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Current Psychiatry Reports Feb 2023Postpartum psychosis is a psychiatric emergency that can affect the health and life of mothers, infants, and families. Postpartum psychosis (PPP) is distinct from... (Review)
Review
PURPOSE OF REVIEW
Postpartum psychosis is a psychiatric emergency that can affect the health and life of mothers, infants, and families. Postpartum psychosis (PPP) is distinct from non-postpartum psychosis in many ways, and it is crucial to study and understand PPP to identify, treat, and possibly prevent this condition. We therefore sought to review the latest research findings about PPP with the intention of updating readers about the latest evidence base.
RECENT FINDINGS
Multiple physiologic pathways have been implicated in the development of PPP, and further understanding these pathways may allow for early detection and treatment. Risk assessment and treatment should include consideration of the woman patient but also the mother-infant dyad and the larger family. It is our hope that this review of research updates in postpartum psychosis may inform clinical practice and promote specialized, evidence-based diagnosis, risk assessment, and treatment.
Topics: Female; Infant; Humans; Psychotic Disorders; Puerperal Disorders; Mothers; Risk Assessment; Postpartum Period; Depression, Postpartum
PubMed: 36637712
DOI: 10.1007/s11920-022-01406-4 -
Current Psychiatry Reports Apr 2022Suicide is a leading cause of death in the perinatal period (pregnancy and 1 year postpartum). We review recent findings on prevalence, risk factors, outcomes, and... (Review)
Review
PURPOSE OF REVIEW
Suicide is a leading cause of death in the perinatal period (pregnancy and 1 year postpartum). We review recent findings on prevalence, risk factors, outcomes, and prevention and intervention for suicide during pregnancy and the first year postpartum.
RECENT FINDINGS
Standardization of definitions and ascertainment of maternal deaths have improved identification of perinatal deaths by suicide and risk factors for perinatal suicide. Reports of a protective effect of pregnancy and postpartum on suicide risk may be inflated. Clinicians must be vigilant for risk of suicide among their perinatal patients, especially those with mental health diagnoses or prior suicide attempts. Pregnancy and the year postpartum are a time of increased access to healthcare for many, offering many opportunities to identify and intervene for suicide risk. Universal screening for suicide as part of assessment of depression and anxiety along with improved access to mental health treatments can reduce risk of perinatal suicide.
Topics: Female; Humans; Maternal Mortality; Parturition; Postpartum Period; Pregnancy; Pregnancy Complications; Suicide, Attempted
PubMed: 35366195
DOI: 10.1007/s11920-022-01334-3 -
Midwifery Nov 2021The anxiety mothers experience during pregnancy is well known and may have negative consequences for the emotional, psychological, and social development of newborns.... (Review)
Review
BACKGROUND
The anxiety mothers experience during pregnancy is well known and may have negative consequences for the emotional, psychological, and social development of newborns. Anxiety must therefore be reduced using different strategies.
OBJECTIVE
To determine published non-pharmacological interventions to reduce anxiety during pregnancy, childbirth and postpartum.
METHODS
A systematic peer-review of experimental and quasi-experimental studies was conducted using the PubMed, Scopus, Web of Science (WOS), and CINAHL databases. The quality of the studies was assessed using the Spanish version of the PEDro scale. Two researchers participated independently in the data selection and extraction process.
FINDINGS
587 articles were identified, of which 21 met the eligibility criteria. In eleven studies the intervention was performed during pregnancy, in three of them during labour, in four of them during the postpartum period, and in three of them during pregnancy and postpartum. During pregnancy, the most effective interventions were behavioural activation, cognitive behavioural therapy, yoga, music therapy, and relaxation; during childbirth: aromatherapy; during pregnancy and postpartum: antenatal training, massage by partners, and self-guided book reading with professional telephone assistance.
CONCLUSION AND IMPLICATIONS
The most effective interventions to reduce anxiety were performed either during pregnancy or during the postpartum period, not during labour. Most of the interventions were performed on the women, with few of them being performed on both partners. Non-pharmacological interventions may be applied by nurses and midwives to reduce anxiety during pregnancy, labour and postpartum.
Topics: Anxiety; Anxiety Disorders; Female; Humans; Infant, Newborn; Labor, Obstetric; Parturition; Postpartum Period; Pregnancy
PubMed: 34464836
DOI: 10.1016/j.midw.2021.103126 -
Archivos Espanoles de Urologia Feb 2023Urinary incontinence in the postpartum period is related to biomechanical and hormonal changes that occur during the obstetric period and also related to perineal trauma... (Review)
Review
BACKGROUND
Urinary incontinence in the postpartum period is related to biomechanical and hormonal changes that occur during the obstetric period and also related to perineal trauma during childbirth. Physiotherapy is currently presented as one of the conservative options for the treatment of urinary incontinence at this stage, so this review aims to go over scientific literature to assess the effect of physiotherapy on postpartum urinary incontinence.
MATERIAL AND METHODS
In February 2022, a bibliographic search was carried out in PubMed, Scopus, Medline, PeDRO and Sport Discuss databases. Studies published within the last 10 years and randomized clinical trials that used physiotherapy techniques for the treatment of postpartum urinary incontinence were identified, but those articles that differ from the objective of the work and those that were duplicated in the databases were excluded.
RESULTS
Out of the 51 articles identified, 8 were finally included that fit the criteria and the subject of the study. Regarding the intervention, we have found that all the articles refer to pelvic floor muscle training. In addition to urinary incontinence, these studies evaluated other variables such as strength, resistance, quality of life and sexual function, obtaining significant results in 6 out of all the studies consulted.
CONCLUSIONS
Pelvic floor muscle training is beneficial for the treatment of urinary incontinence in the postpartum period, then supervised and controlled exercise combined with a home training routine is recommended. It is not clear whether the benefits are maintained over time.
Topics: Pregnancy; Female; Humans; Quality of Life; Exercise Therapy; Pelvic Floor; Urinary Incontinence; Postpartum Period; Physical Therapy Modalities
PubMed: 36914417
DOI: 10.56434/j.arch.esp.urol.20237601.2 -
American Family Physician Oct 2019The postpartum period, defined as the 12 weeks after delivery, is an important time for a new mother and her family and can be considered a fourth trimester. Outpatient...
The postpartum period, defined as the 12 weeks after delivery, is an important time for a new mother and her family and can be considered a fourth trimester. Outpatient postpartum care should be initiated within three weeks after delivery in person or by phone, and may require multiple contacts with the patient to fully address needs and concerns. A full assessment is recommended within 12 weeks. Care should initially focus on acute needs and risks for morbidity and mortality and then transition to care for chronic conditions and health maintenance. Complications of pregnancy, such as hypertensive disorders and gestational diabetes mellitus, affect a woman's long-term health and require specific attention. Women diagnosed with gestational diabetes should receive a 75-g two-hour fasting oral glucose tolerance test between four and 12 weeks postpartum. Patients with hypertensive disorders of pregnancy should have a blood pressure check performed within seven days of delivery. All women should have a biopsychosocial assessment (e.g., depression, intimate partner violence) screening in the postpartum period, and preventive counseling should be offered to women at high risk. Additional patient concerns may include urinary incontinence, constipation, breastfeeding, sexuality, and contraception. Treating these issues during the postpartum period is important to the new mother's immediate and long-term health.
Topics: Breast Feeding; Curriculum; Education, Medical, Continuing; Female; Humans; Mothers; Postnatal Care; Postpartum Period; Practice Guidelines as Topic
PubMed: 31613576
DOI: No ID Found -
BMC Pregnancy and Childbirth Nov 2021Approximately 13-19% of postpartum women experience postpartum depression and a majority report at least some stress during the postpartum phase. Traditional... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Approximately 13-19% of postpartum women experience postpartum depression and a majority report at least some stress during the postpartum phase. Traditional interventions such as psychotherapy and antidepressant medications are often not feasible or desirable. The purpose of this study was to examine two low cost, brief, accessible interventions designed to prevent postpartum depression and perceived stress among women at high risk.
METHODS
Participants (n = 450) who were on average four weeks postpartum, had a history of depression before pregnancy, and exercised less than 60 min per week were randomly assigned to one of the following three conditions: (1) 6-month telephone-based exercise intervention; (2) 6-month telephone-based wellness/support intervention (e.g., healthy eating, sleep, and perceived stress); or (3) usual care.
RESULTS
Overall, 2.4% of participants met criteria for depression at 6 months and 3.6% at 9 months with no differences between groups. At 6 months following randomization, median symptoms of depression were significantly lower among wellness participants compared to usual care participants (b = - 1.00, SE = 0.46, p = .03). Perceived stress at 6 months post-randomization was significantly lower among exercise vs. usual care participants (b = - 2.00, SE = .98, p = .04) and exercise vs. wellness participants (b = - 2.20, SE = 1.11, p = .04).
CONCLUSIONS
The wellness intervention was efficacious for preventing symptoms of depression; however, postpartum depression that met the diagnostic criteria was surprisingly low in all conditions among this at risk sample of postpartum women. Exercise interventions may have a protective effect on perceived stress among women at risk for postpartum depression. Practitioners should consider integrating exercise and wellness interventions into postpartum care.
TRIAL REGISTRATION
Clinical Trials Number: NCT01883479 (06/21/2013).
Topics: Adult; Depression, Postpartum; Exercise; Female; Health Behavior; Health Promotion; Humans; Postpartum Period; Single-Blind Method; Stress, Psychological; Telephone
PubMed: 34802425
DOI: 10.1186/s12884-021-04257-8 -
Journal of Traditional Chinese Medicine... Feb 2020To investigate the effect of acupressure on postpartum low back pain (LBP), salivary cortisol, physical limitations, and postpartum depression. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To investigate the effect of acupressure on postpartum low back pain (LBP), salivary cortisol, physical limitations, and postpartum depression.
METHODS
Participants were 70 postpartum women who were randomly assigned to either an intervention (n = 35) or a control (n = 35) group. The intervention group received 10 acupressure sessions (1 session per day, 5 d per week). The control group received 10 sham acupressure sessions. Outcomes were assessed using a visual analogue scale (LBP intensity), salivary cortisol values (LBP biomarker), and Chinese versions of the Roland-Morris Disability Questionnaire (daily activity limitations), Oswestry Disability Index (physical activity limitations), and the Edinburgh Postnatal Depression Scale (postpartum depression).
RESULTS
Participants in the intervention group had significantly lower levels of LBP intensity, daily activity limitations, physical activity limitations, and postpartum depression than those in the control group. There was no significant between-group difference in salivary cortisol.
CONCLUSION
Acupressure may reduce postpartum LBP intensity and limitations in daily and physical activity, and alleviate postpartum depressive symptoms. Acupressure should be offered in postpartum care settings as an alternative treatment for postpartum women with LBP.
Topics: Acupressure; Adult; Depression; Exercise; Female; Humans; Hydrocortisone; Low Back Pain; Pilot Projects; Postpartum Period; Saliva; Treatment Outcome
PubMed: 32227774
DOI: No ID Found -
Psychiatrike = Psychiatriki 2020Ιn this study we aim to examine and integrate current literature and research on attachment theory and its expression on the specific field of obstetrics, the perinatal... (Review)
Review
Ιn this study we aim to examine and integrate current literature and research on attachment theory and its expression on the specific field of obstetrics, the perinatal period. In medical settings in general, and in the field of obstetrics in specific, which is the clinical domain of the perinatal period, obstetricians, psychiatrists and psychologists frequently come across antenatal and postnatal concerns, psychological issues as well as psychiatric symptomatology stemming from closer observation of the women's difficulties or reported by women themselves. To our theoretical understanding, in order to better comprehend these psychosocial concerns and deliver timely and more effective personalized interventions to women in need, it is of paramount importance to thoroughly examine the perspective proposed by attachment theory, as it was first developed by child psychiatrist-psychoanalyst John Bowlby and the newest theoretical developments on the field that followed. Subtypes of attachment style are examined regarding their imprint on the benefits, as well as the difficulties and risks they place on women during each perinatal stage. "Insecurity" in attachment and significant relationships appears to render women more vulnerable in relation to psychopathology, according to the literature reviewed. As far as the psychopathological symptoms and disorders related to the perinatal period and their connection to attachment are concerned, the main disorders and symptomatology discussed in the literature appear to be perinatal depression, postpartum depression, perinatal anxiety and posttraumatic stress symptoms related to pregnancy and labor. At the same time, "security" attachment-wise, tangibly observed in couples with strong intramarital support, appears to offer a protective barrier against adversities by enabling securely attached women to remain calmer and make better use of their emotional and social resources throughout the challenging perinatal phase. Consequently, mothers-to-be become more eligible to overcome perinatal difficulties by the use of patterns of behavior that promote their well-being. Through the in-depth review of the current literature on attachment theory available and the tools of knowledge it equips us with, we attempted to assemble the real challenges and needs deriving from the demands that pregnancy, labor and the postpartum place on new mothers, as well as the way close relationships become affected by or, correspondingly, can be positively used in order to protect and shield women and their families from acknowledged stressful perinatal phases.
Topics: Adaptation, Psychological; Female; Humans; Perinatal Care; Postpartum Period; Pregnancy; Pregnant Women; Stress, Psychological
PubMed: 33099466
DOI: 10.22365/jpsych.2020.313.257 -
Current Psychiatry Reports Apr 2022We review recent evidence concerning the epidemiology, etiology, and treatment of obsessive-compulsive disorder (OCD) in the perinatal period. We examine studies... (Review)
Review
PURPOSE OF REVIEW
We review recent evidence concerning the epidemiology, etiology, and treatment of obsessive-compulsive disorder (OCD) in the perinatal period. We examine studies reporting on rates of both new-onset OCD and exacerbation in both pregnancy and postpartum; explore both biological and psychosocial risk factors for the disorder; and review the latest evidence concerning treatment.
RECENT FINDINGS
Evidence is limited in all areas, with rates of both OCD and subthreshold obsessive-compulsive symptoms varying widely across studies. Prevalence is likely higher in the perinatal period than in the general population. Clinical features in the perinatal period are more likely than at other times to concern harm to the child, with contamination and aggressive obsessions and cleaning and checking compulsions especially common. Research into the biological etiology is too limited at this time to be definitive. Both observational and randomized controlled trials support cognitive behavioral therapy with exposure and response prevention (CBT with ERP) as a first-line treatment, with limited evidence also supporting the use of selective serotonin reuptake inhibitors (SSRIs). Treatment considerations in the perinatal period must weigh the risks of treatment vs. the risks of untreated illness. Perinatal OCD is common and can be impairing. Clinical features differ somewhat compared to non-perinatal periods. Treatment does not differ from that used in the general population, though evidence pertaining specifically to the perinatal period is sparse.
Topics: Child; Compulsive Behavior; Female; Humans; Obsessive-Compulsive Disorder; Parturition; Postpartum Period; Pregnancy; Selective Serotonin Reuptake Inhibitors
PubMed: 35384553
DOI: 10.1007/s11920-022-01333-4 -
Anesthesiology May 2023Inherited and acquired coagulopathy are frequently associated with major bleeding in severe trauma, cardiac surgery with cardiopulmonary bypass, and postpartum...
Inherited and acquired coagulopathy are frequently associated with major bleeding in severe trauma, cardiac surgery with cardiopulmonary bypass, and postpartum hemorrhage. Perioperative management is multifactorial and includes preoperative optimization and discontinuation of anticoagulants and antiplatelet therapy in elective procedures. Prophylactic or therapeutic use of antifibrinolytic agents is strongly recommended in guidelines and has been shown to reduce bleeding and need for allogeneic blood administration. In the context of bleeding induced by anticoagulants and/or antiplatelet therapy, reversal strategies should be considered when available. Targeted goal-directed therapy using viscoelastic point-of-care monitoring is increasingly used to guide the administration of coagulation factors and allogenic blood products. In addition, damage control surgery, which includes tamponade of large wound areas, leaving surgical fields open, and other temporary maneuvers, should be considered when bleeding is refractory to hemostatic measures.
Topics: Female; Humans; Anticoagulants; Blood Coagulation Disorders; Hemorrhage; Hemostatics; Platelet Aggregation Inhibitors; Postpartum Period
PubMed: 36862401
DOI: 10.1097/ALN.0000000000004520