Perinatal Flashcards

1
Q

Risk of major malformation in all pregnancies

A

2-3%

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2
Q

When is risk of psychiatric episodes greatest in perinatal?

A

3 months postpartum

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3
Q

Most common psychiatric illnesses in postpartum period?

A

Mood disorder - 80%

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4
Q

Risk of depression during pregnancy

A

7-15% (7% outside of pregnancy)

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5
Q

Relapse rate of depression during pregnancy if history of depression

A

50%

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6
Q

Risk of postpartum depression

A

10%

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7
Q

Risk factors for postpartum depression

A

Previous depression

Highest risk with bipolar

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8
Q

Risk of postpartum psychosis

A

0.1-0.25% in general population
50% in bipolar
50-90% in those with history of postpartum psychosis

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9
Q

Incidence of puerpural psychosis

A

1 in 1000 births

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10
Q

Risk of relapse of bipolar in first month postpartum

A

8x increase, most relapses depressive

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11
Q

Most vulnerable period for fetus of teratology from meds

A

Week 6-10

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12
Q

What happens to medications during 3rd trimester?

A

Increase often needed as blood volume expands by 30%

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13
Q

Treatment of SCZ in pregnancy

A

High risks associated with untreated SCZ, thus consensus to use antipsychotic at every stage of pregnancy.

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14
Q

Common antipsychotics used in pregnancy

A

Olanzapine - most common
Haloperidol
Clozapine

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15
Q

Treatment of depression in pregnancy

A

Delay until 2nd or 3rd trimester if possible
Explore CBT
If high risk of relapse or mod-severe depression then antidepressant during and after pregnancy

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16
Q

Recommended antidepressants in pregnancy

A

Nortriptyline
Amitriptyline
Imipramine
Fluoxetine

17
Q

Treatment for pregnant women if treated on valproate or carbamazepine

A

Prophylactic folic acid 5mg OD from at least a month before conception
Prophylactic Vit K to mum and neonate after delivery

18
Q

Risk of SSRI in pregnancy

A

Neonatal withdrawal
No increase in risk of major malformation except Paroxetine - VSD and ASD
13.3% risk of spontaneous abortion
Decreased gestational age
Low birth weight
In late pregnancy risk of persistent pulmonary hypertension

19
Q

Risk of Lithium use in pregnancy

A

1 in 10 chance of malformation in first trimester
3x risk of all types of malformations, 8x risk of cardiac malformations
Ebsteins anomaly - 10-20x higher than general population, absolute risk is 1 in 1000

20
Q

When is risk of malformation with lithium greatest?

A

2-6 weeks after conception

21
Q

Impact of lithium use on neonate

A

Hypotonia
Lethargy
Poor reflexes
Respiratory difficulties

22
Q

Risks of use of carbamazepine in pregancny

A

0.5-1% risk of spina bifida, craniofacial abnormalities, growth retardation, developmental delay

23
Q

Risk of birth defect on valproate

A

10% - any malformation
Dose-related
Mostly seen 17-30 days post conception
Increased risk in FHx of neural defects

24
Q

Impact of valproate use on neonate

A
Growth retardation
1-2% neural tube defect risk
10x increase risk of spina bifida
4x risk of VSD and pulmonary stenosis
Digital and limb defects
Low IQ
25
Risk of lamotrigine during pregnancy
3.2% frequency of malformations | Associated with cleft palate
26
Impact of antipsychotic use on neonate
Floppy infants | Withdrawl - irritable, hyper and hypotone, underdeveloped reflexes
27
Risk of congenital malformation with use of antipsychotic during pregnancy
2-2.4% if used in first trimester
28
Which antipsychotics do not have serious effects on newborn
Clozapine - still birth and neonatal seizures have been reported, and gestational diabetes Olanzapine - gestational diabetes Risperidone Quetiapine
29
Use of benzos on pregnancy
``` 0.6% risk of oral cleft and CNS and urinary tract malformation if used in first trimester Neonatal toxicity (withdrawal), respiratory depression, hypotonia ```
30
Lithium treatment programme in pregnant woman
Serum levels checked every 4 weeks, aim for lower end of therapeutic range Level 2 USS and echo of fetus at 6 and 18 weeks for ebsteins Increased dose in 3rd trimester as total body water increases but this reduces abruptly post delivery
31
Things to take into consideration if mother taking psychotropic meds and breast feeding
In preterm immature infants, do not expose to meds as more sensitive and immature LFTs Infants older than 10 weeks are at lower risk of adverse effects if no evidence of accumulation Check infants cardiac, renal and hepatic function first Monitor infants progress, milestones and adverse effects including drowsiness, reduced tone, rigidity, tremor
32
Factors to consider when deciding breast feeding while use of psychotropic in mother
Severity and frequency of SMI in mother Benefits of breast feeding Impact of untreated mental illness on mother and infant Family support Compliance with treatment Patient and family ability to recognise early warning signs Physical health and maturity of infant
33
Recommended antidepressants in breast feeding
Sertraline Paroxetine SSRIs usually safe including fluoxetine and citalopram TCAs - amitriptyline and imipramine
34
Recommended antipsychotic in breast feeding
Olanzapine | Sulpride
35
Recommended mood stabiliser in breast feeding
Avoid if possible | Valproate if essential
36
Recommended sedatives in breast feeding
Lorazepam for anxiety | Zolpidem for sleep
37
Can clozapine be used in breast feeding?
No, contraindicated due to higher conc of albumin in fetal blood
38
Can lithium be used in breast feeding?
No, contraindicated
39
Risk of neural tube defect on valproate
1.5%