Post-Pregnancy 2 Flashcards
1
Q
What is Androgen Insensitivity Syndrome?
A
- Definition: X-linked recessive condition due to end organ resistance to testosterone causing genotypically male children (46XY) to have female phenotype.
-
Features
- ‘Primary amennorhoea’
- Undescended testes causing groin swellings
- Breast development - results of conversion of testosterone to oestradiol
2
Q
How is Androgen Insensitivity investigated and managed?
A
- Investigation: Buccal smear or Chromosomal analysis to reveal 46XY
-
Management:
- Counselling - raise child as female
- Bilateral orchidectomy (increased risk of testicular cancer due to undescended testes)
- Oestrogen therapy
3
Q
How is Post-Partum Mental Health screened?
A
Edinburgh Postnatal Depression scale used for depression screening
- 10-item questionnaire, with a maximum score of 30
- Indicates how the mother has felt over the previous week
- Score > 13 indicates a ‘depressive illness of varying severity’
- Sensitivity and specificity > 90%
- Includes a question about self-harm
Can also use Becks Depression inventory, Brief screen for depression (wholey and arrol), GAD-2
4
Q
Why are post partum mental health problems detected poorly?
A
- Patient factors: stigma, putting on brave face, fear of being considered a bad mother, fear the baby might be taken away, not knowing what is normal, not knowing if treatment will help
- Health professional factors: not asking, time constraints, not recognising risk factors or red flags, normalising or dismissing symptoms, lack of training or confidence, lack of access to specialist services
5
Q
What are red flags when managing mothers with post partum mental health problems?
A
- Disclosure of mental health problems
- Severe depression
- Bipolar disorder
- Recent change in mental health: new/persistent expression of incompetence as parent or estrangement from infant, new thoughts or acts of violence or self harm
6
Q
What are risk factors for Post Partum Mental Health Problems?
A
- Prior diagnosis of mental health illness
- Family history (1st degree relative) of severe perinatal health illness
- History of childhood abuse and neglect
- Interpersonal conflict
- Inadequate social support
- Substance misuse
- Migration status, language and cultural barrier
- Unplanned or unwanted
- Pregnancy complication or traumatic birth
- Foetal or neonatal loss
7
Q
What are types of Pregnancy Related mental illnesses?
A
- ‘Baby-Blues’ or Postnatal blues
- Postnatal depression
- Puerperal psychosis
8
Q
What are features of ‘Baby-Blues’ or Postnatal blues?
A
- Typically seen 3-7 days following birth and is more common in women who have had their first offspring. Subsides within 14 days
- Mothers are characteristically anxious, tearful, low in mood, overreactive and irritable
- Managed with reassurance and support. Health visitor has a key role
9
Q
What are clinical features of Postnatal Depression?
A
- Affects around 15% of women and most cases start within a month and typically peaks at 3 months
- Usual features of depression and fears about baby’s health, maternal deficiencies and marital tensions including loss of sexual interest. Depending on the severity, women may struggle to take care of the baby
10
Q
How is Postnatal Depression managed?
A
- Reassurance and support are important such as modified antenatal classes and postnatal peer support groups
- Cognitive behavioural therapy may be beneficial.
- If severe, referral to specialist perinatal mental health services essential. Certain SSRIs such as sertraline and paroxetine may be used. TCA can also be used
11
Q
What are clinical features of Puerperal Psychosis?
A
- Affects approximately 0.2% of women
- Onset abrupt usually within the first 2-3 weeks following birth and can take form of manic depression or schizophrenia.
- Features include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations). There can also be a high suicidal drive
12
Q
How is Puerperal Psychosis managed?
A
Admission to hospital is usually required.
- Management within special MDT on mother baby unit and majority will recover quickly and fully
- Treatment with antipsychotics, mood stabilisers, anti-depressants
- Electroconvulsive therapy is used with severe depressive psychoses
- CBT in recovery phase
- ∼25-50% risk of recurrence following future pregnancies
13
Q
What are some disease associations for neurological medications used in pregnancy?
A
- Sodium Valproate: increase risk of neural tube defect and neurodevelopmental issues. Contraindicated in women of childbearing age for psychiatric indication
- Carbamazepine: associated with cleft palate
- Lithium: use with extreme caution due to risk of foetal hypotonia, poor reflexes, arrythmia, ebstein’s anomaly, neonatal goitre (thyroid)
- Lamotrigine: increase risk of steven Johnson syndrome
- Olanzapine: associated with foetal macrosomia, GDM
- SSRI: pulmonary hypertension, paroxetine is associated with cardiac defects in particular
14
Q
How should those with mental health problems be counselled pre-conception?
A
- Women on psychotropic medication should be advised not to discontinue treatment if they find themselves pregnancy without consultation with HCP
- Contraception use and pregnancy plans
- Implications of pregnancy and childbirth for mental illness and relapse
- Implications of treatment in pregnancy – effects on mother and baby
- Risk of no treatment or poor compliance
- Psychiatric review
- Option of discontinuation of treatment
15
Q
What are symptoms of Neonatal abstinence syndrome?
A
- Irritability
- Poor gaze control
- Poor feeding, and rarely seizures.
SSRIs have been associated specifically paroxetine. They are self-limiting
