MEDI7301 Study Guide - Final Guide: Therapeutic Relationship, Obstetrics, Pediatrics
Post-partum disorders
Introduction
Overview Peri-partum period is the period during, or shortly preceding or following childbirth
(eg few weeks before, during and after)
Post-partum period is defined as the first 12 months after birth; a wide range of
overwhelming emotions (anticipation, excitement, happiness, fulfilment, anxiety, frustration,
confusion, sadness/guilt) are experienced that can make an individual highly vulnerable to
various psychiatric disorders
Antepartum 'treated' depression (during pregnancy) has no increased risk for
adverse obstetric or neonatal outcome, but has high risk for postpartum depressive sx
Aim to avoid drugs when pregnancy is planned
Fluoxetine and paroxetine during pregnancy has increased risk of
ventricular or atrial septal defect
Antidepressant use in 2nd or 3rd trimester has associated increase in
pregnancy and neonatal complications (eg pulmonary HTN in newborn)
Antepartum 'untreated' depression would pose a strong risk for mother (suicide)
and infant (infanticide, neglect, impaired attachment)
Epidemiology of
mental
disorders (peri-
partum)
Higher incidence in Western culture, and younger patients
% women affected (2015 statistics)
Post-partum blues 50-75%
postpartum women
Post-partum depression 10-13%
new mothers
Post-partum psychosis 0.1-0.2%
childbearing women
Severity of
illness
Mild to
moderate
5-6 depressive symptoms
No suicidal behaviour or obvious impairment of functioning
Unlikely to develop complications such as psychotic or catatonic
features
Manage in outpatient or partial hospital settings
Severe Post partum depression on verge of post partum psychosis
7-9 depressive symptoms
Report suicidal ideation and behaviour, demonstrate obvious
impairment of functioning and manifest poor judgement that places the patient
and others (including children) at risk of imminent harm
Possible development of psychotic and catatonic features
Referral to psychiatric + inpatient hospitalisation
Postpartum
check up
Current physical status
Breast feeding currently?
General physical status (C-section wound, endometritis, UTI)
History of pregnancy
Planned/ unplanned
Use of ART
Medical complications of pregnancy
Delivery and health of baby
Baby status
Health
Milestones
Postpartum adjustment
Biological changes Hormonal
Obstetric complications that become permanent
deficits (eg pregnancy -> HTN -> stroke)
Medical illness (eg gestational diabetes)
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Weight gain
Fam/ personal hx of mental illness -> emerges
postpartum
Psychosocial changes Age and maturity, flexibility
Younger (13-14yo) - less repertoire of
coping mechanisms
Older (35+yo) - less flexible in schedule,
harder to adjust to caring for child
Premorbid personality, body image
Relationship with partner - less attention
towards each other, more towards baby
Motivation to have child - planned vs unplanned
Unmet dependency needs
Self-esteem and confidence - difficulties dampen
self-esteem
Expectations of parenthood
"Goodness of fit", temperamental differences
Post-partum
blues
A transient condition characterised by emotional liability whereby peak sx occur
between days 3-10 postpartum
Common in Western countries that lack of strong familial support and bonding; it
may be attributed to hormonal changes in women + stress following delivery
Symptoms
Irritability
Anxiety
Decreased concentration
Insomnia
Crying episodes
Mild rapid mood swings (elation <-> sadness)
No interference with social or occupational functioning
Post-partum
depression
Onset of depression related to newborn that present generally within 4wks
postpartum, however it can develop at any point during the first year
Risk factors
Major contributors = hx of postpartum depression, hx of depression prior
to conception, family hx of depression especially PPD
Minor contributors = poor social or financial support, adverse life events
during postpartum period, young maternal age, single or unstable marital status, partner
violence, hx sexual or physical abuse, poor perinatal physical health, Winter, infants with
health problems or perceived difficult temperaments
Symptoms
Similar to major depressive episode with subtle differences - cannot take
into account sleep disturbance, lack of or changes in energy
Negative perception of infant temperament and behaviour (eg
catastrophizing "it's all a disaster")
Difficulty sleeping when the baby sleeps
Lack of enjoyment in the maternal role or infant's activities
Guilty feelings related to parenting ability
Anxiety about the health of the infant
Panic attacks and obsessional fears/ images of harm occurring to their
babies
Using alcohol, illicit drugs, tobacco
Frequent non-routine visits or telephone calls to obstetrician or
pediatrician
Physical burden of caring for infant, resentment towards having child
Clinical workup
History Presenting complaint
"During the last month, have you been
find more resources at oneclass.com
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Document Summary
Peri-partum period is the period during, or shortly preceding or following childbirth (eg few weeks before, during and after) Post-partum period is defined as the first 12 months after birth; a wide range of overwhelming emotions (anticipation, excitement, happiness, fulfilment, anxiety, frustration, confusion, sadness/guilt) are experienced that can make an individual highly vulnerable to various psychiatric disorders. Antepartum "treated" depression (during pregnancy) has no increased risk for adverse obstetric or neonatal outcome, but has high risk for postpartum depressive sx. Aim to avoid drugs when pregnancy is planned. Fluoxetine and paroxetine during pregnancy has increased risk of ventricular or atrial septal defect. Antidepressant use in 2nd or 3rd trimester has associated increase in pregnancy and neonatal complications (eg pulmonary htn in newborn) Antepartum "untreated" depression would pose a strong risk for mother (suicide) Epidemiology of mental disorders (peri- partum) and infant (infanticide, neglect, impaired attachment) Higher incidence in western culture, and younger patients.
