Perinatal Mental Health and Hypertensive Disorders

Question 1

What are the red flag signs for perinatal mental health problems?

Answer 1

1) Recent change in mental state
2) Thoughts/acts of self harm
3) Estrangement from the infant

Question 2

What are symptoms of post-natal depression?

Answer 2

1) Depression
2) irritable
3) Tired
4) Sleepless
5) Anxious
6) Appetite change
7) -ve Thoughts

Question 3

What are the main complications on baby for PND and PeriNatal Dep?

Answer 3

PND: Emotional disorders in child w/ ^ risk of depression
Peri: Pre-term delivery, Behavioural difficulties and same as PND

Question 4

What are the main problems of peri-natal anorexia and schizophrenia?

Answer 4

PNA: Low birth weight
Schiz: LBW, Preterm and stillbirth

Question 5

What are Baby blues?

Answer 5

Feeling down after giving birth
- Affects 50-85%
- Days 3-10 inc. Crying, irritability and anxiety
Management: Self limiting, emotional support/reassurance

Question 6

What is pre-eclampsia?

Answer 6

Gestation hypertension which affects the kidneys, >20 weeks and >0.3g protein/24 (Proteinuria)

Question 7

What 3 signs of pre-eclampsia are detected at the kidneys?

Answer 7

1) GFR/Renal blood flow decrease
2) Raised uric acid
3) Proteinuria

Question 8

How is pre-eclampsia managed?

Answer 8

1) Prevent eclampsia and further complications
2) Treat raised BP with lanetalol/nifedipine
(Deliver baby if further progressive deterioration in liver or renal function)

Question 9

What are the main signs of pre-eclampsia?

Answer 9

1) Raised BP
2) Proteinuria
3) Retinal vasospasm
4) RUQ tenderness
5) Ankle clonus/brisk reflexes
6) pulmonary oedema

Question 10

What are the main symptoms of pre-eclampsia?

Answer 10

1) Visual changes e.g. blurred vision
2) Headaches
3) EG pain
4) Weight gain
5) Vomiting

Question 11

What is the PP behind pre-eclampsia?

Answer 11

1) Spiral arteries don’t remodel and arteries are tight
2) Increased resistance in the placenta –> Plac ischaemia
3) RAAS activated
4) Poor renal perfusion, HTN, proteinuria and oedema –> Pre-eclampsia

Question 12

What is eclampsia?

Answer 12

Pre-eclampsia and generalised tonic clonic seizures

Question 13

What is the treatment for eclampsia?

Answer 13

1) Give IV MgSO4 (Neuroprotection)
2) Treat HTN (Labetalol)
3) Stabilise mum
4) Deliver baby

Question 14

What are the main RF for developing eclampsia?

Answer 14

1) Very young/old mothers
2) 1st pregnancy
3) Afro-Caribbean
4) Multiple pregnancy
5) Renal disease
6) Existing HTN

Question 15

Define chronic HT?

Answer 15

Patient with high BP diagnosed prior to pregnancy or before week 20, high BP not resolved post partum