Postpartum Problems And Antenatal And Postpartum Depression

Question 1

Top 3 causes of maternal mortality

Answer 1

Thrombosis/thromboembolism
Maternal suicide
Haemorrhage

Question 2

Puerperium

Answer 2

Time of delivery - 8wks

Question 3

What happens during puerperium

Answer 3

Uterus involuted
Most physiological changes of pregnancy return to normal

Question 4

How much does the uterus involute each day after birth

Answer 4

1cm

Question 5

What causes uterus involution

Answer 5

Ischaemia
Autolysis of protein
Phagocytosis of elastic/fibrous tissue

Question 6

What delays uterine invokution

Answer 6

Full bladder
Loaded rectum
Uterine infection
Retained products of conception
Fibroids
Broad ligament haematoma

Question 7

Postpartum haemorrhage

Answer 7

Excessive blood loss following delivery

Question 8

2 types of postpartum haemorrhage

Answer 8

Primary/early - 500ml+ lost within 24hrs of delivery
Secondary/late - abnormal bleeding from 24hrs-6wks postpartum

Question 9

Causes of primary PPH

Answer 9

Uterine atony

Question 10

Primary PPH management

Answer 10

Tranexamic acid
Biannual uterine massage and compression
Oxytocin agents
Prostaglandins
Suture tears
Barking balloon
B lynch
Uterine artery embolisation
BEBOPS

Question 11

Causes and treatments of secondary PPH

Answer 11

Infection - antibiotics
Retained products of conception - surgical removal

Question 12

Thromboembolic disease predisposing factors

Answer 12

Slowing of blood in legs
Endothelial dysfunction
Hypercoagulation
Cytokine surge
Pre eclampsia + hypertension

Question 13

Thromboembolic disease signs and symptoms

Answer 13

Sudden onset pain
Calf tenderness
Redness
Incr skin temp
Positive homons sign

Question 14

Homon’s sign

Answer 14

Calf Pain on forced dorsiflexion

Question 15

Thromboembolic disease treatment

Answer 15

Heparin
Hydration

Question 16

Why is thromboembolic disease more common after c section

Answer 16

More immobile after birth

Question 17

Antenatal depression symptoms

Answer 17

Severe worry about birth and parenthood
Lack of energy
Disturbed sleep
Losing interest in self and pregnancy
Emotional detachment
Teary, angry, irritable
Chronic anxiety
No interest in sex
Poor concentration
Sense of hopelessness

Question 18

Factors causing antenatal depression

Answer 18

Hormonal imbalance
Previous miscarriages
Difficult birth experiences
History of depression
Isolation
Poor support
Stressful living conditions
Major life events
Unplanned pregnancy
Difficult childhood experiences
Low self esteem
Pressure to do things right

Question 19

Lifestyle/self help for antenatal depression

Answer 19

Reduce stress
Yoga, mindfulness, meditation, relaxation techniques, healthy eating
Talking to friends/family
Avoid caffeine alcohol and smoking
Antenatal classes
Exercise
Don’t stop/change antidepressants without medical advice
Avoid St. John’s wort
Peer support groups
Community mental health team

Question 20

Antenatal depression treatment

Answer 20

Antidepressants
Counselling
Talking therapy

Question 21

Baby blues

Answer 21

Rapidly fluctuating mood peaking on 4th/5th day after birth. Doesn’t affect mothers ability to function. Spontaneously remit within 2 weeks

Question 22

How long do baby blues symptoms last

Answer 22

<2wks

Question 23

Which questionnaire is used for PPD screening and what score indicates PPD

Answer 23

Edinburgh postnatal depression scale
10+ (or yes on q10 - suicidal thoughts)

Question 24

When does PPD most frequently occur

Answer 24

1st 4 months after birth

Question 25

What hormone changes are associated with PPD

Answer 25

Oestrogen progesterone and cortisol fall
Different transcripts of oestrogen and progesterone

Question 26

What other conditions can make a woman more susceptible to PPD

Answer 26

History of depression/mood disorder
Family history of depression/mood disorder
Gestational diabetes
Sleep disturbance/insomnia

Question 27

PPD causes

Answer 27

Hormones
Psychosocial factors
Biological vulnerability

Question 28

Classes of antidepressants

Answer 28

SSRIs
SNRIs
TCAs
Brexanolone - allopregnanolone

Question 29

What is allopregnanolone

Answer 29

Antidepressant
Analogue of progesterone metabolite
Positive allosteric modulator of GABAa

Question 30

What is the most severe form of PP psychiatric illness

Answer 30

Postpartum psychosis

Question 31

When do PPP symptoms develop

Answer 31

1st 2 wks

Question 32

PPP symptoms

Answer 32

Rapidly evolving manic episode
Restlessness
Insomnia
Irritability
Rapid shifting depression -> elation
Disorganised behaviour

Question 33

PPP management

Answer 33

Inpatient treatment
Mood stabilisers
Antipsychotics
Benzodiazepines
ECT

Question 34

Mood stabilisers

Answer 34

Lithium
Valproic acid
Carbamazepine

Question 35

Do psychotropic medications cross into breast milk

Answer 35

Mostly yes to some degree

Question 36

Why should women on valproic acid and carbamazepine avoid breastfeeding

Answer 36

Crosses into milk and Can cause Hepatotoxicity in infant

Question 37

Which antidepressants can cause toxicity in breast milk

Answer 37

Valproic acid
Carbamazepine
Lithium

Question 38

When may antidepressants be given prophylactically to prevent PP psychiatric illness

Answer 38

Women with bipolar or history of PPP

Question 39

Effects of PPD on child

Answer 39

Behavioural problems
Delayed cognitive development
Emotional dysregulation
Social dysregulation
Early onset depressive illness
Increased weight gain at 6 months

Question 40

Pre menstrual dysphoric disorder

Answer 40

Depressive disorder with cyclical patterns associated with lower luteal estradiol levels or heightened sensitivity to normal fluctuations

Question 41

How can PPD present in men

Answer 41

Aggression
Irritability
Hostility