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