Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OBG: Pregnancy, labour, breast feeding > Psychological aspects of puerperium > Flashcards

Psychological aspects of puerperium Flashcards

1
Q

What is the leading cause of maternal death in the UK?

A

mental illness (majority due to suicide, associated with perinatal depression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When do the majority of maternal suicides occur?

A

between 6 weeks prenatally and 12 weeks postnatally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the best predictor of psychiatric disorder in pregnancy?

A

past history of mental illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are 3 aspects of routine mental health screening in pregnancy?

A
  1. Personal mental health history
  2. Other vulnerability factors, including substance misuse
  3. Family history of bipolar affective disorder (confers genetic vulnerability and a first episode is 7 times more likely to present in the immediate postnatal period)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are 5 reasons why women suffering with recurrent and severe mental disorders who want to have children may benefit frmo pregnancy planning?

A
  1. Relapses are predicted by major life events
  2. Medication holiday an be tried before conception, avoiding complications of relapse on pregnancy
  3. Reproductive toxicology of essential medication can be minimised
  4. Closer antenatal monitoring can be planned in advance
  5. Contingency plans, including those for child protection, can be made with, and shared by, all the relevant agencies and caregivers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are 3 anxiety disorders that are relatively common in pregnancy?

A
  1. Panic disorder
  2. Generalised anxiety disorder
  3. Obsessive-compulsive disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What symptoms of anxiety disorders may be present?

A

pervasive or episodic feafulnes, avoidance, autonomic arousal

excessive reassurance-seeking may be presenting feature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What must you make sure to identify in women who have anxiety in pregnancy?

A

any concurrent depression requiring treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is high antenatal anxiety a predictor for?

A

postnatal depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the preferred way of managing anxiety in pregnancy?

A

psychological management (including cognitive-behavioural therapy) preferable to anxiolytics, but access within timescale of pregnancy may be limited

benzodiazepine use should be avoided

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What type of medication should be avoided in anxiety in pregnancy?

A

benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What proportion of women of childbearing age are affected by schizophrenia?

A

1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some of the clinical features of schizophrenia that may be present during pregnancy?

A

delusions, hallucinations, abnormalities of affect, speech and volition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the recommended management of schizophrenia during pregnancy?

A

maintenance medication usually required throughout pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the lifetime risk of schizophrenia for a child with one affected parent?

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In addition to maternal risks of schizophrenia, what is another potential outcome to consider?

A

significant proportion of patients are unable to care for the child

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What proportion of women of childbearing age are affected by 1. bulimia nervosa 2. anorexia nervosa?

A
  1. 1%
  2. 0.2%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When can patients with anorexia nervosa become pregnant?

A

although it is associated with reduced fertility and fecundity, patients with sub-threshold symptoms can become pregnant - require careful monitoring and management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 4 possible effects of eating disorders on fetal outcome?

A
  1. Fetal growth restriction
  2. Low birth weight
  3. Prematurity
  4. Possible increase in congenital anomalies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does incidence of depression compare postnatally vs antenatally?

A

as common antenatally as it is postnatally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are 8 possible features of depression that may be present during pregnancy?

A
  1. low mood
  2. lack of energy or increased fatigability
  3. loss of enjoyment or interest in usual activities
  4. low self-esteem
  5. feelings of guilt, worthlessness or hopelessness
  6. poor concentration
  7. change in appetite (leading to weight loss or gain)
  8. suicidal ideation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are 3 examples of anticonvulsant mood stabilisers that carry a risk of fetal harm?

A
  1. Carbamazepine
  2. Lamotrigine
  3. Sodium valproate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the major malformation rate of carbamazepine?

A

2.2%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are 3 malformations that can be caused by carbamazepine?

A
  1. Neural tube defects (key one)
  2. Craniofacial abnormalities
  3. Distal digit hypoplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the major malformation rate of lamotrigine?

A

2.1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the key type of malformation that lamotrigine during pregnancy is known to cause?

A

cleft palate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What problems can lamotrigine cause when the mother is breast-feeding?

A

dermatological problems in infants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the major malformation rate of sodium valproate when taken during pregnancy?

A

6%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are 4 fetal affects of sodium valproate when taken during pregnancy?

A
  1. High rate of neural tube defects
  2. Craniofacial abnormalities
  3. Distal digit hypoplasia
  4. Neurobehavioural toxicity (22% of exposed infants develop low verbal IQ)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the advice regarding sodium valproate in pregnancy?

A

should not be prescribed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are 2 reasons why sodium valproate should not be prescribed to women under 18?

A
  1. Increased risk of developing polycystic ovary syndrome (PCOS)
  2. Increased risk of unplanned pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are 2 key effects of benzodiazepines in pregnancy?

A
  1. Increased congenital abnormalities, especially cleft lip and palate
  2. Withdrawal symptoms in baby including hypotonia, respiratory problems, poor feeding (floppy baby syndrome)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What proportion of women with bipolar affective disorder stabilised on lithium relapse within 40 weeks of stopping it (e.g. in pregnancy)?

A

50%

34
Q

What is a fetal risk of lithium in pregnancy when taken in eary pregnancy?

A

risk of Ebstein’s anomaly (tricuspid valve malformation - dlesn’t close properly)

35
Q

What monitoring of lithium needs to be performed during pregnancy?

A

serum levels of lithium should be checked every 4 weeks until 36 weeks, then weekly

36
Q

Where should women taking lithium deliver?

A

consultant-led obstetric unit

37
Q

Why do levels of lithium needed to be measured more ferquently in late pregnancy (weekly from 36 weeks)?

A

plasma volume and GFR increase

38
Q

How can lithium affect a woman in labour and what needs to be done due to this?

A
  • reduced vascular volume and potential dehydration
  • this necessitates careful fluid balance and monitoring of serum lithium levels
39
Q

What are 3 neonatal effects reported in babies when lithium has been taken during pregnancy?

A
  1. Floppy baby syndrome
  2. Neonatal thyroid abnormalities
  3. Nephrogenic diabetes insipidus
40
Q

What is recommended in terms of feeding of the newborn in women who are taking lithium?

A

breastfeeding not recommended

41
Q

If antipsychotics are needed during pregnancy, which are recommended?

A

older antipsychotics such as haloperidol preferred - more data available with no strong evidence of increased malformations

not clozapine

42
Q

Why is clozapine not routinely used in pregnancy and breast-feeding?

A

due to theoretical risk of agranulocytosis in fetus/ neonatae

43
Q

What may be an effective alternative to mood stabilisers in women with bipolar affective disorder?

A

older antipsychotics such as haloperidol

44
Q

What should prescribers bear in mind when prescribing antidepressants during pregnancy?

A

safety is not well-understood

45
Q

Which type of antidepressants have lower known risks than others?

A

Tricyclic antidepressants (amitriptyline, nortriptyline, imipramine)

TCAs have no strong evidence of increased malformations

46
Q

How do tricyclics compare with SSRIs when treating depression in pregnancy?

A

tricyclics have higher fat toxicity index than SSRIs

47
Q

What is the SSRI with the lowest known risk in pregnancy?

A

fluoxetine

48
Q

Which type of SSRI may have an association with cardiac malformations in pregnacy?

A

paroxetine

49
Q

What risk have SSRIs in late pregnancy been associated with in the fetus?

A

increased incidence of persistent pulmonary hypertension in infants

50
Q

What are 3 risks of venlafaxine if used to treat depression during pregnancy?

A
  1. Increased risk of high blood pressure
  2. Increased toxicity in overdose
  3. Increased difficulty in withdrawal
51
Q

Why aren’t SNRIs (duloxetine, venlafaxine) recommended as first-line drugs in pregnancy

A
52
Q

What are 2 types of drugs that are present in breastmilk at relatively high concentrations (so potentially avoid)?

A
  1. Citalopram
  2. Fluoxetine
53
Q

What are 4 types of anti-depressnats that have particularly low concentrations in breastmilk and are recommended for breast-feeding mothers?

A
  1. Imipramine (TCAs)
  2. Nortriptyline (TCAs)
  3. Sertraline (SSRIs)
  4. Paroxetine (SSRIs)
54
Q

How should decisions about psychiatric medication during pregnancy be made?

A

any decision to stop should be made in consultation with specialist

bear in mind period of maximum vulnerablity has often passed by time pregnancy identified

55
Q

What 2 things must be balanced when deciding whether to continue or stop psychiatric medication in pregnancy?

A
  • risk to baby - most psychiatric drugs not associated with significant increase in fetal anomalies
  • risk of relapse during pregnancy should not be underestimated
56
Q

What are 5 areas of risks of continuing maternal psychiatric medication to consider?

A
  1. early fetal exposure
  2. late fetal exposure
  3. delivery and neonatal withdrawal
  4. breast-feeding
  5. longer-term neurobehavioural toxicity
57
Q

What proportion of women are depressed in the postnatal period?

A

10%

58
Q

What is a link between the infant and post-natal depression?

A

link with infant development problems when there are associated difficulties in the mother-infant relationship

59
Q

What are 4 key features of postnatal depression?

A
  1. tearfulness
  2. irritability
  3. anxiety
  4. poor sleep
60
Q

Why is it important to specifically enquire about postnatal depression?

A

can easily be missed, especially with milder cases

new mothers with depression often embarrassed by feelings and reluctant to admit to sadness at a time when they fel they are expected to be happy

61
Q

What are the 3 key points when NICE recommend screning for depression in the mother?

A
  1. Antenatally
  2. 4-6 weeks postnatally
  3. 3-4 months postnatally
62
Q

What are the 3 questions that can be used to screen for postnatal depression?

A
  1. During the past month, have you often been bothered by feeling down, depressed or hopeless?
  2. During the past month, have you often been bothered by having little interest or pleasure in doing things?

If yes to both of these -

  1. Is this something you feel you need or want help with?
63
Q

In addition to the 3 key questions that can be asked to screen for postnatal depression, how else can you screen for it?

A

screening questionnaires such a Edinburgh Postnatal Depression Scale (EPDS)

64
Q

What are 2 methods of management of treatment for mild to moderate postnatal depression?

A
  1. Self-help strategies
  2. Non-directive counselling - ‘listening visits’ by a health visitor
65
Q

What are 2 ways to manage moderate to severe postnatal depression?

A
  1. Antidepressant medication
  2. Psychotherapy (CBT)
66
Q

What should be done for a woman with moderate to severe depression who is breastfeeding?

A

breastfeeding not CI for using antidepressant medication but drugs with low excretion in breast milk such as sertraline are preferred

67
Q

What are 2 risks of postnatal depression in later life?

A
  1. >70% lifetime risk of further depression
  2. 25% risk of depression following subsequent deliveries
68
Q

What should be done for a woman who presents in pregnancy with a history of postnatal depression?

A

will benefit from closer postnatal follow up as 25% risk of recurrence postnatally

69
Q

What is the definition of post-partum ‘baby blues’?

A

brief period of emotional instability starting around 3 days after delivery and resolving spontaneously within 10 days

70
Q

What proportion of women experience the baby blues?

A

over 50%

71
Q

What treatment is usually required for post-partum baby blues?

A

usually responds to support and reassurance

72
Q

What is puerperal psychosis?

A

describes a range of psychotic conditions presenting in the immediate postnatal period

most cases are of bipolar affective disorder, although severe unipolar depression, schizophrenia, and acute physical illnesswith associated organic brain syndrome can all present with psychotic symptoms

73
Q

Within what time frame does puerperal psychosis present?

A

presents rapidly, usually within 2 weeks of delivery

74
Q

How common is puerperal psychosis?

A

following 1-2 in 1000 births

75
Q

What is the associated 1. suicide rate and 2. infanticide rate in puerperal psychosis?

A
  1. 5%
  2. 4%
76
Q

What are 4 risk factors for puerperal psychosis?

A
  1. Personal history of bipolar affective disorder
  2. Previous episode of puerperal psychosis
  3. 1st-degree relative with history of puerperal psychosis
  4. 1st-degree relative with bipolar affective disorder
77
Q

What is the risk of puerperal psychosis in a woman with bipolar affective disorder and a personal or family history of puerperal psychosis?

A

60%

78
Q

What management should be carried out for women at high risk of puerperal psychosis?

A

referred to specialist perinatal mental health services antenatally so appropriate care plan can be developed and use of prophylactic medication following delivery may be considered

79
Q

What is the management of women presenting with puerperal psychosis?

A

urgent psychiatric assessment and treatment

should be admitted due to risks to baby and mother (neglect as well as direct harm) - ideally to specialist mother and baby unit, where maternal-infant relationship can be protected

any decision to admit baby to mother and baby unit must be child-centred

80
Q

What is the key thing to consider when deciding whether to admit a baby to a mother and baby unit?

A

must be child-centred, involve full consideration of longer-term possibility of the baby remaining with the mother if hte mental health problems have been long-standing

81
Q

What are 3 things that treatment of puerperal psychosis may involve?

A
  1. Antidepressant or antipsychotic medication
  2. Mood stabilisers
  3. Electroconvulsive therapy (ECT)
82
Q

What is the prognosis for patients presenting with puerperal psychosis?

A

most make a full recovery, but the 10 year recurrent rate of psychosis (puerperal and non-puerperal) is up to 80%, 10 year readmission rate 60%

OBG: Pregnancy, labour, breast feeding (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions