Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 Obs and Gynae > Obstetrics: Post-Natal Care > Flashcards

Obstetrics: Post-Natal Care Flashcards

1
Q

Define peri-natal mental health?

A

PMH = a woman’s mental health both during and in the first 12 months after giving birth.

Includes both pre-existing conditions and conditions that only develop during the perinatal period.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the most common Peri-natal mental health issues?

A

Pregnancy specific:

  • Postnatal depression
  • Pueperal psychosis
  • Adjustment disorders and distress (most common)

General:

  • Anxiety disorders
  • Depression
  • PTSD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How common is peri-natal mental health?

A

1/5 mothers develop some form of mental health issues.

1/4 maternal deaths are related to mental health problems (including suicide and drug abuse)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the most significant impacts of peri-natal mental health issues?

A
  • Emotional well-being of the woman, and her family
  • Can interfere with bonding, attachment, care of the baby
  • Relationships with partner, wider family and social circles can become strained
  • Increases mortality and use of health services
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the prognosis like for peri-natal mental health issues?

A

Good if seek treatment; effective treatment is available, disorders are sensitive to treatment, shorter illness duration and better prognosis than non-pregnancy related mental health.

HOWEVER 50% of cases go undiagnosed and untreated (stigma, fear of being considered a bad mother, fear baby will be taken away, unaware treatment is available, HCP not asking or having time constraints).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What depression scales are used in pregnancy?

A

EPDS (14-15) and Becks depression inventory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What sort of screening questions are effective in PNMI?

A
  • During the past month have you been bothered by feeling down
  • During the past month have you had little interest in things
  • Is there anything you need help with
  • Have you been feeling anxious or on edge
  • Have you not been able to stop or control your worrying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some risk factors for PNMI?

A
  • Prior mental health issues
  • Family history of PNMI
  • History of child abuse or neglect
  • Domestic violence
  • Interpersonal conflict
  • Inadequate social support
  • Substance misuse
  • Migration status, language or cultural barriers
  • Unplanned, unwanted, or complicated pregnancy
  • Traumatic birth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the most significant red flags for PNMI?

A
  • Diagnosis of Bipolar Disorder
  • Diagnosis of Severe Depression
  • Recent changes in mental health e.g. emergence of new symptoms, new thoughts or acts of self-harm

THEM COMING FORWARD! Usually indicates quite severe cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the baby blues?

A
  • Reasonably benign form of MI
  • Affects more than half of women
  • Starts around day 3-4 goes on to about day 14
  • Tearfulness, low mood, irritability, anxiety, over-reacting
  • Causes: pain from birth, stress of new baby, lack of sleep, breast feeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How would you manage a mother with the baby blues?

A

Nothing specific; just reassure them that what they are feeling is normal, and offer support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is PN depression defined?

A
  • Normal depression symptoms of anhedonia, low mood and low energy +/- struggling to care for baby
  • Within first year after giving birth (normally first couple of months)
  • Look out for difficulty caring for baby, difficulty bonding with baby, feelings of inadequacy, thoughts of harming self or baby
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you manage PND?

A

Mild:

  • Non drug treatments as effective as antidepressants
  • Postnatal support groups
  • Preventative strategies such as modified antenatal classes

Severe:

  • Refer to specialist perinatal mental health services is essential
  • Management normally with TCAs or SSRIs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is puerperal psychosis?

A 
Psychosis symptoms e.g:
- mania
- depression
- confusion
- rapid changes in mood
- withdrawal
- delusions
- hallucinations
- feeling paranoid, suspicious, fearful
...developing rapidly in the days/weeks after giving births.

Psychiatric emergency due to risk of suicide/infanticide!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is puerperal psychosis managed?

A
  • Always managed with a specialist MDT on a mother baby unit
  • Anti-psychotics, mood stabilisers, anti-depressants
  • CBT when in recovery phase
  • Most recovery fairly quickly
  • ECT can be used in severe psychosis
  • Risk of recurrence is 50% if next pregnancy within couple of years so ideally avoid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is some good general advice to give for women with mild PNMI?

A
  • Sleep hygiene (waking and going to bed same time every day, avoiding late caffeine, avoiding late screen use, hot drinks/meditation/reading in soft light before bed
  • Hyperemesis management (ginger, small regular meals, hydration)
  • Importance of regular gentle exercise throughout pregnancy
  • Signposting to services in the community e.g. mindfulness, support groups
17
Q

What services are available to manage PNMH?

A
  • Specialist PNMH clinics, good place to refer to
  • Specialist PNMH midwife
  • Specialist community PNMH team
  • Community mental health team (if specialist team not available)

In cases of emergency:

  • Senior duty psychiatrist
  • Local mental health services crisis line
  • ED
18
Q

How should women with existing mental health issues who want to get pregnant be managed?

A

Pre-Conceptual Counselling:

  • Do not discontinue psychotropic meds without consulting health care professional
  • Use contraception
  • Explain risks of pregnancy and childbirth
  • Psychiatric review- options for switching to safer treatment
  • Option of discontinuing treatment safely

Support in Pregnancy:

  • Referral to specialist PN health service as soon as conceiving/pregnancy known
  • Early referral if new symptoms
  • Treatment and management is patient specific (including birth plan)
  • Use medication with lowest risk at the lowest effective dose that provides symptom control
  • MONITORING (symptoms, drug level) through specialist team
19
Q

How safe are psychotropic medications in pregnancy?

A

Unclear, none are proven safe, some are proven teratogenic.

Must evaluate risks and benefits.

20
Q

Which psych drugs should ideally be avoided in pregnancy?

A
  • Sodium Valproate- Neural tube defect risk (absolutely avoid)
  • Carbamazepine- cleft lip
  • Lithium- associated with cardiac anomalies
  • Lamotrigine- increases risk of stevens johnson syndrome
  • SSRIs- pulmonary hypertension

SSRIs are used quite commonly, lead to neonatal withdrawal effects which require monitoring but are generally self-limiting

21
Q

What should be looked out for in babies exposed to SSRIs during pregnancy?

A

Withdrawal symptoms:

  • poor adaptation
  • jitteriness
  • irritability
  • poor gaze control
  • poor feeding
  • can cause seizures but rare

Normally self limiting but because of seizure risk requires monitoring for 1-2 days. In most cases no treatment is needed and mum can breastfeed as normal.

Mx is normally supportive e.g. feeding support.

Y4 Obs and Gynae (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions