Perinatal Flashcards
1
Q
Sodium Valproate - Risks in Pregnancy
A
- Risk of foetal birth defect (mainly neural tube) 1:100
- Advise to stop and monitor mood
2
Q
BPAD in Pregnancy - Mania
A
- Haloperidol (SEs: tremors and rigidity) and Olanzapine (SEs: weight gain and sedation) treatments of choice
- ECT indicated if antipsychotics fail
3
Q
BPAD in Pregnancy - Depression
A
- CBT for moderate bipolar depression
- Fluoxetine safest AD for pregnancy - suitable if depression severe and few previous manic episodes
4
Q
BPAD in Pregnancy - Lithium
A
- Risk of Ebstein’s anomaly 0.05-0.1% if exposed in first trimester
- If continued needs level 2 USS at 6 and 18 weeks gestation
5
Q
Post-Natal Depression/Psychosis - Risk Factors Assessment
A
- Any personal or family psychiatric history?
- Pregnancy planned?
- First child? If not age gap?
- How was pregnancy and delivery?
- Any complications?
- Did the baby need any hospital treatment?
- How is relationship with husband? Supportive?
- Other support around you?
- Have you been able to bond with you baby?
- Are you breastfeeding?
6
Q
Postnatal Depression/Psychosis - Risk
A
- Any thoughts of harming yourself?
- Any thoughts of harming baby?
- Any neglect or physical abuse?
- Where is the baby now?
7
Q
Post-Natal Psychosis - Assessment Questions
A
- Worried someone is trying to harm you or your baby?
- How certain?
- Worried something is wrong with your baby?
- Have you had mood swings?
- Have you been confused about time, place and person?
- Have you heard any voices since delivery?
- Do they give you instructions? To harm baby?
- Do you feel someone else can control how you think, act or feel?
8
Q
Postnatal Psychosis - Management
A
- Manage based on risk but admission to hospital - preferably mother and baby unit usually indicated.
- Should have a nurse dedicated to care and supervision of child and lockable nursery
- Mother-baby interactions monitored
- Screen to rule out organic causes e.g. thyroid
- Antipsychotics for psychotic symptoms - sulpride and olanzapine best for breastfeeding
- Lithium good for mania but incompatible with breastfeeding
- ECT if drug treatment fails - very effective in psychosis
9
Q
Lithium and Pregnancy - Risks
A
- Increased risk of heart abnormality called Ebstein’s - increase 10-20x normal although still only 1/1000, risk greatest in weeks 2-6.
- Li usually safe after 26 weeks but can cause issues wieh neonatal lethargy, hypotonia, arryhtmias and goitre.
10
Q
Lithium In Pregnancy - Continuation
A
- Lithium continued if needed - risk of relapse if mood stable and stopped 70% perinatally
- If continued would need extra USS at 2, 6 and 18 weeks.
- Regular U+Es. Li levels monthly then weekly after 36 weeks and within 24 hours of birth.
11
Q
Drug Use In Pregnancy - Assessment of drug use
A
- What current drugs are you using?
- Heroin, cannabis, cocaine, ecstasy, sleeping tablets
- If using daily dependency criterion:
- Do you find yourself craving the drug
- Have you found you need more to have the same effect?
- Do you get withdrawal symptoms if you stop using it?
- (Heroin = muscle aches, stomach cramps, nausea, yawning, rhinnorhea)
- Are you preoccupied with taking the drug all the time?
- Alcohol?
- Smoking?
12
Q
Drug Use In Pregnancy - Assessment of Heroin Use
A
- Which route do you take heroin? Smoking or injecting?
- If injecting sharing needles?
- How much do you use on a typical day? How often?
- How much do you spend? How do you get the money?
- Have you been taking methadone? what dose?
13
Q
Drug Use In Pregnancy - Assessment of Pregnancy Circumstances/Risk
A
- Have you confirmed you are pregnant? How?
- Is this planned or unplanned?
- How do you feel about being pregnant?
- Who is at home with you?
- Do you have any other children? Where are they?
- How is your relationship with your partner?
- Are they supportive?
- Do they also use drugs?
- What is your financial situation like?
14
Q
Drug Use In Pregnancy - Heroin Use Management Initial
A
- Physical examination - nutritional status and needle marks
- Confirm pregnancy
- Bloods including BBV screen
- STD screen
- Aim is to stabilise heroin intake and introduce methadone substition under methadone treatment program - will need admission
- Also education about harm reduction - safe injecting
- Optimise nutrition with folate and iron tablets
- MDT care - drugs and alcohol service, obstretician, neonatologist, anaethetist, social services
- Other substances:
- Cocaine, cannabis and amphetamines stop
- Alcohol detox
- Benzos - lowest dose.
15
Q
Drug Use In Pregnancy - Heroin/Methadone Detox
A
- Detox not recommended in first trimester due to risk of sponteaneous abortion
- In second trimester detox can be safely undertaken with methdone over a 4 week period under care of addiction specialist and obstretician
- Afterwards needs MDT support from psychiatrist, drug prevention workers, psychologist and social worker to prevent relapse
- If methadone continued into third trimester needs increased dose towards end of pregnancy and divided doses to prevent withdrawal
