Obstetrics: Post-Natal Care Flashcards
Define peri-natal mental health?
PMH = a woman’s mental health both during and in the first 12 months after giving birth.
Includes both pre-existing conditions and conditions that only develop during the perinatal period.
What are the most common Peri-natal mental health issues?
Pregnancy specific:
- Postnatal depression
- Pueperal psychosis
- Adjustment disorders and distress (most common)
General:
- Anxiety disorders
- Depression
- PTSD
How common is peri-natal mental health?
1/5 mothers develop some form of mental health issues.
1/4 maternal deaths are related to mental health problems (including suicide and drug abuse)
What are the most significant impacts of peri-natal mental health issues?
- Emotional well-being of the woman, and her family
- Can interfere with bonding, attachment, care of the baby
- Relationships with partner, wider family and social circles can become strained
- Increases mortality and use of health services
What is the prognosis like for peri-natal mental health issues?
Good if seek treatment; effective treatment is available, disorders are sensitive to treatment, shorter illness duration and better prognosis than non-pregnancy related mental health.
HOWEVER 50% of cases go undiagnosed and untreated (stigma, fear of being considered a bad mother, fear baby will be taken away, unaware treatment is available, HCP not asking or having time constraints).
What depression scales are used in pregnancy?
EPDS (14-15) and Becks depression inventory
What sort of screening questions are effective in PNMI?
- During the past month have you been bothered by feeling down
- During the past month have you had little interest in things
- Is there anything you need help with
- Have you been feeling anxious or on edge
- Have you not been able to stop or control your worrying
What are some risk factors for PNMI?
- Prior mental health issues
- Family history of PNMI
- History of child abuse or neglect
- Domestic violence
- Interpersonal conflict
- Inadequate social support
- Substance misuse
- Migration status, language or cultural barriers
- Unplanned, unwanted, or complicated pregnancy
- Traumatic birth
What are the most significant red flags for PNMI?
- Diagnosis of Bipolar Disorder
- Diagnosis of Severe Depression
- Recent changes in mental health e.g. emergence of new symptoms, new thoughts or acts of self-harm
THEM COMING FORWARD! Usually indicates quite severe cases
What is the baby blues?
- Reasonably benign form of MI
- Affects more than half of women
- Starts around day 3-4 goes on to about day 14
- Tearfulness, low mood, irritability, anxiety, over-reacting
- Causes: pain from birth, stress of new baby, lack of sleep, breast feeding
How would you manage a mother with the baby blues?
Nothing specific; just reassure them that what they are feeling is normal, and offer support
How is PN depression defined?
- Normal depression symptoms of anhedonia, low mood and low energy +/- struggling to care for baby
- Within first year after giving birth (normally first couple of months)
- Look out for difficulty caring for baby, difficulty bonding with baby, feelings of inadequacy, thoughts of harming self or baby
How do you manage PND?
Mild:
- Non drug treatments as effective as antidepressants
- Postnatal support groups
- Preventative strategies such as modified antenatal classes
Severe:
- Refer to specialist perinatal mental health services is essential
- Management normally with TCAs or SSRIs
What is puerperal psychosis?
Psychosis symptoms e.g: - mania - depression - confusion - rapid changes in mood - withdrawal - delusions - hallucinations - feeling paranoid, suspicious, fearful ...developing rapidly in the days/weeks after giving births.
Psychiatric emergency due to risk of suicide/infanticide!
How is puerperal psychosis managed?
- Always managed with a specialist MDT on a mother baby unit
- Anti-psychotics, mood stabilisers, anti-depressants
- CBT when in recovery phase
- Most recovery fairly quickly
- ECT can be used in severe psychosis
- Risk of recurrence is 50% if next pregnancy within couple of years so ideally avoid
