Women's Health - Obstetrics Flashcards
Split the spectrum of postnatal depression into 3
give timings post birth
baby blues - 1st week after birth
postnatal depression- 3 months after birth
puerperal psychosis - few weeks (2-3) after birth
Explain Baby Blues
Symptoms
affect 50% women, especially first-time mother.
sx:
- mood swings
-low mood
-anxiety
-irritability
-tearfulness
Why might Baby Blues happen?
significant hormone changes
recovery from birth
fatigue and sleep deprivation
responsibility of caring for neonate
establishing feeding
any other events
How long do symptoms last and what is tx?
mild sx
few days
resolve within 2 weeks of delivery
no tx
Triad of postnatal depression
low mood
anhedonia (lack of pleasure in acitivities)
low energy
cognitive impairement
how long should postnatal depression symptoms last before diagnosing?
at least 2 weeks
treatment of postnatal depression
mild - additional support,self-help, follow up GP
Moderate - SSRI/TCA and CBT/IPT
Severe: specialist psychiatry, mother+baby unit rarely
What is the screening scale for postnatal depression?
Edinburgh postnatal depression scale
assesses how mother felt over past week.
10 qus
total 30 pts.
10 or more is postnatal depression
What psychotic symptoms are experienced for puerperal psychosis?
delucions
hallucintions
depression
mania
confusion
thought disorder
infanticide
cognitive impairement
treatment for puerperal psychosis?
admit to mother and baby unit
hospitalise for safety of mother and child.
cbt
antidepressants,antipsychotics, mood stabilisers
Electroconvulsive therapy (ECT)
What is a mother and baby unit?
specialist unit for pregnant and women given birth in last 12 months.
mother and baby stay together and bond.
supported care for both.
How to manage mental health concerns during pregnancy?
perinatal mental health services
potential complication of SSRI in pregnant women?
presentation:
symptoms:
tx:
neonatal abstinence syndrome.
presents 1st few days postnatal.
sx:
irritability
poor feeding.
supportive mx.
pathophysiology of postnatal depression
hormonal changes
fluctuations in oestrogen and progesterone levels
psychosocial stressors.
pathophysiology of puerperal psychosis?
unknown
hormonal fluctuations
genetic predisposition
sleep deprivation
What is electroconvulsive therapy?
used for severe medication-resistant and psychotic depression.
course of tx : twice weekly for 4 weeks.
general anaethesia
electrods on pts head
electrical current administer
short generalised seizure triggered - 30secs
side effects:
headache
muscle aches
short-term memory loss
Tell me the process of making a baby
fertilisation: sperm meets egg in fallopian tube = zygote
zygote to uterus down from fallopian. divides to blastocyte.
blastocyte implants in endometrium.
blastocyte embeds and develops into embryo.
cells differentiate. 8 weeks becomes fetus.
9 months fetus grows in uterus, nourished by placenta via umbilical cord.
contractions push baby through cervical os and out of vagina.
cervical os gradually dilates
What is an ectopic pregnancy?
life threatening obs emergency
fertilised ovum implants outside uterine cavity: MC fallopian tube (97%)
other sites:
- ovary
-cervix
-abdominal cavity
-entrance to fallopian tube (cornual region)
Risk Factors for Ectopic Pregnancy (EP)
Previous EP
Previous Pelvic Inflammatory Disease
Previous surgery to fallopian tubes
Intrauterine devices (coils)
Older Age
Smoking - impaired tubal function and ciliary beat frequency.
endometriosis
tubal surgery - salpingectomy, tubal ligation, reconstructive surgery impairs tubal function.
ART LIKE IVF
how can endometriosis cause ectopic pregnancy?
presence of endometrial tissue outside uterine cavity can cause tu
What is pelvic inflammatory disease commonly caused by?
chlamydia trachomatis
Neisseria gonorrhoeae
RF for ectopic pregnancy
leads to tubal inflammation, damage and impaired motility.
Pathophysiology of ectopic pregnancy
Clinical Features of Ectopic Pregnancy
typical presentation: female hx of 6-8 weeks amenorrhoea, later presents with lower abdo pain and later develops vaginal bleeding.
lower abdo pain: due to tubal spasm, 1st sx, constant unilateral pain
vaginal bleed: less than normal period. poss dark brown
hx of recent amenorrhoea: typically 6-8 weeks from start of last period. if longer then other cause: inevitable abortion.
peritoneal bleeding: cause shoulder tip pain. pain on defacation/tenesmus secondary to blood pooling in pouch of douglas
dizziness, fainting or syncope
sx of pregnancy eg breast tenderness
Ix -Ectopic Pregnancy
Serum hCG level : viability of pregnancy./ single value not diagnostic. slower than expected rise/decline suggests it. Discriminatory zone (1500-2000 mIU/mL)
TVUS: transvaginal ultrasonography. high res visual of uterus,adnexa.
Abdominal Ultrasonography - when TVUS CI’D. lower sensitivity/specificity.
Doppler Ultrasonography - colour/power supplements TVUS - detect blood flow in trophoblastic tissue of ectopic pregnancies.
on a tvus what would be suggestive of ectopic pregnancy?
adnexal mass
extrauterine gestational sac
complex adnexal fluid colleciton.
empty uterine cavity
absense of intrauterine gestational sac
the above 2 in prescence of high hCG level.
