Postpartum Problems And Antenatal And Postpartum Depression Flashcards
Top 3 causes of maternal mortality
Thrombosis/thromboembolism
Maternal suicide
Haemorrhage
Puerperium
Time of delivery - 8wks
What happens during puerperium
Uterus involuted
Most physiological changes of pregnancy return to normal
How much does the uterus involute each day after birth
1cm
What causes uterus involution
Ischaemia
Autolysis of protein
Phagocytosis of elastic/fibrous tissue
What delays uterine invokution
Full bladder
Loaded rectum
Uterine infection
Retained products of conception
Fibroids
Broad ligament haematoma
Postpartum haemorrhage
Excessive blood loss following delivery
2 types of postpartum haemorrhage
Primary/early - 500ml+ lost within 24hrs of delivery
Secondary/late - abnormal bleeding from 24hrs-6wks postpartum
Causes of primary PPH
Uterine atony
Primary PPH management
Tranexamic acid
Biannual uterine massage and compression
Oxytocin agents
Prostaglandins
Suture tears
Barking balloon
B lynch
Uterine artery embolisation
BEBOPS
Causes and treatments of secondary PPH
Infection - antibiotics
Retained products of conception - surgical removal
Thromboembolic disease predisposing factors
Slowing of blood in legs
Endothelial dysfunction
Hypercoagulation
Cytokine surge
Pre eclampsia + hypertension
Thromboembolic disease signs and symptoms
Sudden onset pain
Calf tenderness
Redness
Incr skin temp
Positive homons sign
Homon’s sign
Calf Pain on forced dorsiflexion
Thromboembolic disease treatment
Heparin
Hydration
Why is thromboembolic disease more common after c section
More immobile after birth
Antenatal depression symptoms
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
Factors causing antenatal depression
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
Lifestyle/self help for antenatal depression
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
Antenatal depression treatment
Antidepressants
Counselling
Talking therapy
Baby blues
Rapidly fluctuating mood peaking on 4th/5th day after birth. Doesn’t affect mothers ability to function. Spontaneously remit within 2 weeks
How long do baby blues symptoms last
<2wks
Which questionnaire is used for PPD screening and what score indicates PPD
Edinburgh postnatal depression scale
10+ (or yes on q10 - suicidal thoughts)
When does PPD most frequently occur
1st 4 months after birth
What hormone changes are associated with PPD
Oestrogen progesterone and cortisol fall
Different transcripts of oestrogen and progesterone
What other conditions can make a woman more susceptible to PPD
History of depression/mood disorder
Family history of depression/mood disorder
Gestational diabetes
Sleep disturbance/insomnia
PPD causes
Hormones
Psychosocial factors
Biological vulnerability
Classes of antidepressants
SSRIs
SNRIs
TCAs
Brexanolone - allopregnanolone
What is allopregnanolone
Antidepressant
Analogue of progesterone metabolite
Positive allosteric modulator of GABAa
What is the most severe form of PP psychiatric illness
Postpartum psychosis
When do PPP symptoms develop
1st 2 wks
PPP symptoms
Rapidly evolving manic episode
Restlessness
Insomnia
Irritability
Rapid shifting depression -> elation
Disorganised behaviour
PPP management
Inpatient treatment
Mood stabilisers
Antipsychotics
Benzodiazepines
ECT
Mood stabilisers
Lithium
Valproic acid
Carbamazepine
Do psychotropic medications cross into breast milk
Mostly yes to some degree
Why should women on valproic acid and carbamazepine avoid breastfeeding
Crosses into milk and Can cause Hepatotoxicity in infant
Which antidepressants can cause toxicity in breast milk
Valproic acid
Carbamazepine
Lithium
When may antidepressants be given prophylactically to prevent PP psychiatric illness
Women with bipolar or history of PPP
Effects of PPD on child
Behavioural problems
Delayed cognitive development
Emotional dysregulation
Social dysregulation
Early onset depressive illness
Increased weight gain at 6 months
Pre menstrual dysphoric disorder
Depressive disorder with cyclical patterns associated with lower luteal estradiol levels or heightened sensitivity to normal fluctuations
How can PPD present in men
Aggression
Irritability
Hostility
