 3rd stage of labour

IV/IM oxytocin

112
Q

What is secondary post-partum haemorrhage

A

Excessive vaginal bleeding between 24 hours and 12 weeks post-partum

113
Q

What are the risk factors for secondary post-partum haemorrhage

A

Uterine infection

Retained placental fragments/tissue

Inadequate closure of spiral arteries

Trophoblastic disease

Previous history of PPH

114
Q

What are the clinical features of secondary post-partum haemorrhage

A

Excessive vaginal bleeding (spotting, occasional gush of fresh blood)

Endometritis (fever, lower abdominal pain, foul smelling discharge)

Lower abdominal tenderness, high uterus

115
Q

What investigations are needed for secondary post-partum haemorrhage

A

Bloods
FBC, U&Es, CRP, coagulation profile, group and save

Blood cultures

USS pelvis (look for retained placental tissue)

116
Q

What is the management for secondary post-partum haemorrhage

A

Antibiotics (ampicillin and metronidazole)

Uterotonics (syntocinon…)

Surgical (balloon catheter insertion)

Manage massive secondary PPH as primary PPH

117
Q

What are the core symptoms of depression during pregnancy

A

Low mood

Lethargy

Anhedonia

Poor sleep

Poor appetite

118
Q

When should an urgent mental health referral be made for depression in pregnancy

A

Risk of self harm/suicide

Evidence of self neglect

Psychotic symptoms

Manic behaviour

Previous diagnosis of MH issues

Previous suicide attempts

119
Q

What is post-natal depression

A

Depressive episode within first 12 months post-partum

Peaks around first 2 months

Not the same as baby blues (at day 3-4, for 7 days)

Negative thoughts about motherhood and ability to cope

Anxieties about baby

120
Q

What is post-partum psychosis

A

Severe mental illness

Can develop within a few hours

More common in women with previous bipolar disorder/psychotic illness

50% chance of recurrence in future pregnancies

121
Q

How do patients with post-partum psychosis present

A

Confused/distracted

Relatives report: withdrawn, agitated/distressed

Bizarre ideas

Auditory hallucinations

May appear manic

Sleep disturbances

Obs and gynae (6 decks)

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