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Committee on Maternal Welfare. Rupture of the cecum after cesarean section.
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Post-partum thyroid dysfunction.
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Psychosocial disturbances during and after pregnancy.
The identification of patients at risk for psychologically mediated complications during and after pregnancy should be a part of obstetric care. Psychologic assessment can be incorporated into routine prenatal evaluation. Typically, patients who cope poorly during pregnancy have had previous emotional difficulty. Transient emotional disturbances during the early stages of pregnancy are not unusual. Treatment consists of providing support, education, and opportunity for the patient to ventilate her feelings. These interventions can be provided by the sensitive primary care physician who is willing and able to commit the time, to listen, and to communicate. Drug therapy should usually be avoided. Postpartum blues is common, occurring most often in those who experienced emotional distress during pregnancy and in those with a history of premenstrual tension. Management ideally begins before delivery. Treatment of postpartum depression or psychosis involves use of medication and/or psychotherapy. The effects of medication on breast milk must be considered.
Postpartum mental and physical problems. How common are they?
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"In a black hole": the (negative) space between longing and dread: Home-based psychotherapy with a traumatized mother and her infant son.
This paper offers fragments from the first year of a home-based mother-baby psychotherapy, in which I attempted to help a traumatized and dissociated mother to emotionally engage with her infant son. The treatment was organized in part around certain developmental objectives common to both attachment and psychoanalytic theory. These include: The ability to name and metabolize feelings, to evoke a soothing maternal introject, and to relate to the partner's mind as a separate, understandable center of initiative and intention. In addition, attachment theory, with its emphasis on the critical psychobiological role of containing fear and distress in infancy, was a useful guide in formulating the treatment. The paper reviews research findings on mother-infant pairs described as frightened-disorganized, discusses some of the challenges encountered in home-based mother-infant psychotherapy and then discusses the case of Mary and John. The case illustrates how mother-infant psychotherapy may interrupt the intergenerational transmission of disorganized attachment by working within the couple to name, metabolize and flexibly respond to painful, dissociated or frightening experiences.
Post-partum mental disorders: pattern and problems of management in Wesley Guild Hospital, Ilesa, Nigeria.
Sixty-seven consecutive women who presented with postpartum mental disorder within 1 year after delivery over a 5-year period in a teaching hospital serving rural and semi-urban communities were evaluated. All patients were followed-up until they defaulted or for a maximum period of 1 year after presentation. There were more primiparous women (43.3%) than women of other parities. In 16.4%, a previous history of mental disorder was elicited. Family history of mental disorder was present in 13.4%. Premorbidly, marital disharmony was present in 23.9%, obstetric complications in 22.4%, neonate/infant mortality in 19.4% and unwanted pregnancy in 16.4%. Onset of illness occurred during the peurperium in majority of cases (58.2%). Schizophrenia topped the list of clinical types. Short-term prognosis was good but defaulting rate was high. Breastfeeding was stopped permanently by nine patients and two babies died. Ten husbands deserted their wives. The pattern of postpartum mental disorders has remained stable in the past two decades. Although the cause and effect relationship is difficult to establish in our study, the relative stability of some sociocultural factors suggests their usefulness in planning preventive strategies. A multidisciplinary approach is essential.
Postpartum mood and anxiety disorders: a guide for the nonpsychiatric clinician with an aside on thyroid associations with postpartum mood.
This article summarizes the considerable progress that has been made in recent years in our understanding of the risks of pregnancy-associated mood and anxiety disorders, effective somatic and nonsomatic treatments for those disorders, and the risks and benefits of psychotropic medications during pregnancy and breast-feeding. Ten to 15% of women develop syndromal depressions within the first 2 to 3 months postpartum, making this the most common serious medical complication of the puerperium. Prior history of depressive disorders, lack of social support, and stressful life events all increase the risk of postpartum depression. Psychotic mood disorders (commonly called postpartum psychosis) occur after approximately 1 to 2 deliveries per 1000. To ensure safety, women who develop postpartum psychotic symptoms should be hospitalized. History of bipolar illness increases the risk of postpartum psychosis to as much as 25%. Prior episodes of postpartum psychosis further increase the risk to 50%-75%. The risk of first onset or exacerbation of panic disorder or obsessive-compulsive disorder appears to increase during pregnancy and the puerperium. Postpartum mood and anxiety disorders are highly responsive to psychotherapy and in more serious cases, to medication. Fortunately, several classes of psychotropic medications, especially tricyclic and selective serotonin reuptake inhibitor antidepressants, appear to be reasonable safe during pregnancy and breast-feeding. Electroconvulsive therapy is the most effective treatment for very severe postpartum mood disorders, including postpartum psychosis. Preliminary results are also presented that suggest that lower range total and free thyroxine concentrations during late pregnancy are related to postpartum depressive symptoms.
Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality.
The Confidential Enquiry into Maternal Deaths 1997 to 1999 finds that psychiatric disorder, and suicide in particular, is the leading cause of maternal death. Suicide accounted for 28% of maternal deaths. Women also died from other complications of psychiatric disorder and a significant minority from substance misuse. Some of the findings of the Confidential Enquiry confirm long established knowledge about postpartum psychiatric disorder. The findings highlight the severity and early onset of serious postpartum mental illness and of the risk of recurrence following childbirth faced by women with a previous history of serious mental illness either following childbirth or at other times. These findings led to the recommendation that all women should be asked early in their pregnancy about a previous history of serious psychiatric disorder and that management plans should be in place with regard to the high risk of recurrence following delivery. Other findings of the Enquiry were new and challenged some of the accepted wisdoms of obstetrics and psychiatry. It is likely that the suicide rate following delivery is not significantly different to other times in women's lives and for the first 42 days following delivery may be elevated. This calls into question the so-called 'protective effect of maternity'. The overwhelming majority of the suicides died violently, contrasting with the usual finding that women are more likely to die from an overdose of medication. Compared to other causes of maternal death, the suicides were older and socially advantaged. The Enquiry findings suggest that the risk profile for women at risk of suicide following delivery may be different to that in women at other times and in men. None of the women who died had been admitted at any time to a Mother and Baby Unit and their psychiatric care had been undertaken by General Adult Services. None of the women who died had had a previous episode correctly identified and none had had adequate plans for their proactive care. The conclusion is that there is a need for both Psychiatry and Obstetrics to acknowledge the substantial risk that women with a previous psychiatric history of serious mental illness face following delivery.
Psychiatric complications of progesterone and oral contraceptives.
Progesterone plays a critical role in the menstrual cycle, pregnancy, and sexuality. Its role in premenstrual syndrome, dysmenorrhea, and postpartum disorders is outlined. Oral contraceptives seem to affect mood and behavior in some women without preexisting psychiatric illness, sometimes inducing depression and loss of libido. When used as psychotropic agents, they can have mood-stabilizing effects and relieve premenstrual syndrome.
Post-partum depression and the effect of nomifensine treatment.
The purpose of this study was to examine the difference in certain hormonal and biochemical parameters in post-partum depressed women and age and status matched post-partum, non-depressed controls and study the effect of 6 weeks treatment with nomifensine on these parameters in the depressed group. The parameters examined were: plasma oestradiol, progesterone and prolactin concentrations, platelet 3H-serotonin uptake and alpha-2adrenoceptor density and lymphocyte beta-adrenoceptor densities. There was a significant decrease in platelet serotonin uptake rate in the depressed pre-treatment group as compared to controls. Six weeks treatment with nomifensine normalized the rate of uptake in the depressed group. Lymphocyte beta-adrenoceptor density was increased in the untreated depressed group as compared to the control group. This difference was also eliminated by 6 weeks of nomifensine treatment. Both plasma prolactin levels and platelet alpha-adrenoceptor density were decreased in the depressed group following 6 weeks treatment with nomifensine. There was no difference between the untreated depressed and control groups in any of the other parameters studied.
Pseudopregnancy, prenatal, and postpartum psychosis: a case study.
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Infanticidal ideas and infanticidal behavior in Indian women with severe postpartum psychiatric disorders.
Few studies have investigated maternal aggression toward infants among women with a severe mental illness that emerges in the postpartum period. In this prospective study of 50 Indian women admitted to a psychiatric hospital for severe mental illness occurring in the postpartum period, we examined the prevalence, pattern, and predictors of maternal aggression, infanticidal ideas, and infanticidal behavior. Nearly half (43%) of the mothers reported infanticidal ideas, 36% reported infanticidal behavior, and 34% reported both infanticidal ideas and behavior. Infanticidal ideas and behavior co-occurred frequently (r =.80). Infanticidal ideas were associated with depression in the mother, adverse maternal reaction to separation from the infant, and psychotic ideas toward the infant. Infanticidal behavior was associated with having a female infant, psychotic ideas toward the infant, and adverse maternal reaction to separation from the infant. Logistic regression analyses indicated that presence of depression and of psychotic ideas predicted infanticidal ideas, whereas presence of psychotic ideas toward the infant predicted infanticidal behavior.
Incidence of post-abortion psychosis: a prospective study.
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Emotional illness in habitual aborters following suturing of the incompetent cervical os.
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Early and late postpartum illnesses.
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Prevention of postpartum psychosis.
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