This document discusses postpartum complications that can occur after childbirth. It defines the postpartum period as the 6 weeks following birth when the mother's body returns to a non-pregnant state. Common early complications include pain, breast engorgement, urinary retention, and postpartum fever. Late complications include postpartum thyroiditis, depression, and weight retention. The document provides details on symptoms, risk factors, diagnosis and management of various postpartum complications like mastitis, endometritis, and postpartum thyroiditis. It also discusses postpartum blues, depression, and the rare but serious condition of postpartum psychosis.
This topic contains detailed description regarding Normal puerperium, it's definition, duration, phases, involution of uterus and other pelvic organs, lochia, general physiological changes of puerperium, lactation, management of normal puerperium, management of ailments and postnatal care.
It explains the mechanism of normal labour to medical and para-medical staff.It also puts light on principle movements underlying mechanism of normal labour with pictures.Thank You Like an share it to the maximum.
Hyperemesis Gravidarum - Disorder of PregnancyJaice Mary Joy
Hyperemesis gravidarum is characterized by severe nausea and intractable vomiting sufficient to interfere with maternal nutrition causing deleterious effect on her health. It has got deleterious effect on health of the patient and incapacitates her day-to-day activities. According to the national health portal 0.3%-3% pregnant women suffer from hyperemesis gravidarum – commonest indication for hospitalization in the first trimester of pregnancy.
This document covers following topics -
• Introduction
• Definition
• Prevalence
• Etiology
• Risk factors
• Theories behind hyperemesis gravidarum
• Symptoms:
• Signs
• Investigation
• Diagnosis
• Complications
• Prevention
• Management principles
• Nursing management
Many women experience some minor disorders during pregnancy.
Every system of the body may be affected during pregnancy. These disorders, however , are not minor to the pregnant woman.
This topic contains detailed description regarding Normal puerperium, it's definition, duration, phases, involution of uterus and other pelvic organs, lochia, general physiological changes of puerperium, lactation, management of normal puerperium, management of ailments and postnatal care.
It explains the mechanism of normal labour to medical and para-medical staff.It also puts light on principle movements underlying mechanism of normal labour with pictures.Thank You Like an share it to the maximum.
Hyperemesis Gravidarum - Disorder of PregnancyJaice Mary Joy
Hyperemesis gravidarum is characterized by severe nausea and intractable vomiting sufficient to interfere with maternal nutrition causing deleterious effect on her health. It has got deleterious effect on health of the patient and incapacitates her day-to-day activities. According to the national health portal 0.3%-3% pregnant women suffer from hyperemesis gravidarum – commonest indication for hospitalization in the first trimester of pregnancy.
This document covers following topics -
• Introduction
• Definition
• Prevalence
• Etiology
• Risk factors
• Theories behind hyperemesis gravidarum
• Symptoms:
• Signs
• Investigation
• Diagnosis
• Complications
• Prevention
• Management principles
• Nursing management
Many women experience some minor disorders during pregnancy.
Every system of the body may be affected during pregnancy. These disorders, however , are not minor to the pregnant woman.
This power point goes over how an organization can implement and sustain a hospital wide pressure ulcer prevention program using current evidence-based practice.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This slide will highlight the most important theoretical and practical concept regarding abortion. In this slide preparation the definition, types, clinical presentation, the magnitude and prevalence, types of abortion in different settings, managing of abortion based presentation are presented.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Objectives
Introduction to postpartum period and its
significance
Discuss different issues and complications
regarding this period to the mother
We will focus on non-bleeding
complications
Management of some of the
complications
3. Introduction
A postpartum period is the period
beginning immediately after the birth of a
child and extending for about six weeks.
It is the time after birth, a time in which the
mother's body, including hormone levels
and uterus size, returns to a non-pregnant
state.
4. Upon spontaneous vaginal delivery, the
mother spends an average of 1-2 days in
hospital, up to 3-4 days in caesarian
sections.
Providing support and reassurance during
the postpartum period helps to instill a
sense of confidence in new mothers and
a healthy mother-infant relationship.
6. Early Complications/ Issues Late Complications
Pain Postpartum thyroiditis
Breast Engorgement Postpartum depression
Voiding difficulty and retention Postpartum psychosis
Preeclampsia/ Eclampsia Sexual dysfunction
Postpartum fever and infection Weight retention and gain
Varicose veins
Postpartum blues
7. Pain
• Pain and fatigue are the two most common
complaints after vaginal or cesarean delivery.
[1]
• Afterpains may occur after uncomplicated
vaginal delivery due to hypertonic uterine
contractions.
• Short acting NSAIDs as ibuprofen are as or
more effective than opioids for relief of pain.[2]
• The pain usually spontaneously resolves by
the end of the first postpartum week.
8. Breast Engorgement
• The breast becomes firm, enlarged, tender,
and may be warm to the touch.
• Early engorgement is secondary to edema,
tissue swelling, and accumulated milk, while
late engorgement is due solely to
accumulated milk.
• Cool compresses or ice packs and mild
analgesics, may provide effective pain
management.
9. Voiding difficulty and urinary retention
• It is a relatively common complication
in the early puerperium
• absence of spontaneous micturition
within six hours of vaginal delivery or within
six hours of removal of an indwelling
catheter.[3]
• appears to be due to injury to the
pudendal nerve during the birth process. [4]
10. Preeclampsia/ Eclampsia
• Delayed postpartum onset or exacerbation of
disease
• Signs and symptoms can be atypical; for
example, the patient may have thunderclap
headaches alternating with mild headaches
or intermittent hypertension.
• Risk factors are similar to those for
preeclampsia during pregnancy
11. Case 1
28-year-old G1P1 who have just delivered
last night. On postpartum day 1, your
patient complains of sore breasts from
breast-feeding, and her abdomen is sore
“from all the rubbing.” Following delivery
and on morning rounds her temperature
was 38.5°C.
What is the most likely cause and the
most appropriate course of action?
13. Definition
Postpartum fever is defined as a temperature
of 38.7 degrees C (101.6 degrees F) or greater
for the first 24 hours or greater than 38.0
degrees C (100.4 degrees F) on any two of
the first 10 days postpartum.
If fever is present, a physical examination
should be performed to identify the source of
infection and direct optimal therapy.
14. Differential Diagnosis
Urinary tract infection
Mastitis or breast abscess
Atelectasis
Wound infection (episiotomy or other surgical site
infection)
Endometritis or deep surgical infection
Septic pelvic thrombophlebitis
Drug reaction
Complications related to anesthesia
15. Postpartum Endometritis
Postpartum endometritis is
a common cause of
postpartum febrile
morbidity.
The infection begins in the
decidua, and then may
extend into the myometrial
and parametrial tissues.
The infection is
polymicrobial.
16. Cesarean delivery is the most important risk factor
for development of postpartum endometritis.
The diagnosis of postpartum endometritis is based
upon clinical criteria of fever and uterine
tenderness occurring in a postpartum woman.
Other signs and symptoms which support the
diagnosis include foul lochia, chills, and lower
abdominal pain.
17. Treatment
Broad spectrum antibiotics with coverage of
beta-lactamase producing anaerobes.
Example clindamycin(900 mg Q8) plus
gentamicin (1.5 mg/kg Q8 or 5 mg/kg QD in
patients with normal renal function) (
Grade 2B). Ampicillin-sulbactam (1.5 g Q6) is
a reasonable alternative in areas with
significant clindamycin resistance in B.
18. Lactational mastitis
Lactational mastitis is a localized, painful
inflammation of the breast that occurs in
breastfeeding women.
Mastitis typically presents as a hard, red, tender,
swollen area of one breast often associated with
systemic complaints including fever, myalgia,
chills, malaise, and flu-like symptoms.
Ultrasound is the most effective method of
differentiating mastitis from a breast abscess.
19. Most lactation associated breast infections are
caused by staphylococcus aureus
Lactational mastitis should be managed initially
with systematic emptying of the breast, anti-
inflammatory agents and symptomatic treatment
to reduce pain and swelling.
If there is difficulty with breastfeeding, hand
expression or breast pumps can be effective for
maintaining the milk supply until the mother can
resume nursing.
20. Septic thrombolphlebitis
occurs in the setting of pelvic vein endothelial
damage, venous stasis and hypercoagulability
There are two types of SPT: ovarian vein
thrombophlebitis (OVT) and deep septic pelvic
thrombophlebitis (DSPT).
Patients with OVT usually present with fever and
abdominal pain within one week after delivery or
surgery, and thrombosis of the right ovarian vein is
visualized radiographically in about 20 percent of
cases
21. Patients with DSPT usually present within a
few days after delivery or surgery with
unlocalized fever that persists despite
antibiotics, in the absence of
radiographic evidence of thrombosis. “a
diagnosis of exclusion”
23. Management
Broad Spectrum Antibiotics
• Antibiotics should be continued for at least
48 hours following resolution of leukocytosis
and clinical improvement.
Systemic anticoagulation
• If septic emboli or extensive pelvic
thromboses are documented
radiographically, anticoagulate with low
molecular weight heparin or warfarin for at
least six weeks
24. Case 2
A 26 year old white female presented to your office
with complaints of heart palpitations. She states that
the palpitations have been constant over the past
two weeks but seem worse at night. When asked to
describe them, she states that they are regular and
it feels as if her heart is going to jump out of her
chest. She denies chest pain, shortness of breath or
lightheadedness. She has felt a bit warm of late but
denies any frank diaphoresis. It is of note that she
recently delivered a normal baby boy during an
uncomplicated delivery 5 weeks before this visit.
She complains of feeling tired but unable to get a
good night sleep. She denies any nausea, vomiting
or abdominal pain.
25. Her blood work at the time of the clinic visit
included a
• CBC (WBC 14.2, Hct, 38.6, MCV normal, platelet
count normal, differential 56% neutrophiles, 7%
bands, 34% lymphocytes and 3% monocytes)
• Electrolytes (NA 142, K 3.6, Cl 101), glucose 86,
BUN 26, creatinine 1.
• TFTs thyroxine 16.2 (NL 4-13), T3 resin uptake 34%
(NL 25 - 35%) and a TSH of <0.05 (NL 0.3 - 5.0).
What is your diagnosis and management ?
26. Postpartum thyroiditis
Postpartum thyroiditis is a destructive
thyroiditis induced by an autoimmune
mechanism within one year afte. [5]
It usually presents in one of three ways:
1. Transient hyperthyroidism alone
2. Transient hypothyroidism alone
3. Transient hyperthyroidism followed by
hypothyroidism and then recovery
27. Prevalence
varies globally and ranges from 1 to 17
percent. [6]
Higher rates, up to 25 percent, have been
reported in women with type 1 diabetes
mellitus, and among women with a prior
history of postpartum thyroiditis
28. Pathogenesis
It is considered a variant form of chronic
autoimmune thyroiditis (Hashimoto's
thyroiditis).
usually have high serum anti-thyroid
peroxidase antibody concentrations early
in pregnancy, which decline later and
then rise again after delivery. [7]
29. Clinical Presentation
typically mild and consist mainly of
fatigue, weight loss, palpitations, heat
intolerance, anxiety, irritability,
tachycardia, and tremor.
Similarly, hypothyroidism is also usually
mild, leading to lack of energy, cold
intolerance, constipation, sluggishness,
and dry skin. [8]
30. Serum antithyroid peroxidase antibody
concentrations are high in 60 to 85
percent of women with postpartum
thyroiditis. [9]
It is highest during the hypothyroid phase.
32. Screening
There is insufficient evidence to support a
recommendation for screening
However, women at highest risk for
developing postpartum thyroiditis should
have a serum TSH measurement at three
and six months postpartum.
33. Management
The American Thyroid Association [10]
,has
outlined the following:
1. The majority of women with postpartum
thyroiditis need no treatment during either the
hyperthyroid or the hypothyroid phases of
their illness.
2. TFTs should be monitored every four to eight
weeks to confirm resolution of biochemical
abnormalities or to detect the development
of more severe hypothyroidism, indicating
possible permanent hypothyroidism.
34. 3. Women who have bothersome
symptoms of hyperthyroidism can be
treated with 40 to 120 mg propranolol or
25 to 50 mg atenolol daily until their
serum T3 and serum free T4
concentrations are normal.
4. Women with symptomatic
hypothyroidism should be treated with
levothyroxine (T4) irrespective of the
degree of TSH elevation.
35. Case 3
A 26-year-old primigravida delivers a healthy male
infant at 40 weeks of gestation who she breastfeeds
on demand. She was doing fairly well until day 4
postpartum. At that time, she developed insomnia,
fatigue, and feelings of sadness and depression. The
patient has a history of bipolar disorder, but she has
not had an episode of either hypomania or
depression for the past 5 years. Despite your concern
regarding her history of bipolar disorder, she begins
to improve on the day 8 postpartum and returns to
her normal mental state at 2 weeks postpartum.
When you see her in the office in 6 weeks she is well.
36. What is the most likely diagnosis in this
patient?
What is the best initial choice of treatment
for this
patient?
37. Postpartum blues and
depression
Pregnant women and
their friends, families,
and clinicians expect
the postpartum period
to be a happy time,
characterized by the
joyful homecoming of
the newborn.
Unfortunately, this is not
the case in many
mothers.
38. Postpartum blues
Postpartum blues refer to a transient condition
characterized by mood swings from elation to
sadness, irritability, anxiety, decreased
concentration, insomnia, tearfulness, and crying
spells.
Forty to 80 percent of postpartum women
develop these mood changes, generally within
two to three days of delivery.
Symptoms typically peak on the fifth postpartum
day and resolve within two weeks
39. Etiology
Although there are no conclusive data
regarding the etiology of postpartum
blues, multiple factors are probably
involved.
Although all women experience hormonal
fluctuations postpartum, some women
may be more sensitive to these changes
than others.
40. Women at high risk
Major risk factors for postpartum blues include
[13]
:
• History of depression
• Depressive symptoms during pregnancy
• Family history of depression
• Premenstrual or oral contraceptive
associated mood changes
• Stress around child care
• Psychosocial impairment in the areas of work,
relationships, and leisure activities.
41. Postpartum depression
depression that begins within the first month
after delivery, using the same criteria as for
non-pregnancy related depression.
It often goes unrecognized because many of
the usual discomforts of the puerperium (eg,
fatigue, difficulty sleeping, low libido) are
similar to symptoms of depression.
42. Prevalence
Postpartum depression (PPD) affects many
women worldwide.
Although the prevalence of depression is
similar for postpartum and non-pregnant
women.
The onset of new episodes of depression is
higher in the first five weeks postpartum than
in non-pregnant controls.
43. Risk factors
Marital conflict
Stressful life events in the previous 12 months
Lack of social support from family and
Lack of emotional and financial support from the
partner
Living without a partner
Unplanned pregnancy
Having contemplated terminating the current
pregnancy
Previous miscarriage
Family psychiatric history
44. Screening
The Edinburgh Postnatal Depression Scale
(EPDS) is a 10 item self-report questionnaire
designed specifically for the detection of
depression in the postpartum period. [14]
Women who report depressive symptoms
without suicidal ideation or major functional
impairment (or score between 5 and 9 on the
EPDS) are reevaluated within one month to
determine the state of depression
45.
46. Management
A biopsychosocial approach to treatment
is often utilized to maximize clinical
response.
Pharmacotherapy has been proven to be
an effective treatment of depression.
The major issue in selecting a medication
for treatment of PPD is whether or not the
woman is breastfeeding. If she is not, then
drug choices are based upon the same
selection criteria used for nonpuerperal
depression.
47. Antidepressants in lactating
mothers
All psychotropic medications are transferred
into breast milk, and thus are passed on to
the nursing infant.
Exposure of most infants to antidepressants
via human milk is clinically insignificant, with
some exceptions.
The benefits of breastfeeding generally
outweigh the relatively small risk of the
psychotropic medication
48. In women who choose to breastfeed while
using antidepressants, we suggest sertraline or
paroxetine in women whose psychiatric
disorder is effectively managed by these
medications
However, if the woman was taking a different
SSRI successfully during pregnancy, we do not
suggest switching SSRIs during lactation
49. Postpartum psychosis
Postpartum psychosis most commonly
presents within two weeks of childbirth.
Women with postpartum psychosis are
more likely to commit suicide or
infanticide than the general population.
50. DEFINITIONS
disturbance in an individual's perception of
reality. Psychosis can be manifested
through one or more of the following:
Delusions: fixed, false beliefs
Hallucinations: false perceptions (eg,
visual, auditory, or olfactory)
Thought disorganization
52. Risk factors
History of postpartum psychosis
History of bipolar disorder
Family history of postpartum psychosis
First pregnancy
Recent discontinuation of lithium or other
mood stabilizers
53. Examination
The onset and course of psychotic symptoms (eg,
episodic versus chronic)
The nature of the affective symptoms (eg,
depressed, manic, or mixed state, or not present)
The impact of these symptoms on the patient's
behavior and functioning
The patient's history and family history of prior
affective or psychotic episodes
Safety of the child and others under the patient’s
care
The presence of a comorbid substance-use
disorder
54. DIAGNOSIS
DSM-5 does not classify postpartum
psychosis as a distinct diagnostic entity
55. TREATMENT
General principles of treatment include:
Early identification of psychotic symptoms
Emergent evaluation
Hospitalization for safety and acute
management
Pharmacotherapy
Coordination of care among clinicians
Involvement of family and other support systems
for the patient and the newborn
Psycho-education for the patient and family
members
56. Acute management
A woman experiencing psychosis will not
be able to care for herself or her baby;
she should be hospitalized until stable.
The mother should not be left alone with
the infant.
Hospitals may make supervised day-time
visits with the infant.
58. Breastfeeding
The benefits of breastfeeding need to be
weighed against risks to the infant for
each psychotropic medication.
All psychotropic medications are
transferred into breast milk, and thus are
passed on to the nursing infant.
the effects of some of these medications
are believed to be clinically insignificant.
59. Other complications
Sexual dysfunction
• 47 to 57 % of women interviewed at three
months postpartum noted a decreased
interest. [15]
• Lower libido has been attributed to fatigue,
pain, and concern over injury.
• Dyspareunia is common, occurring in about
50 percent of women at two months
postpartum.
60. Weight retained after
pregnancy is defined as
the difference between
postpartum and pre-
pregnancy weight.
Approximately one-half of
gestational weight gain is
lost in the first six weeks
after delivery, with a slower
rate of loss through the first
six months postpartum. [16]
Postpartum weight
retention
61. Risk factors for weight retention
include:
Excessive weight gain during pregnancy — women who
gain more than the IOM guideline are twice as likely to
retain ≥9 kgs postpartum
Black race — black women retain more weight than
white women, despite comparable prepregnancy BMI
or weight gain during pregnancy.
Obesity — an increasing BMI correlates with an
increased tendency to postpartum weight retention.
Quitting cigarette smoking — women who quit smoking
during pregnancy and do not resume postpartum are
at high risk of retaining weight