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164 Cards in this Set
- Front
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What are the Implications of Delayed Pregnancy - Advanced Maternal Age?
7 Things. |
Pre-existing conditions
Preterm labor - Small gestational age/Low birth weight IUGR - Intra-uterine growth retardation PIH - Abruption C-section - Older women often times don't have labors that progress as usual. Uterine fibroids - Post Partum hemorrhage Chromosomal Abnormalities |
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If a baby isn't at least 5lbs or greater, at birth, they are susceptible for what two things?
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Preterm Labor: Small gestational age/Low birth weight.
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What are the four main things to assess with advance maternal age?
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1. Pre-existing medical conditions
2. Fetal growth and development 3. Anxiety 4. Psychosocial issues (career vs. baby) |
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This is also known as miscarriage.
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Spontaneous Abortion
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This is defined as the loss of a fetus during pregnancy due to natural causes before fetal development has reached 20 weeks, this is naturally occurring.
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Spontaneous Abortion
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What is the loss rate in women who have first trimester bleeding?
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20%
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What things cause an increase in the risk of spontaneous abortion?
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Increasing maternal age, paternal age, and parity
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threatened abortion?
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(pregnancy may continue)
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inevitable abortion?
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(pregnancy will not continue and will proceed to incomplete/complete abortion)
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incomplete abortion?
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(products of conception are partially expelled)
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complete abortion?
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(products of conception are completely expelled)
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when the woman herself provides this information, or when such information is provided by a health worker or a relative (in the case of the woman dying), or when there is evidence of trauma or of a foreign body in the genital tract.
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Certainly induced abortion:
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when the woman has signs of abortion accompanied by sepsis or peritonitis, and the woman states that the pregnancy was unplanned (she was either using contraception during the cycle of conception or she was not using contraception because of reasons other than desired pregnancy).
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Probably induced abortion
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if only one of the “probably” induced conditions listed above is present.
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Possibly induced abortion
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if none of the conditions listed above is present, or if the woman states that the pregnancy was planned and desired.
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Spontaneous abortion
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Spontaneous Abortion Etiology: Infectious
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Mycoplasma, Toxoplasmosis, Listeria
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Spontaneous Abortion Etiology: Environmental
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Alcohol abuse, Smoking
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Spontaneous Abortion Etiology: Uterine
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Septum, Fibroids, Synechiae, Cervical Incompetence
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Spontaneous Abortion Etiology: Systemic Disease
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Thyroid, Diabetes
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Spontaneous Abortion Etiology: Paternal factors
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Chromosomal translocation
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Spontaneous Abortion Etiology: Fetal Factors
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Chromosomal 50% of 1st trimester abortions caused by chromosomal anomalies
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These symptoms are a sign of what?
Vaginal bleeding in almost all patients Cramping and pelvic pain very common Hemorrhage can lead to syncope from hypovolemia/shock Often discovered when fetal heart activity cannot be detected on exam |
Spontaneous abortion
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You can see this in the ER and it can result in significant vaginal bleeding.
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Incomplete abortion - Some products of conception have been expelled but not all.
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1 in every 4 pregnancies
1st TM bleeding/cramping Half will abort, Half will be OK Bedrest will not prevent abortion but may postpone it. |
Threatened abortion
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Some tissue remains behind
Continuing bleeding/cramping Tissue in cervical os Uterus tender Fever if infection present Ultrasound helpful if available |
Incomplete spontaneous abortion
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How do you manage threatened abortion?
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Educate pt. re: signs and symptoms
Pt. to be seen as soon as symptoms occur Check fetus by U/S Bedrest, no sexual activity for 2 weeks after bleeding stops |
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How do you manage inevitable abortion?
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No false reassurance
Check by U/S for complete vs. incomplete Refer for Dilatation & Curettage RhoGAM |
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How do you manage incomplete abortion?
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Hospitalization
Before 14 wks – D&C + IV Pitocin After 14 wks – Pitocin or Prostaglandins |
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How do you manage a missed abortion?
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Wait 3 to 5 wks for spont Ab (93%)
Monitor for DIC |
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What do you education the patient about in post abortion?
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Bleeding
cramping X 1-2 wks vaginal rest X 1 wk check temp BID f/u in 2 wks |
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1. Initial symptom is vaginal bleeding
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Threatened abortion
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2. Membranes rupture and cervix dilates
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Inevitable abortion
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3. Some, not all, products of conception are expelled.
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Incomplete abortion
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4. Treatment includes D&C
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Incomplete abortion
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5. All products of conception passed
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Complete abortion
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6. All unsensitized Rh neg women should receive RhoGAM
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Threatened abortion
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7. May be treated with bedrest
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Threatened abortion
Complete abortion |
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8. Retained dead fetus
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Incomplete abortion
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9. May be complicated by DIC
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Incomplete abortion
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10. Pregnancy may continue
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Threatened abortion
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This is any pregnancy
that occurs outside the uterine cavity. Pregnancies in the fallopian tube account for 97 percent of these. |
Ectopic Pregnancy
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What are the three highest odds ratio risk factors leading to ectopic pregnancy?
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Previous tubal surgery - 21.00 odds ratio
Previous ectopic pregnancy - 8.3 odds ratio In utero diethylstilbestrol exposure - 5.6 odds ratio Previous genital infections - 2.4-3.7 odds ratio |
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This is a risk factor that affects many women that can lead to ectopic pregnancy.
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Previous genital infections
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Lists the sites of ectopic pregnancy from 1. site closest to ovary to 4. site furthest away from ovary.
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1. Fimbrial
2. Ampular 3. Isthmic 4. Interstitial |
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The following are signs and symptoms for what?
Missed Period Abdominal Pain Vaginal Spotting Rupture ↓ BhCG levels No gestational sac on U/S |
Ectopic pregnancy
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What is the medical management option for ectopic pregnancy?
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Methotrexate
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This is known to have the fallowing features?
Toxic to Trophoblast Cells Minimal Side Effects May Preserve Fertility in Cases of Cervical Pregnancy Requires Compliant Patient, Time - need to measure beta hcg Pain Not Uncommon BSU May Rise Initially |
Methotrexate
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Ectopic Summary
Ectopic Pregnancy is a Common, Treatable Problem Sensitive BSU Assays Allow Early Detection Surgical and Medical Options Exist Ruptured Ectopics Should be Unusual with Compliant Patients and Appropriate Medical Care |
Ectopic Summary
Ectopic Pregnancy is a Common, Treatable Problem Sensitive BSU Assays Allow Early Detection Surgical and Medical Options Exist Ruptured Ectopics Should be Unusual with Compliant Patients and Appropriate Medical Care |
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Two distinct types of hydatidiform moles are:
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Complete (or classic): mole results from fertilization of egg with lost or inactivated nucleus
Partial mole: result of two sperm fertilizing a normal ovum |
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What are the Signs and Symptoms of a hydatiform mole?
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Vaginal bleeding leading to anemia
Increased Uterus size and cramps No Fetal Heart Tones Increased Nausea and Vomiting Early Pregnancy Induced Hypertension |
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What is the therapeutic management for hydatiform mole?
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Vacuum aspiration and curettage. This must be removed due to future cancer risk.
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Malposition of the placenta in the lower uterine segment
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Placenta previa
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body of placenta overlaps the entirety of the cervical os
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Complete Placenta previa
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placental edge covers (totally or partially
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Partial Placenta previa
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Edge of placenta near, but not over the cervical os. Placenta extends to the margin of the internal cervical os
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Marginal Placenta previa
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What are the signs of Placenta previa?
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Hallmark sign is painless vaginal bleeding with sudden onset
Bleeding usually occurs in third trimester (but can start in the second trimester) Malpresentation |
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The following are associated factors with what?
Multiparity Maternal age >35 Previous experiences with this Previous uterine surgery (including c/s) Multiple gestation Smoking |
Placenta previa
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What are the five things associated with the management of Placenta previa?
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Ultrasound to try to determine placental placement
Avoid digital exams Expectant management if no symptoms/no active bleeding If active bleeding, management will be determined by gestational age, severity of bleeding, and fetal status. If active bleeding and mother and/or baby symptomatic for blood loss delivery is indicated usually via c/s |
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What is absolutely essential with any pregnant patient if they present with bleeding in the 2nd or 3rd trimester?
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Do NOT do a pelvic exam, but rather an ultrasound.
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How do you manage placenta previa if the mother is stable and the fetus is immature?
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Bedrest
No sexual activity Report bleeding |
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How do you manage placenta previa if the fetus is over 36 weeks old?
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Amnio to assess lung maturity
Delivery |
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When managing a patient with placenta previa, and you see positive signs of hypovolemia in the mother what do you do?
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Delivery
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A 19 year old primagravid woman is expecting her first child; she is 12 weeks pregnant by dates, she has vaginal bleeding and an enlarged for dates uterus. In addition, no fetal heart sounds are heard. What is the most likely dx?
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The history, clinical picture, and ultrasound of the woman described in the question are characteristic of hydatidiform mole. The most common initial symptoms include an enlarged-for-dates uterus and continuous or intermittent bleeding in the first two trimesters. Other symptoms include hypertension, proteinuria, and hyperthyroidism. Hydatidiform mole is 10 times as
common in the Far East as in North America, and it occurs more frequently in women over 45 years of age. A tissue sample would show a villus with The condition of women who have hydatidiform moles but no evidence of metastatic disease should be followed routinely by hCG titers after uterine evacuation. Most authorities agree that prophylactic chemotherapy should not be employed in the routine management of women having hydatidiform moles because 85% to 90% of affected patients will require no further treatment. For a young woman in whom preservation of reproductive function is important, surgery is not routinely indicated. |
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Premature separation of the normally implanted placenta.
Can be partial or complete Bleeding may be revealed (vaginal bleeding) or occult Can occur from mid-trimester (second) onward Incidence 0.45-1.3% of deliveries |
Placental Abruption (Abruptio Placentae)
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What are the associated factors with Abruptio Placentae?
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Maternal hypertensive disorders (present in 50% of women with placental abruption)
Advanced maternal age Advanced maternal parity - Multiple pregnancy Abdominal trauma Cocaine use Maternal smoking Chorioamnionitis Sudden uterine decompression-usually in accident- (rupture of membranes in polyhdramnios or between deliveries of multiple gestations) External cephalic version-in OB when a woman has a breech baby Placental abruption in a previous pregnancy (10% recurrence rate) |
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What are the signs of Abruptio Placentae?
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Hallmark sign is painful vaginal bleeding
Colicky abdominal/back pain Non-reassuring fetal heart rate tracing Intrauterine fetal death Uterine tenderness/uterine irritability Contractions Uterine enlargement Couvelaire uterus – in a major abruption blood extravasates into myometrium causing uterus to become “woody hard” and fetal parts will no longer be palpable” DIC Maternal shock |
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Pathologic form of diffuse clotting causing widespread external and internal bleeding
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Disseminated intravascular coagulation (DIC)
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What is the management for abruptio placentae?
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Delivery (with preparations for massive postpartum hemorrhage)
If mother symptomatic/deteriorating, urgent delivery irregardless of fetal maturity If fetus very immature and maternal and fetal vital signs are stable, tocolytics for uterine quiescence may be considered If fetus alive and viable urgent delivery by cesarean section unless vaginal delivery imminent (vaginal delivery preferred unless contraindications) Resuscitation/correction of hypovolemia Correction of coagulopathy |
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What are the signs and symptoms of an incompetent cervix?
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advanced cervical dilation
low abdominal pressure bloody show urinary frequency |
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What is the Tx for incompetent cervix?
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cerclage
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What are the signs and symptoms of premature labor/rupture of membranes?
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contractions
cramps backache diarrhea vag d/c ROM |
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What is the Tx for premature labor/rupture of membranes?
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Tocolytics
IV hydration Bedrest Steroids, if needed ABX, if needed |
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What are the tocolytics?
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Agents that have been used as tocolytics (drugs that inhibit myometrial contractions) include ethanol (no longer used), ß-sympathomimetics, magnesium sulfate, calcium channel blockers, NSAIDs, and nitroglycerin.
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What are the signs and symptoms of postterm pregnancy?
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Wt loss
Decrease uterine size Meconium in Amnionic Fluid |
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What are the risks for postterm pregnancy?
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Increased fetal mortality
cord compression meconium aspiration LGA leads to shoulder dystocia leads to CS episiotomy/laceration depression |
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How do you treat postterm pregnancy?
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fetal surveillance
Non stress test, Contraction stimulating test, Bile physical profile-do U/S to measure fluid and check fetal movement Q wk mom monitors mvmt Induction Pitocin (10-20U/L) @ 1-2 mU/min every 20-60 min |
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Every week after __ weeks the placenta becomes unstable?
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40 weeks
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What are two disorders of amniotic fluid?
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Polyhydramnios and Oligohydramnios
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What are the Signs and Symptoms of Polyhydramnios?
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uterine dist
dyspnea edema of lower extr |
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How do you TX polyhydramnios?
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therapeutic amniocentesis
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What are the risks for oligohydramnios?
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cord compression
musculoskeletal deformities pulmonary hypoplasia |
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What is the TX for oligohydramnios?
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amnioinfusion
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What is the primary cause of oligohydramnios?
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Not enough fluid due to the mother's kidneys
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What is a usual cause of polyhydramnios?
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Usually abnormalities in fetal kidneys.
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Risks of multifetal gestation -
Twins are at greater risk for all of these? |
PIH
GDM PPH Anemia UTI PTL Placenta previa CS |
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What are the signs and symptoms of fetal Rh incompatibility?
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Hyperbilirubinemia
jaundice Kernicterus (severe neuro d.o. r/t increased bili) anemia hepatosplenomegaly Hydrops fetalis |
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How do you prevent Rh incompatibility?
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RhoGAM at 28 weeks (unsensitized women only)
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How do you manage Rh incompatibility postpartum?
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check direct Coomb’s
RhoGAM to mom if baby is Rh+ (within 72 hrs of birth) |
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What are the signs and symptoms of hyperemesis gravidarum?
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Decreased Intake and decreased Output
Weight loss Ketonuria Dry mucous membranes Poor skin turgor |
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How do you TX hyperemesis gravidarum?
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IVF, Total parenteral nutrition
antiemetics advance diet as tol |
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1 check GTT (24 - 28 wks)
drink 50g glucose, if 1 check is BS > 140 what do you do? |
3 check GTT
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3 GTT
hi carb diet X 2 days, then NPO after MN FBS, then drink 100g glucose, check 1, check 2, check 3 BS What do you look for in the results? |
Gestational Diabetes is diagnosed with FBS > 105 or with 2 of the following BS results:
1 check > 190, 2 check > 165, 3 check > 145 |
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What are the maternal effects with pre-existing DM?
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Increased risk of
PIH (pregnancy induced HTN) Cystitis DKA (diabetic ketoacidosis) Spontaneous Abortion |
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What are the fetal effects with pre-existing DM?
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NTD’s (neural tube defects)
Cardiac defects Increased risk of Macrosomia - really big baby or IUGR (intrauterine growth retardation) Polycythemia hyperbilirubinemia |
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How do you TX pre-existing DM in pregnant patient?
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Team approach
Monitor glycosylated Hgb A Diet: 50% carb, 20% prot, 30% fat Insulin TID Hourly glucoses during labor NST’s (nonstress tests) weekly (starting at 28-30 wks) Amniocentesis (check lung maturity) - Macrosomia that occurs causes big baby with immature lungs |
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What are the maternal effects of gestational diabetes?
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UTI
hydramnios PROM/preterm labor shoulder dystocia episiotomy/lacerations Cesarean Section HTN |
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What are the fetal effects of gestational diabetes?
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macrosomia
hypoglycemia at birth RDS (respiratory distress syndrome) |
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What is the TX of gestational diabetes?
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30 to 35 cal/kg/day (3 meals, 2 snacks)
Insulin check FBS, post-prandial BS’ Q week Non Stress Test, Bio Physical Profile Q weekly glycosylated Hgb A Amniocentesis (check lung maturity) |
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What is involved with patient education in diabetes and pregnancy?
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Glucose monitoring
insulin administration type, onset, peak, duration, times, sites, injection technique diet s/s hypoglycemia tremors, pallor, cold/clammy skin give milk & crackers or glucagon inj s/s hyperglycemia fatigue, flushed skin, thirst, dry mouth, check glu, call MD for insulin order |
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What are the maternal affects of sickle cell disease?
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Pain
Jaundice Pyelonephritis PIH/Preeclampsia Leg ulcers CHF |
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What are the fetal effects of sickle cell disease?
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Intrauterine growth retardation
Small for gestational age Skeletal changes |
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What is considered the "toxemia" of pregnancy?
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Pregnancy Induced Hypertension
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What things are factors in Pregnancy Induced Hypertension?
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Elevated BP (>140/90)
Proteinuria (>300 mg in 24 hours) Weight Gain (>2 pounds/week) Swelling (?) Increased reflexes (Clonus) |
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What is classified as hypertension in pregnancy?
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BP ≥ 140 mmHg systolic or 90 mmHg diastolic with proteinuria (>300mg/24 h) after 20 weeks gestation
Can progress to eclampsia (seizures) |
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New onset proteinuria after 20 weeks in a woman with hypertension
Or Sudden, 2-3 fold increase in proteinuria, sudden increase in BP, thrombocytopenia, and/or elevated AST or ALT in a woman with hypertension and proteinuria prior to 20 weeks gestation |
Chronic Hypertension with Superimposed Preeclampsia
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Hypertension without proteinuria occurring after 20 weeks gestation
May represent preproteinuric phase of preeclampsia or recurrence of chronic HTN May evolve to preeclampsia If severe, may result in higher rates of premature delivery and IUGR than mild preeclampsia |
Gestational HTN
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Retrospective diagnosis
BP return to normal by 12 weeks postpartum May recur in subsequent pregnancies Predictive of future primary HTN |
Transient HTN
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Microvascular, vasospastic, hypertensive disorder of the second half of pregnancy
Consistently one of the top three causes of maternal mortality in U.S. Affects approximately 5%-8% of pregnancies |
Preeclampsia
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What are the risk factors for preeclampsia?
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Nulliparity
Multiple gestation Chronic HTN ≥ 4 years duration Family history of preeclampsia Preeclampsia or HTN in a previous pregnancy Renal disease Extremes of age Antiphospholipid syndrome |
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The development of trophoblastic prostacyclin deficiency is a pathophysiological sign of what?
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Preeclampsia
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What are the three significant diagnostic criteria for severe preeclampsia?
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BP >160-180 mmHg systolic or >110 mmHg diastolic
Proteinuria >5 g/24 hours Cerebral or visual disturbances (headache, dizziness, tinnitus, drowsiness, change in respiratory rate, tachycardia, fever) |
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If you see a grand mal seizure in a pregnant woman it can mean what?
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Full blown eclampsia
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What do you TX Preeclampsia with?
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MgSO4
4-6 gm IV loading dose over 15-20 minutes 2-3 g/hr IV infusion maintenance dose |
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What are the guidelines for MgSO4 therapy in Preeclampsia?
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Monitor urine output, patellar reflexes, respiratory rate and magnesium level
Have calcium gluconate available 1-g dose (10mL of a 10% solution) IV over 2 minutes as antidote Remember that magnesium sulfate is not an antihypertensive agent; goal of mag therapy is to prevent seizures |
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At what dose are the patellar reflexes lost with MgSO4?
At what dose does respiratory arrest occur with MgSO4? |
Platellar reflexes lost at 8-10 mEq/L
Respiratory arrest at 13 mEq/L |
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What is the therapeutic plasma level for MgSO4?
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4-7 mEq/L therapeutic plasma mag level
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Variant of severe preeclampsia
Affects approximately 12% of patients with preeclampsia Characterized by: Hemolysis Elevated liver enzymes Low platelets Not primarily a disease or primigravidas May not meet BP criteria for severe preeclampsia Known as the “great masquerader” because clinical presentation and lab findings may suggest many diseases |
HELLP
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What are the signs and symptoms of HELLP?
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BP mildly elevated
Proteinuria +/- Malaise almost 100% Gastrointestinal symptoms Frequently referred Frequently misdiagnosed |
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What three things make the diagnosis of HELLP?
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Hemolysis
Abnormal peripheral smear Elevated Bilirubin (>1.2 mg/dl) Increased Lactic Dehyrogenase (> 600 U/L) Elevated Liver Enzymes SGOT (> 70 U/L) LDH (> 600 U/L) Low Platelets < 100,000 |
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What complications can occur from HELLP?
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Abruption (7-20%)
Acute renal failure Hepatic hematoma Liver rupture Ascites Hemorrhage Fetal death Maternal death |
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What is the management for HELLP?
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Deliver the baby
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What are the complications of eclampsia?
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Placental abruption
Perinatal asphyxia Maternal hemorrhage Cerebrovascualr damage Severe respiratory insufficiency Disseminated intravascular coagulopathy (DIC) Perinatal death Maternal death |
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How do you manage eclampsia?
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If antepartum or intrapartum: Magnesium sulfate and deliver regardless of gestational age
If postpartum: Magnesium sulfate Again, remember magnesium sulfate not antihypertensive so patient will need antihypertensive therapy to control BP |
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The most frequent cause of postpartum hemorrhage is
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uterine atony
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Continues to be a leading cause of maternal morbidity and death in the US
Can occur with little warning - Definitions > 500 mL blood |
Postpartum hemorrhage
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- Most common cause (90%) is uterine atony (marked hypotonia)
- Less common causes are retained placenta, placenta accreta, cervical/vaginal lacerations, uterine rupture |
Postpartum hemorrhage
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What are the predisposing causes of uterine atony?
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Multiparity
Hydramnios Macrosomic fetus Traumatic birth Rapid or prolonged labor |
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What are two things that are part of the TX regimen for the management of postpartum hemorrhage?
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* IV of lactated Ringer’s or normal saline with 10-40 units of oxytocin added
* Ergonovine or methyl-ergonovine (IM) if not hypertensive |
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This may result from partial separation of the placenta or entrapment of the partially or fully separated placenta.
This is treated by manual removal of the placenta If no epidural, nitrous oxide and oxygen inhalation can be given. |
Non-adherent Retained Placenta
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This is when there is a slight penetration of the mymetrium.
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Placenta accreta
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This is when there is a deep penetration of the myometrium.
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Placenta percreta
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If you have adherent retained placenta (accreta, increta or perceta) what may be the indicated TX?
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Hysterectomy and blood replacement
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This is a potentially life threatening post partum complication that ocurs in 1 in 2000-2500 births.
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Inversion of the uterus
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Unknown etiology
Probably implantation in a defective area of endometrium Manual removal is unsuccessful and laceration or perforation of uterine wall may result from attempts |
Adherent retained placenta
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These are the varrying degrees of adherent retained placenta?
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placenta accreta, increta, perceta.
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Postpartum hemorrhage is seen most often in what two adherent retained placenta stages?
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Most often in multiparas with placenta accreta/increta
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Decreased platelets Decreased fibrinogen level
Increased fibrin degradation products Prolonged bleeding time * Idiopathic throbocytopenia * Von Willebrand Disease |
Signs of coagulopathies in postpartum patients
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- Diffuse and consumes large amounts of clotting factors
- Widespread external and internal bleeding - Predisposing factors: abruptio placentae, amniotic fluid embolism, dead fetus syndrome (6 weeks), severe pre-eclampsia, septicemia, cardiopulmonary arrest, hemorrhage |
Dissimintated Intravascular Coagulation
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How do you treat DVT in a postpartum patient?
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IV heparin (5-7 days), bedrest with affected leg elevated, analgesia followed by elastic stockings and oral anticoagulant therapy (warfarin) for 3 months
* Woman should be encouraged not to massage area and, when on bedrest, not to flex knees sharply * Anticoagulant therapy for 6 months |
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How do you TX pulmonary embolism in a postpartum patient?
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Treated with continuous IV heparin followed by intermittent subcutaneous or oral
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This is any infection of the genital canal within twenty eight days after abortion or birth?
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Puerperal sepsis
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What are the most common infecting agents with postpartum infections?
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numerous streptococcal and anaerobic organisms
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What are four types of typical postpartum infections?
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Endometriosis
Wound infection UTI Mastitis |
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What is the most common source of postpartum infection?
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endometriosis
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This is almost always unilateral
Develops well after milk flow established Usually hemolytic S. aureus which comes from baby's oropharynx |
Mastitis
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This may be characterized by lower abdominal tenderness on one or both sides of the abdomen, adnexal and/or parametrial tenderness elicited with bimanual examination, temperature elevation (most commonly >38.3C)
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Endometriosis
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Some infections are frequently assocaited with scanty, odorless lochia?
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PostPartum infections caused by group A beta hemolytic strep.
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In most cases of endomettritis, the bacteria responsible for pelvic infections are those that normally reside in what four places?
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bowel, vagina, perineum, and cervix
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When does the uterine cavity, which is normally sterile, become unsterile?
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When the amniotic sac ruptures
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When does the risk of endometritis increase dramatically?
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After cesarean delivery
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What is the most common organism reported in mastitis?
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Staph aureus
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How do you TX mastitis?
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Administor dicloxacillin, penicillinase-resistant penicillin, or clindamycin, and use local measures, such as ice packs, analgesics, and breast support.
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What is an important piece of information to make sure to tell a mother with mastitis?
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That she should continue breastfeeding.
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Mastitis can lead to an abscess formation which would require?
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surgical drainage
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What are three psychiatric disorders that may arise in the postpartum period?
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Postpartum blues
Postpartum depression Postpartum psychosis |
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This is a transient disorder that lasts hours to weeks and is characterized by bouts of crying and sadness?
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Postpartum blues
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This occurs in the first postpartum year and refers to a group of severe and varied disorders that elicit psychotic symptoms.
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Postpartum psychosis
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This commonly arises during the first two weeks after delivery and is characterized by bouts of sadness, crying, anxiety, irritation, restlessness, mood lability, headache, confustion, forgetfulness and insomnia.
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Pospartum blues
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This is when a patient reports insomnia, lethargy, loss of libido, diminshed appetite, pessimism, incapacity for familial love, feelings of inadequacy, ambivalence or negative feelings toward the infant, and inability to cope.
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Postpartum depression.
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When do you consupt a psychiatrist for PPD?
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When it is associated with comorbid drug abuse, lack of interest in the infant, excessive concern for the infant's health, suicidal or homicidal ideations, hallucniations, psychotic behavior, overall impairment of function, or failure to respond to therapeutic trial.
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Patients with this usually present with schizophrenia or manic depression, which signals the emergence of preexisting mental illness induced by the physical and emotional stresses of pregnancy and delivery.
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Postpartum psychosis
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How do you TX postpartum blues?
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It normally resolves in postpartum day 10, so no TX necessary.
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How do you TX PPD?
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First line TX - Supportive care and reassurance from healthcare professionals and the patient's family is the first line therapy for patients with PPD.
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What is the TX for postpartum psychosis?
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TX of postpartum psychosis should be supervised by a psychiatrist and should involve hospitalization. Specific therapy is controversial and should be targed to the patient's specific symptoms.
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