Puerperium Flashcards
define pueperium?
the period of about six weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition.
characterise baby blues
normal
feeling weepy, irritable, labile mood, possible trouble sleeping
can progress to post natal depression
rx : explain and reassure
what are the risk factors for post natal depression?
1/10 get it - 10%
hx of depression fhx PND young mother martial discord poor social support life events
how does PND present?
fatigue, irritable, anxiety
guilt, ‘failed as mother’, hopeless
thoughts of harming the baby
ivx for PND?
Edinburgh postnatal depression scale:
Self administered questionnaire consisting of 10 questions.
Mothers who score above 12 are likely to be suffering from a depressive illness of varying severity
prognosis of PND?
most respond to rx in a month
increased future risk of PND
Complications of PND?
Depression affects the mother’s capability to function with everyday things, can lead to neglect, self harm etc
Negative Impact on attachment of baby to mother;
baby’s Cognitive, emotional and social development impacted
management for PND?
MILD - self help resources.
Mod- severe:
- High intensity psychological input - CBT
- SSRI or TCA - any (Low dose amitriptyline) - consider which she has had good response to previously
- consider social support etc
Hospital admission should be considered if depression is severe with suicidal or infanticidal ideation. A mother and baby unit (MBU)
Refer to perinatal mental health team
characterise puerperal psychosis?
one in 500–1000 births, 0.1%
usually occurring in the fortnight after childbirth
Onset is usually rapid, often beginning with insomnia,
restlessness, and perplexity.
Later, psychotic symptoms emerge, generally settling into one of three patterns:
• delirium
• affective (psychotic depression or mania)
• schizophreniform (like schizophrenia).
don’t be misled by temporary symptom-free periods.
Exclude an underlying delirium state or substance misuse
(intoxication or withdrawal).
risk factors for puerperal psychosis?
personal or family history of puerperal psychosis
or BPAD.
Other risk factors:
puerperal infection
obstetric complications
management of puerperal psychosis?
prognosis?
Antipsychotics, mainly
Others; antidepressants, or lithium may be needed, and benzodiazepines may be added to control agitation.
In severe cases; ECT
Admission to an MBU
others; Video Interaction Guidance (VIG):
a relationship-based intervention which helps parents become more sensitive and attuned to their child’s emotional needs
Most recover within 6–12 weeks
Risk of recurrence is about a third 33%
what is the perinatal period?
9 months pregnancy + 1 month post delivery
what is the onset period for postnatal depression?
Can develop anywhere between 2 weeks to 1 year after birth.
What are some red flags that can alert you of postnatal depression?
- recent significant changes to Mother’s mental state
- Expressing intent (thoughts or acts) to commit suicide / acts of violence/ self harm
- Growing estrangement from the baby and /or new persistent expressions of incompetency.
A woman is looking to get pregnant. she has a hx of BPAD and is on lithuim. You help her weigh up the positives and negatives of staying on lithium around pregnancy. she decides to stay on it.
what do you need to advise her now?
A feotal echocardiogram will be arranged (ebsteins anomaly) - essential
1g Total lithium dose will be broken up into smaller doses throughout the day -> 300mcg. cant be less because subtherapeutic doses as dangerous as too high dose.
lithium monitored monthly but weekly in last trimester - avoid feotal toxicity
go on maternity leave early, rest and avoid stress.
gradual discontinuation of lithium before labour - reduce risk of feotal toxicity
