postpartum blues.pptx

postnatal complications

1. Postpartum Blues By dr Abdiasis Omar Mohamed MBBS

2. Introduction Psychiatric illnesses that are non-psychotic are one of the most common morbidities of pregnancy and the perinatal period. These disorders include depressive disorders (postpartum blues, postpartum depression), anxiety, post-traumatic stress disorder (PTSD), and personality disorders. Postpartum “blues” are defined as low mood and mild depressive symptoms that are transient and self-limited.

3. The depressive symptoms include sadness, crying, exhaustion, irritability, anxiety, decreased sleep, decreased concentration, and labile mood.  These symptoms typically develop within two to three days of childbirth, peak over the next few days, and resolve by themselves within two weeks of their onset.

4. Etiology Several risk factors can lead to the development of postpartum blues. These include a history of menstrual cycle-related mood changes or mood changes associated with pregnancy, a history of major depression or dysthymia, a larger number of lifetime pregnancies, or a family history of post-partum depression.

5. The factors that, when present, do not predispose a patient to the development of postpartum blues: low economic status, ethnic or racial background, gravidity status (primiparous vs multiparous), planned vs unplanned pregnancy, spontaneous pregnancy vs IVF, type of delivery (vaginal vs cesarean), family history of mood disorders, or history of postpartum depression in the past. [

6. According to one particular study, the three predisposing factors most often found in women who developed postpartum blues were higher levels of depressive symptoms during pregnancy , at least one previous episode of diagnosed depression, and a history of premenstrual depression or other menstrual-related mood changes.

7. Other studies have also proposed that elevated monoamine oxidase levels or decreased serotoninergic activity in the immediate postpartum period are also significant risk factors or etiological characteristics that could predispose a woman to the development of postpartum blues.

8. Epidemiology Postpartum blues are extremely common and are estimated to occur in about 50% or more of women within the first few weeks after delivery. Postpartum major depression is approximately 4 to 11 times more common among women who have postpartum blues.

9. History and Physical As with all psychiatric diagnoses, the most important diagnostic tool is the interview. In the setting of a female patient who presents immediately after or within two weeks of delivery, a low mood and depressive symptoms that do not meet the major depressive disorder criteria can point to a diagnosis of postpartum blues. If the criteria for major depressive disorder are met or if the mood disturbances persist beyond two weeks after delivery, a diagnosis of postpartum blues should not be made.

10. Evaluation Symptoms of postpartum blues include Crying Dysphoric affect Irritability Anxiety Insomnia Appetite changes.

11. These symptoms, when present, should not meet the criteria for major depressive disorder or, when occurring in the postpartum period, of postpartum depression.  To fully meet the criteria for a diagnosis of postpartum blues, the symptoms usually develop within two to three days of delivery and resolve within two weeks.

12. If the symptoms persist beyond two weeks, the diagnostic criteria for postpartum depression are then fulfilled. A clinical tool that can be useful to screen for postpartum depression is the Edinburgh Postpartum Depression Scale.

13. Treatment / Management Peripartum mood disorders can be viewed as occurring on a spectrum of severity, with postpartum “blues” being milder and self-limited and postpartum depression more disabling. By its diagnostic criteria, postpartum blues are transient and self-limited. Therefore, it resolves on its own and requires no treatment other than validation, education, reassurance, and psychosocial support.

14. Patients diagnosed with postpartum blues should be carefully evaluated to see if the diagnostic criteria for postpartum depression are met. This would entail ensuring both that symptoms do not meet the criteria for a depressive episode at the time of presentation and that symptoms do not persist beyond two weeks.

15. If a diagnosis of postpartum depression, or depression with peripartum onset, is finalized, the clinician should initiate a treatment regimen with supportive psychotherapy and antidepressants. Concurrently, with a diagnosis of postpartum depression, antipsychotics should be considered if psychotic features are present

16. While postpartum blues symptoms are mild, transient, and self-limited, patients should still be carefully screened for suicidal ideation, paranoia, or homicidal ideation towards the infant. Moreover, home help should be sought to help the patient in getting enough sleep. If insomnia persists, cognitive therapy and/or pharmacotherapy can be recommended.

17. Differential Diagnosis Sleep disturbances postpartum depression

18. Prognosis Postpartum blues involve mood changes that are typically mild, transient, and self-limited. However, a diagnosis of postpartum blues can predispose an individual to postpartum depression or postpartum anxiety disorders.

19. Complications postpartum depression postpartum psychosis

20. THE END