Overview

Perinatal → pregnancy + 1 year post-partum.

• Baby Blues
  • Distressing but normal feeling experienced by 50-75% of mothers.
  • Onset 3-5 days post-natal → recover within 10-14 days (lasts <2 weeks, any longer = PPD).
  • May complain that their mood feels all over the place. Insomnia, Fatigue, Anziety, Irritability, Tearfulness, Impaired Concentration.
  • Management → explanation and reassurance.
    • Often resolves without treatment within 10-14 days following birth.
• Postnatal Depression
  • Common, occurs in 10% of mothers in the year after birth. Most patients present 6-8 weeks postpartum (defined as depression occuring from 4 weeks - 1 year postpartum).
  • Onset during pregnancy to 1 year post-natal → recover within around 4 weeks (lasts >2 weeks).
  • Screening → edinburgh postnatal depression scale (>12 = likely depressive episode). Describes feelings over last 7 days.
  • Symptoms → low mood + anergia + anhedonia, biological symptoms (poor sleep, appetite, concentration).
  • Management:
    • CBT
    • Recommended SSRI’s when breastfeeding → sertraline and paroxetine. (Avoid lithium and sodium valproate).
    • Hospital admission to mother and baby unit if severe.
    • Mild → advise about local social support: local children’s centres, mother and baby groups and the health visitor.
  • Prognosis → most women respond well to treatment within a month.
• Puerperal Psychosis
  • Usually occurs 2 weeks after birth.
  • Onset from 2-3 days post-partum to 1 year post-natal → recover within 6-12 weeks.
  • Features include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations).
  • Management → admission to mother and baby unit.
    • Antipsychotics.
    • Benzodiazepines may be needed for agitation.
    • Most patients recover within 6-12 weeks.
  • 30% risk of recurrence in future pregnancies.

Making Diagnosis

Clinical Features

Investigations

Management Plan

Complications →

Prognosis →