Single umbilical artery, Postpartum depression

Question 1

How many vessels are in the umbilical cord?

Answer 1

2 arteries
1 vein

Question 2

What is single umbilical artery associated with?

Answer 2

Isolated finding
Congenital anomalies
Aneuplodies

Question 3

What is the mechanism of single umbilical artery?

Answer 3

Atresia or atrophy of previous normal umbilical artery

Question 4

What pregnancies do you see more cases of single umbilical artery?

Answer 4

Twin gestations
Maternal extremes of age

Question 5

What are risk factors for single umbilical artery?

Answer 5

Smoking
Diabetes
HTN
Seizure disorders

Question 6

How can you diagnose single umbilical artery via ultrasound?

Answer 6

1. Ultrasound showing only 2 vessels
2. Color flow doppler in the region of the bifurcation of the fetal aorta shows umbilical vessels only on one side of the bladder

Question 7

What is the management for single umbilical artery?

Answer 7

Assess for structural anomalies of the heart, GI, kidney, CNS system. Assess growth

Question 8

What is postpartum blues?

Answer 8

Mild depressive symptoms that is self limited

Question 9

What are risk factors for postpartum depression?

Answer 9

History of depression in the pregnancy or outside of pregnancy
Stressful life events
Abusive relationship
Lack of support
Anxiety disorder
Adverse pregnancy outcomes

Question 10

How do you diagnose postpartum depression?

Answer 10

Presence of 5 or more symptoms with 1 being either depressed mood or loss of interest

Question 11

What are the symptoms of depression

Answer 11

1. Depressed mood most of the day
2. Loss of interest in pleasurable activities
3. Weight loss
4. Insomnia or hypersomnie
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feeling of guilt
8. Inability to concentrate
9. Suicidal or homicidal ideations

Question 12

What is postpartum psychosis?

Answer 12

An obstetric and psychiatric emergency consisting of symptoms of hallucinations, delusions, manic mood, depressed or low mood, restlessness, fearful, confused

Question 13

When does postpartum psychosis present?

Answer 13

Within 2 weeks of delivery, often within hours or days

Question 14

What are the risk factors for postpartum psychosis?

Answer 14

History of postpartum psychosis
Personal history of bipolar disorder
Family history of bipolar disorder

Question 15

When do you screen for depression in your patients during pregnancy?

Answer 15

Initial prenatal visit
3rd trimester of pregnancy
postpartum visit

Question 16

What screening test do you use?

Answer 16

EDPH screening test

Question 17

What is the EDPH screening test?

Answer 17

Screening tool to assess for depression and anxiety

Question 18

What is a positive EDPH test?

Answer 18

Score of 10 or more

Question 19

What is the management for postpartum depression?

Answer 19

Social work consult
Behavioral medicine referral
Offer SSRI

Question 20

What is the treatment for postpartum psychosis?

Answer 20

Consult psychiatry
Short term benzo or antipsychotic

Question 21

What is the benefit of elective BSO at time of hysterectomy

Answer 21

Reduce risk of ovarian cancer
Reduce risk of breast cancer in premenopausal
Reduce risk of reoperation

Question 22

What are ways to reduce risk of ovarian cancer?

Answer 22

Tubal ligation
Salpingectomy
oral contraceptives
Breastfeeding
Ovarian removal

Question 23

What are the risk of elective ovarian removal?

Answer 23

1. Increased risk of all cause mortality
2. Cardiovascular disease
3. Non ovarian cancer
4. Cognitive impairment
5. Osteoporosis

Question 24

What is recommended when considering elective BSO during hysterectomy?

Answer 24

If normal appearing ovaries recommended to conserve ovaries through age 65