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OB > post partum > Flashcards

post partum Flashcards

1
Q

prevalence or perinatal depression

A

Major depression during pregnancy
9.4 – 12.7%

  1. 1% in first 3 months
  2. 9% in first 12 months
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2
Q

prevalence of depression in MDD

A

25%-30% of women with history of MDD are at risk for postpartum depression

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3
Q

postpartum blues peaks

A

Features: tearfulness, lability, reactivity

different than postpartum depression

Peaks 3-5 days after delivery

Present in 50-80% of women

Common for women to feel this after their baby’s birth, but for 1 in 7 women this progresses to more serious mood disorder of PPD

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4
Q

blues correlate with the magnitude of the drop in

A

estrogen

these recptors are concentrated in the brain during pregnancy and the experience

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5
Q

how to progesterone play a role in blues

A

allopregnalone is the progesterone metabolite

this is a GABA agonists and CNS GABA levels & sensitivity may decrease during pregnancy as an adaptation

The reduced brain GABA may recover more slowly in women with “blues”

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6
Q

oxytocin

A

1 thing that helps uterus go back to normal post delivery

Peripheral effects include uterine contraction and milk ejection

disruption in oxytocin affects maternal behavior negatively
The normal heightened emotional responsiveness caused by oxytocin may predispose to depression in the context of high stress and low social support

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7
Q

criteria for MD

A

At least one of the following (by self-report or others’ observations) for 2 weeks

Depressed mood most of the day, nearly every day

Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

four or more:

Changes in weight and appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feeling worthless or guilty
Impaired concentration, indecisiveness
Thoughts of death
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8
Q

Clinical Features of Postpartum Depression

A

Depressed, despondent and/or emotionally numb

Sleep disturbance, fatigue, irritability

Loss of appetite

Poor concentration

Feelings of inadequacy

Ego-dystonic thoughts of harming the baby

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9
Q

clinical presentation peaks

A

Clinical presentation peaks 3-6 months after delivery

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10
Q

by DSM -IV definition postpartum depression beings when

A

Begins within 4 weeks of birth
by DSM-IV definition

Postpartum period considered up to 1 year

Related to environmental stressors

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11
Q

Postpartum Psychoses

A

Bipolar disorder
Major depression with psychotic features
Schizophrenia spectrum disorders
Medical conditions (e.g. thyroid disease, low B12)
Drugs (e.g. amphetamines, hallucinogens, bromocriptine

1-2 per 1,000 women giving birth
About 35% of women with bipolar diathesis

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12
Q

onset of postpartum psychoses

A

Onset usually within 3 weeks postpartum

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13
Q

sxs of psychoses

A

Delusions (e.g. baby is possessed by a demon)

Hallucinations (e.g. seeing someone else’s face instead of baby’s face)

Insomnia

Confusion/disorientation (more than non-postpartum psychoses)

Rapid mood swings (more than non-postpartum psychoses)

Waxing and waning (can appear and feel normal for stretches of time between psychotic symptoms)

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14
Q

Factors That May Contribute To Risks Associated With Antenatal Depression

A

Indirect effects
Reduced prenatal care
Less optimal nutrition
Poor appetite and weight loss

Socioeconomic deprivation

Increased use of cigarettes and alcohol

Direct effects
Changes in cortisol & HPA
axis development

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15
Q

Effects of Untreated Depression on Obstetric Complications

A

Low birth weight
Premature birth
Pre-eclampsia

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16
Q

effects of antenatal depression

A

Newborns cry excessively and are more inconsolable

Babies (up to age 1) have poorer growth and increased risk of infection

Children (up to age 5) have more difficult temperaments, more distress, sadness, fear, shyness, frustration

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17
Q

Early Consequences of Untreated Postpartum Depression for Offspring

A

Sometimes none

Disturbed mother-infant relationship

Cortisol elevation (baby and mother)

Failure to thrive

Physical injury/death

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18
Q

Later Consequences of Prolonged Maternal Depression for Offspring

A

Depression

Behavioral disturbance, including conduct disorder

Reduced cognitive abilities

More school problems (truancy, dropping out)

Role reversal

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19
Q

Effects of Maternal Stress and Anxiety During Pregnancy (5)

A

Altered fetal hemodynamics and movement

Lower gestational age

Lower infant birth weight

Lower Apgar scores

Enduring changes in cortisol measures in offspring – so far observed up to age 10

20
Q

Potential Effects of Postpartum Depression on Relationships

A

Altered roles within the couple

Altered roles within the extended family

Establishing alternate caregiver patterns that become difficult to change later

Impaired communication

Psychiatric symptoms in the partner

21
Q

increase risk of suicide in post partum depression

A

Pregnancy is unwanted, especially when woman wanted an abortion but could not obtain one
Partner abandoned woman during pregnancy
Woman has had prior pregnancy loss and/or death of children

22
Q

prevalence of thoughts of harm: low risk

A

Common in non-psychotic PPD – 41% of depressed mothers vs 7% of controls

ego-dystonic (obsessive in nature & odd/frightening to mother)

Mother has taken steps to protect baby (distance)

23
Q

Thoughts of Harming Baby: High Risk

A

Mother has delusional beliefs about the baby
e.g. that the baby is a demon
Thoughts of harming baby are ego-syntonic
mother thinks they are reasonable and/or feels tempted to act on them
Mother has a history of violence
Mother has labile mood and/or impulsive behavior

24
Q

attachment theroy impacts

A

Infants of depressed mothers are at high risk for developing an insecure attachment

Relational problems between infants and their caregivers are connected to early social, emotional, and behavioral problems for children

25
Q

child views caretaker as unresponsive (possibly rejecting) and her/himself unworthy of love

A

Insecure attachment

Insecurely attached child at risk for later behavior disorders, mood disorders, and delayed cognitive development

26
Q

Screening for Peripartum Depression should include

A

Edinburgh Postnatal Depression Scale (EPDS)

27
Q

disadvantages of EPDS

A

Screening for Peripartum Depression

28
Q

Hoe to use EPDS

A

Maximum score: 30

Always look at item 10 [suicidal thoughts]

Sensitivity and specificity vary according to the chosen cut-off score
Validated cut off score of 10-
13

Use an assessment tool to further evaluate women with high scores

29
Q

which item in the PEDS is responsible for suicidal thoughts

A

10

30
Q

benefits of PHQ9

A

Ability to treat according to DMSV

31
Q

What are you looking for with treatment associated with DSM V

(what is positive and how should the score change after treatment)

A

A score of 5 or above out of 27 is considered positive

Initial treatment response: drop in score of 5 or more from pre-treatment baseline after 4 weeks of treatment

50% decrease in score after 8 weeks of treatment

32
Q

what should remission look like of PHQ9

A

Remission: post-treatment score < 5

33
Q

Best validated screening for peripartum populations

A

EPDS

34
Q

Enoxaparin

A

is an anticoagulant used in the treatment of venous thromboembolic disease. Although pulmonary embolism is on the differential for a pregnant patient with shortness of breath and hypoxia, preeclampsia is more likely in this clinical scenari

35
Q

why would Furosemide not be indicated in preeclampsia

A

(a loop diuretic) is not first line in the treatment of preeclampsia since the pathophysiology involves vasoconstriction and hemoconcentration, not fluid overload

36
Q

What underlying process should be suspected if preeclampsia develops in the first trimester of pregnancy?

A

molar pregnancy

37
Q

When membrane rupture occurs before 37 weeks gestation*

A

PROM

38
Q

nitrazine testing that would indicate PROM*

A

a pH of 7.1–7.3 as opposed to a normal pH of 3.5–6.0

39
Q

Chorioamnionitis *

A

Chorioamnionitis, an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection.

40
Q

brexanolone

A

progesterone analog

hormonal component dn injection instead of just a SSRI

41
Q

What is the most common cause of postpartum hemorrhage?

A

uterine atony

when the uterus fails to contract after the delivery of the baby

42
Q

Postpartum hemorrhage (PPH) is defined as

A

> 500 mL of blood loss after vaginal delivery or > 1,000 mL of blood loss after cesarean delivery

43
Q

brexanolone

A

progesterone analog

hormonal component dn injection instead of just a SSRI

44
Q

What is the most common cause of postpartum hemorrhage?

A

uterine atony

when the uterus fails to contract after the delivery of the baby

45
Q

Postpartum hemorrhage (PPH) is defined as

A

> 500 mL of blood loss after vaginal delivery or > 1,000 mL of blood loss after cesarean delivery

OB (14 decks)

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