ACOG Practice Guideline # 4 & 5
Clinical Presentation of topic/ issue
Diagnosing ( labs, diagnostics, & why)
Management options
Discussion 10 minutes – notes to read
Perinatal Mental Health Conditions ACOG Guidelines 4 & 5
Latasha Carothers
NURS 7601-M50
Discussion Board 1
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ACOG Practice Guideline
ACOG’s Clinical Practice Guideline 4: Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum
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ACOG Practice Guideline
ACOG Clinical Guideline 5
Treatment of Perinatal Mental Health Conditions During Pregnancy and Postpartum
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Clinical Presentation of the Topic
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Baby blues: The experience of abrupt mood swings, feeling extremely happy then extremely sad, or crying uncontrollably (ACOG, 2023).
Unipolar or Major Depression: Experience of a depressive episode during a pregnancy or within a year of giving birth(ACOG, 2023).
Bipolar: It is a manic-depressive illness that results in unusual changes in mood, energy, level of activity, and capacity to do daily chores (ACOG, 2023).
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After giving birth, most new mothers endure postpartum baby blues, which frequently include mood changes, crying bouts, anxiety, and trouble sleeping. The first two to three days after delivery are when baby blues typically start, and they can linger for up to two weeks. Major Depression: Suicidal thoughts, low mood, reduced focus, loss of interest, and sleep disturbances are all symptoms of prenatal depression in women. However, they also show symptoms that are similar to those of pregnancy, such as somatic complaints, exhaustion, low energy, irregular sleep patterns, and changes in appetite. Major Depression: Suicidal thoughts, low mood, reduced focus, loss of interest, and sleep disturbances are all symptoms of prenatal depression in women (Sethuraman et al., 2021). However, they also show symptoms that are similar to those of pregnancy, such as somatic complaints, exhaustion, low energy, irregular sleep patterns, and changes in appetite (Sethuraman et al., 2021). Bipolar : Pregnant bipolar women experience negative effects such gestational hypertension and antepartum hemorrhage. Additionally, they are more likely to get a caesarean section and induce labor, and their chances of developing mood disorders after giving birth are higher(Mohamed et al., 2023).
Clinical Presentation Continued
Perinatal Anxiety Disorders
Schizoaffective and Schizophrenia
Postpartum psychosis
Boarderline Personality Disorder
Post-traumatic Disorder (PTSD)
Obsessive Compulsive Disorder (OCD)
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Diagnosis
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Screening for depressive symptoms.
Screening for perinatal anxiety and depression.
Screen for risk of suicide.
Screen for self-harm
Screening early in pregnancy or right after birth : meant to ensure timely access to diagnosis, treatment, follow-up and monitoring.
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At the first prenatal appointment, later in pregnancy, and at postpartum appointments, perinatal depression and anxiety are screened for. The implementation of mental health screening should be accompanied by procedures that, depending on severity, guarantee prompt access to evaluation and diagnosis, efficient treatment, and appropriate monitoring and follow-up. If it hasn't already been done, bipolar disorder screening should be done before beginning medication for anxiety or depression. When someone indicates they are considering self-harm or suicide, physicians make an initial assessment of the likelihood, acuity, and severity of the risk of attempting suicide before making arrangements for risk-tailored management. Clinicians treat postpartum psychosis right away with medicine.
Patient Screening Tools
Edinburgh Postnatal Depression Scale(EPDS)
Patient Health Questionnaire (PHQ-9)
Mood Disorder Questionnaire (MDQ)
General Anxiety Disorder (GAD-7)
Primary Care PTSD for DSM-5 (PC-PTSD-5)
Suicide Risk Assessment
Patient Safety Screener
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Management Options
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Baby blues;
Have a support system for the patient.
Psychoeducation.
Sleep hygiene
Unipolar disorder;
individual therapy
Social and community support
Bipolar disorder;
Behavioral therapy and medication
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Support groups, psychoeducation, and sleep hygiene are all available resources for parents who are experiencing baby blues. Infant behavioral dysregulation, like as crying, sleep, and feeding issues, must be addressed in the context of perinatal emotional difficulties (ACOG, 2023). Individual counseling, mother-and-baby dyadic therapy, group therapy, and medication are all available treatments for depression (ACOG, 2023). It's crucial to promote self-care as well as participation in social and community supports. Treatment for bipolar disorder that combines medication control and individual counseling works well (ACOG, 2023). The patient should be encouraged consistency in daily routine, good sleeping habits, and accepting aid when needed when giving overnight feedings (ACOG, 2023). As early hypomanic episodes can be accompanied by medication non-compliance and general decompensation, it is important to emphasize consistency with medication regimen (ACOG, 2023).
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References
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ACOG. (2023). Perinatal mental health. Www.acog.org. https://www.acog.org/programs/perinatal-mental-health
Mohamed, M. A., Abdulrahman Elhelbawy, Khalid, M., AbdAllatif, L. A., & Lialy, H. E. (2023). Effects of bipolar disorder on maternal and fetal health during pregnancy: a systematic review. BMC Pregnancy and Childbirth, 23(1). https://doi.org/10.1186/s12884-023-05924-8
Sethuraman, B., Thomas, S., & Srinivasan, K. (2021). Contemporary management of unipolar depression in the perinatal period. Expert Review of Neurotherapeutics, 21(6), 643–656. https://doi.org/10.1080/14737175.2021.1914591
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