Puerperium

1. Ms. Mandeep Kaur
Associate Professor
OBG

2. INTRODUCTION
The events of pregnancy and
during delivery together with the
peak experience of giving birth, all
contribute to a mixture of
emotional reactions in the mother
during the 1st week of puerperium.

3. PSYCHOLOGICAL COMPLICATIONSTYPES
There are three distinctive types of
psychological disturbances seenin
the puerperium theyare
Postnatal blues
Postpartum depression
Puerperal psychosis

4. INCIDENCE OF PSYCHIATRIC ILLNESSDURING
PUERPERIUM
15-20%-postnatal blues
10%-postnatal
depression
0.1-0.2%-postpartum
psychosis

5. HIGH RISKFACTORS
 Past history-psychiatric illness,
puerperal psychiatric illness
 Family history-major psychiatricillness,
marital conflict
 Present pregnancy-caesareandelivery,
difficulty labour, neonatal
complications
 Others-unmetexpectations

6. POSTPARTUM BLUES
DEFINITION
A brief period of
anxiety, mood swings and
sadness which occurs in
some women after delivery
and usually resolves withina
week.

7. INCIDENCE
Nearly 50% of the
postpartum women
suffer from baby blues.

8. SYMPTOMS
 Unprovokedweeping
 Spikes of elation
 Irritability
 Anger
 Hostility
 Headache
 Feeling of unreality
 Exhaustion
 Sleepdeprivation
 Restlessness

9. INTERVENTIONS
 Reassurance and psychologicalsupport by
family members
 Get as much sleep
 Partner, family and friends should help the
mother.
 Mother should take time for herself.
 Don’t drink alcohol. It can affect the mood
and make feel worse.
 Try to connect her with new mothers, who
have the same kind of concerns

10. POSTPARTUM DEPRESSION
DEFINITION
Post partumdepression
/Postnatal depression mayseem
like baby blues at first however
symptoms are more intense and
longer lasting eventually
impacting a mothers ability to
care for herbaby.

11. ONSET
Onset can beanytime
one year after delivery and
last more than 2weeks

12. INCIDENCE
It is observed in10-20%
of the postnatal mothers.
Risk of reoccurrence is
high(50-100%) insubsequent
pregnancies

13. CAUSES
Demand overload
Specific etiology isunknown

14. CONTRIBUTING FACTORS
 Experiencing stress
 Low self esteem
 Lack of support
 Stress associated with postnatalcare
 Severe maternal blues
 Demands of motherhood
 Loss of personal freedom

15. RISK FACTORS
Problems with baby’shealth
Major life changes aroundtime
of delivery
Lack of support or helpwith
baby
Severe premenstrual syndrome

16. CLINICAL MANIFESTATIONS
 Loss of energy
 Loss of Appetite
 Insomnia
 Social withdrawal
 Irritability
 Suicidal attitude
 Anxiety
 Excessiveguilt
 Depressed mood
 Fatigue

17. DIAGNOSIS
History collection
Edinburgh postnatal depression
scale
Medical history
Perform physical examination
and lab test

18. MANAGEMENT
 Early detection and initiation ofappropriate
treatment brings bestprognosis
 Less severecasescan be treated with mild
sedation orantidepressant
 Counseling
 Involvementof spouseand other family members
 For more severe casesadmission is necessary
 Serotoninuptake inhibitors are given
 Breast feeding alsocan begiven to baby

19. POSTPARTUM PSYCHOSIS
Post partum psychosis is a
very serious mental conditionthat
requires immediateattention.
Postpartum psychosis isalsooneof
the rarest usually described as a
period when a woman loses touch
with reality, the disorder occurs in
women who have recently given
birth.

20. INCIDENCE
Observed in about 1/500to
1000 mothers. Commonly
seen in women with past
history of psychosis or with a
positive family history.

21. ONSET
Onset is relativelysudden
usually within 4 days ofdelivery.
Risk of reoccurrence in the
subsequent pregnancy is 20-25%
and there is increased risk of
psychiatric illness outside
pregnancy also.

22. CAUSES
 Lack of social and emotionalsupport
 Low sense of self esteem due to a
woman's postpartumappearance
 Feeling inadequate as amother
 Feeling isolated and alone
 Financial problems
 Major lifechanges

23. SIGNS OF POSTPARTUM
PSYCHOSIS
 Hallucinations
 Delusions
 Illogical thoughts
 Insomnia
 Refusing toeat
 Extreme feeling of anxiety andagitation
 Periods of delirium ormania
 Suicidal or homicidalthoughts

24. RISK FACTORS
Woman with apersonal
history of psychosis, bipolar
disorder or schizophrenia
have a increased risk of
developing postpartum
psychosis.

25. TREATMENT-PRINCIPLES
 Early identification of psychoticsymptoms
 Emergentevaluation
 Hospitalization for safetyand acute management
 Pharmacotherapy
 Co ordination of care amongclinicians
 Involvementof familyand othersupportsystem
forthe patient and thenewborn
 Psycho education forthe patientand family
members

26. TREATMENT
 Active management
 Pharmacotherapy
 Antipsychotic medication
 Other psychotic medications-
Benzodiazepines(lorozepam &
clonazepam)
 ECT-Electroconvulsive therapy

27. PREVENTION
Women with bipolar disorders
or a history of postpartum
psychosis can be identified
through screening during
prenatal care. They should be
monitored continuously forfew
weeks of postpartum.

28. NURSING MANAGEMENT
1. Listen to thewoman regarding heradjustmentto
role of mother and observe for any clinical
manifestations suggestingdepression.
2.Ask the woman about the infant's behaviour.
Negativestatementsabout the infant maysuggest
that thewoman is having difficulty coping.
3. Provide support and encourage husband, family
and friends to support and assist with the infant
and mother. Physical supportaswell asemotional
support may beindicated.
4.Educate the woman that treatment may help
alleviate hersymptomsand allow her to bettercare
for herself and infant.