Puerperium Franzblau N, Witt K.  Normal and Abnormal Puerperium.  Emedicine available at www.emedicine.com/med/topic3240.h...
Puerperium <ul><li>The time from the delivery of the placenta through the first few weeks after the delivery </li></ul><ul...
Uterus <ul><li>Immediately after the delivery, the uterus can be palpated at or near the umbilicus </li></ul><ul><li>Most ...
Lochia <ul><li>Vaginal discharge, lasts about 5 weeks </li></ul><ul><ul><li>15% of women have lochia at 6 weeks postpartum...
Cervix, Vagina, Perineum <ul><li>Tissues revert to a nonpregnant state but never return to the nulliparous state </li></ul>
Abdominal Wall <ul><li>Remains soft and poorly toned for many weeks </li></ul><ul><ul><li>Return to a prepregnant state de...
Ovulation <ul><li>Breastfeeding </li></ul><ul><li>Longer period of amenorrhea and anovulation </li></ul><ul><ul><li>Highly...
Breasts <ul><li>Changes to the breast that prepare for breastfeeding occur throughout pregnancy </li></ul><ul><li>Lactatio...
Breastfeeding <ul><li>“ Breastfeeding is neither easy nor automatic.” </li></ul><ul><li>Should be initiated ASAP after del...
Considerations <ul><li>Vaginal Birth  </li></ul><ul><li>Swelling and pain in the perineum </li></ul><ul><ul><li>Episiotomy...
Sexual Intercourse <ul><li>May resume when… </li></ul><ul><li>Red bleeding ceases </li></ul><ul><li>Vagina and vulva are h...
Concerns - Puerperal Period
Hemorrhage
Postpartum Hemorrhage <ul><li>Excessive blood loss during or after the 3 rd  stage of labor </li></ul><ul><ul><li>Average ...
Postpartum Hemorrhage <ul><li>Incidence </li></ul><ul><li>Vaginal birth: 3.9% </li></ul><ul><li>Cesarean: 6.4% </li></ul><...
Postpartum Hemorrhage <ul><li>May result from: </li></ul><ul><li>Uterine atony </li></ul><ul><li>Lower genital tract lacer...
Uterine Atony <ul><li>Lack of closure of the spiral arteries and venous sinuses </li></ul><ul><li>Risk factors: </li></ul>...
Lower genital tract lacerations <ul><li>Result of obstetrical trauma </li></ul><ul><ul><li>More common with operative vagi...
Infection
Endometritis <ul><li>Ascending polymicrobial infection </li></ul><ul><ul><li>Usually normal vaginal flora or enteric bacte...
Endometritis <ul><li>Risk factors: </li></ul><ul><li>C-section </li></ul><ul><li>Young age </li></ul><ul><li>Low SES </li>...
Endometritis <ul><li>Clinical presentation </li></ul><ul><li>Fever </li></ul><ul><li>Chills </li></ul><ul><li>Lower abdomi...
Urinary Tract Infection <ul><li>Bacterial inflammation of the bladder or urethra </li></ul><ul><li>3-34% of patients </li>...
Urinary Tract Infection <ul><li>Risk factors </li></ul><ul><li>C-section </li></ul><ul><li>Forceps delivery </li></ul><ul>...
Urinary Tract Infection <ul><li>Clinical Presentation </li></ul><ul><li>Urinary frequency/urgency </li></ul><ul><li>Dysuri...
Mastitis <ul><li>Inflammation of the mammary gland </li></ul><ul><li>Milk stasis & cracked nipples contribute to the influ...
Mastitis <ul><li>Clinical Presentation </li></ul><ul><li>Fever </li></ul><ul><li>Chills </li></ul><ul><li>Myalgias </li></...
Wound Infection <ul><li>Perineum  </li></ul><ul><li>(episiotomy or laceration) </li></ul><ul><li>3-4 days postpartum </li>...
Wound Infection <ul><li>Perineum  </li></ul><ul><li>Risk Factors: </li></ul><ul><ul><li>Infected lochia </li></ul></ul><ul...
Wound Infection <ul><li>Clinical Presentation </li></ul><ul><li>Perineal Infection: </li></ul><ul><li>Pain </li></ul><ul><...
Endocrine Disorders
Postpartum Thyroiditis (PPT) <ul><li>Transient destructive lymphocytic thyroiditis occuring within the 1 st  year after de...
Postpartum Thyroiditis (PPT) <ul><li>~4% develop transient thyrotoxicosis </li></ul><ul><ul><li>66-90% return to normal </...
Postpartum Thyroiditis (PPT) <ul><li>Clinical Presentation </li></ul><ul><li>Fatigue </li></ul><ul><li>Palpitations </li><...
Postpartum Thyroiditis (PPT) <ul><li>Exam findings </li></ul><ul><li>Tachycardia </li></ul><ul><li>Mild exopthalmos </li><...
Postpartum Graves Disease <ul><li>Autoimmune disorder </li></ul><ul><li>Diffuse hyperplasia of the thyroid gland </li></ul...
Psychiatric Disorders
<ul><li>Postpartum Blues </li></ul><ul><li>Transient disorder </li></ul><ul><ul><li>Lasts hours to weeks </li></ul></ul><u...
Etiology <ul><li>Unknown </li></ul><ul><li>Theory: multifactorial </li></ul><ul><li>Stress  </li></ul><ul><ul><li>Responsi...
Risk factors <ul><li>Undesired pregnancy </li></ul><ul><li>Feeling unloved by mate </li></ul><ul><li><20 years </li></ul><...
Incidence <ul><li>50-70% develop postpartum blues </li></ul><ul><li>10-15% of new mothers develop PPD </li></ul><ul><li>0....
Postpartum Blues <ul><li>Mild, transient, self-limiting </li></ul><ul><li>Commonly in the first 2 weeks </li></ul><ul><li>...
Postpartum Blues <ul><li>Often resolves by postpartum day 10 </li></ul><ul><li>No pharmacotherapy is indicated </li></ul><...
Postpartum Depression (PPD) <ul><li>Signs and symptoms </li></ul><ul><li>Insomnia  </li></ul><ul><li>Lethargy </li></ul><u...
Postpartum Depression (PPD) <ul><li>Consult a psychiatrist if… </li></ul><ul><li>Comorbid drug abuse </li></ul><ul><li>Lac...
Postpartum Depression (PPD) <ul><li>Lasts 3-6 months </li></ul><ul><ul><li>25% are still affected at 1 year </li></ul></ul...
Postpartum Psychosis <ul><li>Signs and symptoms </li></ul><ul><li>Acute psychosis </li></ul><ul><ul><li>Schizophrenia </li...
Postpartum Psychosis <ul><li>Treatment </li></ul><ul><li>Therapy should be targeted to the patient’s specific symptoms </l...
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Puerperium Franzblau N, Witt K. Normal and Abnormal ...

  1. 1. Puerperium Franzblau N, Witt K. Normal and Abnormal Puerperium. Emedicine available at www.emedicine.com/med/topic3240.htm; accessed 13 December 2005.
  2. 2. Puerperium <ul><li>The time from the delivery of the placenta through the first few weeks after the delivery </li></ul><ul><ul><li>Usually considered to be 6 weeks </li></ul></ul><ul><ul><li>Body returns to the nonpregnant state </li></ul></ul>
  3. 3. Uterus <ul><li>Immediately after the delivery, the uterus can be palpated at or near the umbilicus </li></ul><ul><li>Most of the reduction in size and weight occurs in the first 2 weeks </li></ul><ul><ul><li>2 weeks postpartum, the uterus should be located in the true pelvis </li></ul></ul>
  4. 4. Lochia <ul><li>Vaginal discharge, lasts about 5 weeks </li></ul><ul><ul><li>15% of women have lochia at 6 weeks postpartum </li></ul></ul><ul><ul><ul><li>Lochia rubra </li></ul></ul></ul><ul><ul><ul><ul><li>Red </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Duration is variable </li></ul></ul></ul></ul><ul><ul><ul><li>Lochia serosa </li></ul></ul></ul><ul><ul><ul><ul><li>Brownish red, more watery consistency </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Continues to decrease in amount </li></ul></ul></ul></ul><ul><ul><ul><li>Lochia alba </li></ul></ul></ul><ul><ul><ul><ul><li>Yellow </li></ul></ul></ul></ul>
  5. 5. Cervix, Vagina, Perineum <ul><li>Tissues revert to a nonpregnant state but never return to the nulliparous state </li></ul>
  6. 6. Abdominal Wall <ul><li>Remains soft and poorly toned for many weeks </li></ul><ul><ul><li>Return to a prepregnant state depends greatly on exercise </li></ul></ul>
  7. 7. Ovulation <ul><li>Breastfeeding </li></ul><ul><li>Longer period of amenorrhea and anovulation </li></ul><ul><ul><li>Highly variable </li></ul></ul><ul><li>50-75% return to periods within 36 weeks </li></ul><ul><li>Not breastfeeding </li></ul><ul><li>As early as 27 days after delivery </li></ul><ul><li>Most have a menstrual period by 12 weeks </li></ul>
  8. 8. Breasts <ul><li>Changes to the breast that prepare for breastfeeding occur throughout pregnancy </li></ul><ul><li>Lactation can occur by 16 weeks’ gestation </li></ul><ul><li>Colostrum </li></ul><ul><ul><li>1 st 2-4 days after delivery </li></ul></ul><ul><ul><li>High in protein and immune factors </li></ul></ul><ul><li>Milk matures over the first week* </li></ul><ul><ul><li>Contains all the nutrients necessary </li></ul></ul><ul><li>*Continues to change thoughout the period of breastfedeing to meet the changing demands of the baby </li></ul>
  9. 9. Breastfeeding <ul><li>“ Breastfeeding is neither easy nor automatic.” </li></ul><ul><li>Should be initiated ASAP after delivery </li></ul><ul><li>Feed baby every 2-3 hrs to stimulate milk production </li></ul><ul><ul><li>Production should be established by 36-96 hrs </li></ul></ul>
  10. 10. Considerations <ul><li>Vaginal Birth </li></ul><ul><li>Swelling and pain in the perineum </li></ul><ul><ul><li>Episiotomy? Laceration? </li></ul></ul><ul><li>Hemorrhoids </li></ul><ul><ul><li>Often resolve as the perineum recovers </li></ul></ul><ul><li>Cesarean Delivery </li></ul><ul><li>Pain from the abdominal incision </li></ul><ul><li>Slower to begin ambulating, eating, and voiding </li></ul>
  11. 11. Sexual Intercourse <ul><li>May resume when… </li></ul><ul><li>Red bleeding ceases </li></ul><ul><li>Vagina and vulva are healed </li></ul><ul><li>Physically comfortable </li></ul><ul><li>Emotionally ready </li></ul><ul><li>*Physical readiness usually takes ~3 weeks </li></ul>
  12. 12. Concerns - Puerperal Period
  13. 13. Hemorrhage
  14. 14. Postpartum Hemorrhage <ul><li>Excessive blood loss during or after the 3 rd stage of labor </li></ul><ul><ul><li>Average blood loss is 500 mL </li></ul></ul><ul><li>Early postpartum hemorrhage </li></ul><ul><ul><li>1 st 24 hrs after delivery </li></ul></ul><ul><li>Late postpartum hemorrhage </li></ul><ul><ul><li>1-2 weeks after delivery (most common) </li></ul></ul><ul><ul><li>May occur up to 6 weeks postpartum </li></ul></ul>
  15. 15. Postpartum Hemorrhage <ul><li>Incidence </li></ul><ul><li>Vaginal birth: 3.9% </li></ul><ul><li>Cesarean: 6.4% </li></ul><ul><li>Delayed postpartum hemorrhage: 1-2% </li></ul><ul><li>Mortality </li></ul><ul><li>5% of maternal deaths </li></ul>
  16. 16. Postpartum Hemorrhage <ul><li>May result from: </li></ul><ul><li>Uterine atony </li></ul><ul><li>Lower genital tract lacerations </li></ul><ul><li>Retained products of conception </li></ul><ul><li>Uterine rupture </li></ul><ul><li>Uterine inversion </li></ul><ul><li>Placenta accreta </li></ul><ul><ul><li>adherence of the chorionic villi to the myometrium </li></ul></ul><ul><li>Coagulopathy </li></ul><ul><li>Hematoma </li></ul>Most common
  17. 17. Uterine Atony <ul><li>Lack of closure of the spiral arteries and venous sinuses </li></ul><ul><li>Risk factors: </li></ul><ul><ul><li>Overdistension of the uterus secondary to multiple gestations </li></ul></ul><ul><ul><li>Polyhydramnios </li></ul></ul><ul><ul><li>Macrosomia </li></ul></ul><ul><ul><li>Rapid or prolonged labor </li></ul></ul><ul><ul><li>Grand multiparity </li></ul></ul><ul><ul><li>Oxytocin administration </li></ul></ul><ul><ul><li>Intra-amniotic infection </li></ul></ul>
  18. 18. Lower genital tract lacerations <ul><li>Result of obstetrical trauma </li></ul><ul><ul><li>More common with operative vaginal deliveries </li></ul></ul><ul><ul><ul><li>Forceps </li></ul></ul></ul><ul><ul><ul><li>Vacuum extraction </li></ul></ul></ul><ul><li>Other predisposing factors: </li></ul><ul><ul><li>Macrosomia </li></ul></ul><ul><ul><li>Precipitous delivery </li></ul></ul><ul><ul><li>Episiotomy </li></ul></ul>
  19. 19. Infection
  20. 20. Endometritis <ul><li>Ascending polymicrobial infection </li></ul><ul><ul><li>Usually normal vaginal flora or enteric bacteria </li></ul></ul><ul><li>Primary cause of postpartum infection </li></ul><ul><ul><li>1-3% vaginal births </li></ul></ul><ul><ul><li>5-15% scheduled C-sections </li></ul></ul><ul><ul><li>30-35% C-section after extended period of labor </li></ul></ul><ul><ul><ul><li>May receive prophylactic antibiotics </li></ul></ul></ul><ul><li><2% develop life-threatening complications </li></ul>
  21. 21. Endometritis <ul><li>Risk factors: </li></ul><ul><li>C-section </li></ul><ul><li>Young age </li></ul><ul><li>Low SES </li></ul><ul><li>Prolonged labor </li></ul><ul><li>Prolonged rupture of membranes </li></ul><ul><li>Multiple vaginal exams </li></ul><ul><li>Placement of intrauterine catheter </li></ul><ul><li>Preexisting infection </li></ul><ul><li>Twin delivery </li></ul><ul><li>Manual removal of the placenta </li></ul>
  22. 22. Endometritis <ul><li>Clinical presentation </li></ul><ul><li>Fever </li></ul><ul><li>Chills </li></ul><ul><li>Lower abdominal pain </li></ul><ul><li>Malodorous lochia </li></ul><ul><li>Increased vaginal bleeding </li></ul><ul><li>Anorexia </li></ul><ul><li>Malaise </li></ul><ul><li>Exam findings </li></ul><ul><li>Fever </li></ul><ul><li>Tachycardia </li></ul><ul><li>Fundal tenderness </li></ul><ul><li>Treatment </li></ul><ul><li>Antibiotics </li></ul>
  23. 23. Urinary Tract Infection <ul><li>Bacterial inflammation of the bladder or urethra </li></ul><ul><li>3-34% of patients </li></ul><ul><ul><li>Symptomatic infection in ~2% </li></ul></ul>
  24. 24. Urinary Tract Infection <ul><li>Risk factors </li></ul><ul><li>C-section </li></ul><ul><li>Forceps delivery </li></ul><ul><li>Vacuum delivery </li></ul><ul><li>Tocolysis </li></ul><ul><li>Induction of labor </li></ul><ul><li>Maternal renal disease </li></ul><ul><li>Preeclampsia </li></ul><ul><li>Eclampsia </li></ul><ul><li>Epidural anesthesia </li></ul><ul><li>Bladder catheterization </li></ul><ul><li>Length of hospital stay </li></ul><ul><li>Previous UTI during pregnancy </li></ul>
  25. 25. Urinary Tract Infection <ul><li>Clinical Presentation </li></ul><ul><li>Urinary frequency/urgency </li></ul><ul><li>Dysuria </li></ul><ul><li>Hematuria </li></ul><ul><li>Suprapubic or lower abdominal pain </li></ul><ul><li>OR… </li></ul><ul><li>No symptoms at all </li></ul><ul><li>Exam Findings </li></ul><ul><li>Stable vitals </li></ul><ul><li>Afebrile </li></ul><ul><li>Suprapubic tenderness </li></ul><ul><li>Treatment </li></ul><ul><li>antibiotics </li></ul>
  26. 26. Mastitis <ul><li>Inflammation of the mammary gland </li></ul><ul><li>Milk stasis & cracked nipples contribute to the influx of skin flora </li></ul><ul><li>2.5-3% in the USA </li></ul><ul><ul><li>Neglected, resistant or recurrent infections can lead to the development of an abscess (5-11%) </li></ul></ul>
  27. 27. Mastitis <ul><li>Clinical Presentation </li></ul><ul><li>Fever </li></ul><ul><li>Chills </li></ul><ul><li>Myalgias </li></ul><ul><li>Warmth, swelling and breast tenderness </li></ul><ul><li>Exam Findings </li></ul><ul><li>Area of the breast that is warm, red, and tender </li></ul><ul><li>Treatment </li></ul><ul><li>Moist heat </li></ul><ul><li>Massage </li></ul><ul><li>Fluids </li></ul><ul><li>Rest </li></ul><ul><li>Proper positioning of the infant during nursing </li></ul><ul><li>Nursing or manual expression of milk </li></ul><ul><li>Analgesics </li></ul><ul><li>Antibiotics </li></ul>stasis
  28. 28. Wound Infection <ul><li>Perineum </li></ul><ul><li>(episiotomy or laceration) </li></ul><ul><li>3-4 days postpartum </li></ul><ul><li>rare </li></ul><ul><li>Abdominal incision </li></ul><ul><li>(C-section) </li></ul><ul><li>Postoperative day 4 </li></ul><ul><li>3-15% </li></ul><ul><li>prophylactic antibiotics </li></ul><ul><ul><li>2% </li></ul></ul>
  29. 29. Wound Infection <ul><li>Perineum </li></ul><ul><li>Risk Factors: </li></ul><ul><ul><li>Infected lochia </li></ul></ul><ul><ul><li>Fecal contamination </li></ul></ul><ul><ul><li>Poor hygiene </li></ul></ul><ul><li>Abdominal incision </li></ul><ul><li>Risk factors: </li></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>Obesity </li></ul></ul><ul><ul><li>Corticosteroid treatment </li></ul></ul><ul><ul><li>Immunosuppression </li></ul></ul><ul><ul><li>Anemia </li></ul></ul><ul><ul><li>Prolonged labor </li></ul></ul><ul><ul><li>Prolonged rupture of membranes </li></ul></ul><ul><ul><li>Prolonged operating time </li></ul></ul><ul><ul><li>Abdominal twin delivery </li></ul></ul><ul><ul><li>Excessive blood loss </li></ul></ul>
  30. 30. Wound Infection <ul><li>Clinical Presentation </li></ul><ul><li>Perineal Infection: </li></ul><ul><li>Pain </li></ul><ul><li>Malodorous discharge </li></ul><ul><li>Vulvar edema </li></ul><ul><li>Abdominal Infection </li></ul><ul><li>Persistent fever </li></ul><ul><li>(despite antibiotics) </li></ul><ul><li>Diagnosis </li></ul><ul><li>Erythema </li></ul><ul><li>Induration </li></ul><ul><li>Warmth </li></ul><ul><li>Tenderness </li></ul><ul><li>Purulent drainage </li></ul><ul><li>With or without fever </li></ul>
  31. 31. Endocrine Disorders
  32. 32. Postpartum Thyroiditis (PPT) <ul><li>Transient destructive lymphocytic thyroiditis occuring within the 1 st year after delivery </li></ul><ul><li>Autoimmune disorder </li></ul><ul><ul><ul><li>Thyrotoxicosis </li></ul></ul></ul><ul><ul><ul><ul><li>1-4 months postpartum; self-limited </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Increased release (stored hormone) </li></ul></ul></ul></ul><ul><ul><ul><li>Hypothyroidism </li></ul></ul></ul><ul><ul><ul><ul><li>4-8 months postpartum </li></ul></ul></ul></ul>
  33. 33. Postpartum Thyroiditis (PPT) <ul><li>~4% develop transient thyrotoxicosis </li></ul><ul><ul><li>66-90% return to normal </li></ul></ul><ul><ul><li>33% progress to hypothyroid </li></ul></ul><ul><ul><ul><li>10-3% develop permanent thyroid dysfunction </li></ul></ul></ul><ul><li>Risk Factors </li></ul><ul><li>Positive antithyroid antibody testing </li></ul><ul><li>History of PPT </li></ul><ul><li>Family or personal history of thyroid or autoimmune disorders </li></ul>
  34. 34. Postpartum Thyroiditis (PPT) <ul><li>Clinical Presentation </li></ul><ul><li>Fatigue </li></ul><ul><li>Palpitations </li></ul><ul><li>Eat intolerance </li></ul><ul><li>Tremulousness </li></ul><ul><li>Nervousness </li></ul><ul><li>Emotion liability </li></ul><ul><li>*mild & nonspecific </li></ul><ul><li>(may go undiagnosed) </li></ul><ul><li>Hypothyroid Phase: </li></ul><ul><li>Fatigue </li></ul><ul><li>Dry skin </li></ul><ul><li>Coarse hair </li></ul><ul><li>Cold intolerance </li></ul><ul><li>Depression </li></ul><ul><li>Memory & concentration impairment </li></ul>
  35. 35. Postpartum Thyroiditis (PPT) <ul><li>Exam findings </li></ul><ul><li>Tachycardia </li></ul><ul><li>Mild exopthalmos </li></ul><ul><li>Painless goiter </li></ul><ul><li>Lab testing </li></ul><ul><li>TSH  thyrotoxicosis  </li></ul><ul><li>TSH  hypothyroid </li></ul><ul><li>Treatment </li></ul><ul><li>Thyrotoxicosis </li></ul><ul><ul><li>No treatment (mild) </li></ul></ul><ul><ul><li>Beta-blocker </li></ul></ul><ul><li>Hypothyroid </li></ul><ul><ul><li>No treatment (mild) </li></ul></ul><ul><ul><li>Thyroxine (T4) </li></ul></ul>
  36. 36. Postpartum Graves Disease <ul><li>Autoimmune disorder </li></ul><ul><li>Diffuse hyperplasia of the thyroid gland </li></ul><ul><ul><li>Response to antibodies to the thyroid TSH receptors </li></ul></ul><ul><li>Increased thyroid hormone production and release </li></ul><ul><li>Les common than PPT </li></ul><ul><li>Accounts for 15% of postpartum thyrotoxicosis </li></ul>
  37. 37. Psychiatric Disorders
  38. 38. <ul><li>Postpartum Blues </li></ul><ul><li>Transient disorder </li></ul><ul><ul><li>Lasts hours to weeks </li></ul></ul><ul><li>Bouts of crying and sadness </li></ul><ul><li>Postpartum Depression </li></ul><ul><li>More prolonged affective disorder </li></ul><ul><ul><li>Weeks to months </li></ul></ul><ul><li>S&S of depression </li></ul><ul><li>Postpartum Psychosis </li></ul><ul><li>First postpartum year </li></ul><ul><li>Group of severe and varied disorders </li></ul><ul><li>(psychotic symptoms) </li></ul>
  39. 39. Etiology <ul><li>Unknown </li></ul><ul><li>Theory: multifactorial </li></ul><ul><li>Stress </li></ul><ul><ul><li>Responsibilities of child rearing </li></ul></ul><ul><li>Sudden decrease in endorphins of labor, estrogen and progesterone </li></ul><ul><li>Low free serum tryptophan (related to depression) </li></ul><ul><li>Postpartum thyroid dysfunction (psychiatric disorders) </li></ul>
  40. 40. Risk factors <ul><li>Undesired pregnancy </li></ul><ul><li>Feeling unloved by mate </li></ul><ul><li><20 years </li></ul><ul><li>Unmarried </li></ul><ul><li>Medical indigence </li></ul><ul><li>Low self-esteem </li></ul><ul><li>Dissatisfaction with extent of education </li></ul><ul><li>Economic problems </li></ul><ul><li>Poor relationship with husband or boyfriend </li></ul><ul><li>Being part of a family with 6 or more siblings </li></ul><ul><li>Limited parental support </li></ul><ul><li>Past or present evidence of emotional problems </li></ul>
  41. 41. Incidence <ul><li>50-70% develop postpartum blues </li></ul><ul><li>10-15% of new mothers develop PPD </li></ul><ul><li>0.14-0.26% develop postpartum psychosis </li></ul><ul><li>History of depression </li></ul><ul><ul><li>30% chance of develping PPD </li></ul></ul><ul><li>History of PPD or postpartum psychosis </li></ul><ul><ul><li>50% chance of recurrence </li></ul></ul>
  42. 42. Postpartum Blues <ul><li>Mild, transient, self-limiting </li></ul><ul><li>Commonly in the first 2 weeks </li></ul><ul><li>Signs and symptoms </li></ul><ul><li>Sadness </li></ul><ul><li>Crying </li></ul><ul><li>Anxiety </li></ul><ul><li>Irritation </li></ul><ul><li>Restlessness </li></ul><ul><li>Mood lability </li></ul><ul><li>Headache </li></ul><ul><li>Confusion </li></ul><ul><li>Forgetfullness </li></ul><ul><li>Insomnia </li></ul>
  43. 43. Postpartum Blues <ul><li>Often resolves by postpartum day 10 </li></ul><ul><li>No pharmacotherapy is indicated </li></ul><ul><li>Treatment </li></ul><ul><li>Provide support and education </li></ul>
  44. 44. Postpartum Depression (PPD) <ul><li>Signs and symptoms </li></ul><ul><li>Insomnia </li></ul><ul><li>Lethargy </li></ul><ul><li>Loss of libido </li></ul><ul><li>Diminished appetite </li></ul><ul><li>Pessimism </li></ul><ul><li>Incapacity for familial love </li></ul><ul><li>Feelings of inadequacy </li></ul><ul><li>Ambivalence or negative feelings towards the infant </li></ul><ul><li>Inability to cope </li></ul>
  45. 45. Postpartum Depression (PPD) <ul><li>Consult a psychiatrist if… </li></ul><ul><li>Comorbid drug abuse </li></ul><ul><li>Lack of interest in the infant </li></ul><ul><li>Excessive concern for the infant’s health </li></ul><ul><li>Suicidal or homicidal ideations </li></ul><ul><li>Hallucinations </li></ul><ul><li>Psychotic behavior </li></ul><ul><li>Overall impairment of function </li></ul>
  46. 46. Postpartum Depression (PPD) <ul><li>Lasts 3-6 months </li></ul><ul><ul><li>25% are still affected at 1 year </li></ul></ul><ul><li>Affects patient’s ADLs </li></ul><ul><li>Treatment </li></ul><ul><li>Supportive care and reassurance (healthcare professionals and family) </li></ul><ul><li>Pharmacological treatment for depression </li></ul><ul><li>Electroconvulsive therapy </li></ul>
  47. 47. Postpartum Psychosis <ul><li>Signs and symptoms </li></ul><ul><li>Acute psychosis </li></ul><ul><ul><li>Schizophrenia </li></ul></ul><ul><ul><li>Manic depression </li></ul></ul>
  48. 48. Postpartum Psychosis <ul><li>Treatment </li></ul><ul><li>Therapy should be targeted to the patient’s specific symptoms </li></ul><ul><li>Psychiatrist </li></ul><ul><li>Hospitalization </li></ul><ul><li>*Generally lasts only 2-3 months </li></ul>
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