Obstetrics & Gynecology>>>>>The Puerperium, Lactation, and Immediate Care of the Newborn
Question 10#

A 24-year-old who delivered her first baby 5 weeks ago calls your office and asks to speak to you. She states that she is feeling very overwhelmed and anxious about taking care of her newborn son. She feels she cannot do anything right, and feels sad throughout the day. She tells you that she cries on most days, and is having difficulty sleeping at night. She also states she doesn’t feel like eating or doing any of her normal activities. She reports no suicidal or homicidal ideation.

Which of the following is the most likely diagnosis?

a. Postpartum depression
b. Maternity blues
c. Postpartum psychosis
d. Bipolar disorder
e. Postpartum blues

Correct Answer is A

Comment:

This patient is exhibiting classic symptoms of postpartum depression. Postpartum depression develops in about 8% to 15% of women, and generally is characterized by an onset about 2 weeks to 12 months postdelivery, with an average duration of 3 to 14 months. Perinatal depression includes major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery, and is one of the most common medical complications during pregnancy or the postpartum period. It often goes unrecognized, because changes in sleep, appetite, and libido may be attributed to normal pregnancy and postpartum changes. Women with postpartum depression may display irritability, labile mood, difficulty sleeping, phobias, and anxiety. About 50% of women experience postpartum blues within 3 to 6 days after delivering. This mood disturbance is thought to be precipitated by progesterone withdrawal following delivery, and usually resolves in 10 to 14 days. Postpartum blues is characterized by mild insomnia, tearfulness, fatigue, irritability, poor concentration, and depressed effect. Postpartum psychosis usually has its onset within a few days of delivery and is characterized by confusion, disorientation, and loss of touch with reality. Postpartum psychosis is very rare and occurs in only 1 to 4 in 1000 births. Bipolar disorder or manic-depressive illness is a psychiatric disorder characterized by episodes of depression followed by mania.