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BMC Family Practice Sep 2018Responding to and caring for women who experience mental health problems during the perinatal period, from pregnancy up to one year after birth, is complex and requires... (Review)
Review
BACKGROUND
Responding to and caring for women who experience mental health problems during the perinatal period, from pregnancy up to one year after birth, is complex and requires a multidisciplinary response. Family physicians are ideally placed to provide an effective response as it is recognised that they are responsible for organising care and supports for women and their families. This paper reports an integrative review undertaken to examine family physicians' perceived role in perinatal mental health care and concludes with recommendations for health policy, research and practice.
METHOD
A systematic search of literature in seven databases from January 2000 to March 2016 identified a total of 1125 articles. Qualitative, quantitative and mixed-method studies were eligible for inclusion if they explored family physicians' experiences of caring for women who experience perinatal mental health problems.
RESULTS
Thirteen articles reporting 11 studies met the inclusion criteria for this review and quality of included studies were assessed using published criteria for the critical appraisal of qualitative and quantitative research methods. Cross-study narrative syntheses of quantitative and qualitative findings are presented under three themes: identification of perinatal mental health problems, management of perinatal mental health problems and barriers to care provision. While family physicians recognise their role in relation to perinatal mental health the collective interpretation revealed that; they receive variable levels of preparation for this role, no consistent approach to screening exists, pharmacological management of mood disorders is the main treatment modality and limited access to specialist perinatal mental health services exists which impacts on pharmacology decisions.
CONCLUSION
Family physicians require timely access to local integrated care pathways that provide a wide range of services that are culturally sensitive, perinatal mental health specific, support psychological well-being and infant/family mental health. Family physicians are open to incorporating a brief validated screening tool into primary practice supported by succinct guidelines. Research that examines training needs in relation to perinatal mental health could be used to inform family physician training programmes and curriculum development around perinatal mental health.
Topics: Attitude of Health Personnel; Depression, Postpartum; Female; Humans; Mass Screening; Mental Disorders; Mental Health; Perception; Physician's Role; Physicians, Family; Postnatal Care; Pregnancy; Pregnancy Complications; Prenatal Care; Puerperal Disorders
PubMed: 30193572
DOI: 10.1186/s12875-018-0843-1 -
Clinical Cardiology May 2018Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure. It is defined as cardiomyopathy that develops in the last month of pregnancy or within 5 months of... (Review)
Review
Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure. It is defined as cardiomyopathy that develops in the last month of pregnancy or within 5 months of the postpartum period without an identifiable cause. We conducted a systematic review of literature of prospective studies with a focus on echocardiographic and long-term clinical outcomes in PPCM. We searched MEDLINE and Embase up to October 1, 2017. Prospective studies (sample size ≥20) reporting all-cause mortality and follow-up duration of ≥1 year were included. Of the 956 studies identified, 7 met the inclusion criteria. A total of 445 patients with a mean age of 30 years (range, 27-32 years) were included. The mean follow-up duration was 41 months (range, 12-61 months). The majority of patients had New York Heart Association class III or IV symptoms at the time of diagnosis. Only 3 studies reported data on ethnicity where the majority of patients were non-Caucasian. Most of the patients (81%-93%) were on guideline-directed medical therapy, except 1 study (41%). Left ventricular ejection fraction at baseline ranged from 24% to 35% (mean, 28%) and at follow-up from 31% to 53% (mean, 44%). Recovery in systolic function was noted in 20% to 82% (mean, 50%) of patients. All-cause mortality ranged from 0% to 28% (mean, 16%). This systematic review summarizes the evidence to date on the clinical characteristics and outcomes of patients with PPCM. Multicenter registries with long-term follow-up will help shed further light on characteristics and outcomes of patients with this rare disease.
Topics: Adult; Cardiomyopathies; Echocardiography; Female; Humans; Peripartum Period; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders; Recovery of Function; Risk Factors; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Function, Left; Young Adult
PubMed: 29749620
DOI: 10.1002/clc.22932 -
The Journal of Clinical Psychiatry Aug 2010The primary goal of this study was to examine the impact of pregnancy, childbirth, and menstruation on the onset of obsessive-compulsive disorder (OCD) and/or... (Comparative Study)
Comparative Study
BACKGROUND
The primary goal of this study was to examine the impact of pregnancy, childbirth, and menstruation on the onset of obsessive-compulsive disorder (OCD) and/or exacerbation of OCD symptoms.
METHOD
One hundred twenty-six women aged between 18 and 69 years attending a university-based OCD clinic who met DSM-IV criteria for OCD according to the Structured Clinical Interview for DSM-IV Disorders were interviewed retrospectively to assess OCD onset and symptom exacerbation in relationship to reproductive events. Women were placed into 2 groups: those who had ever been pregnant (ever pregnant group) and those who had never been pregnant. The ever pregnant group was further subdivided into those who reported onset of OCD in the perinatal period (perinatal-related group) and those who denied onset related to pregnancy (nonperinatal-related group). Between-group comparisons were done using a Student t test for continuous measures, and categorical variables were assessed using the χ² test.
RESULTS
Of the 78 women in the ever pregnant group, 32.1% (n = 24) had OCD onset in the perinatal period (perinatal-related group), 15.4% in pregnancy, 14.1% at postpartum, and 1.3% after miscarriage. Of 132 total pregnancies, 34.1% involved an exacerbation of symptoms, 22.0% involved an improvement in OCD symptoms, and 43.9% did not change symptom severity in women with preexisting illness. Women in the perinatal-related group and women with perinatal worsening of preexisting OCD were more likely to have premenstrual worsening of OCD symptoms compared to women in the nonperinatal-related group (66% vs 39%, P = .047).
CONCLUSIONS
Findings from this study provide additional evidence that pregnancy and childbirth are frequently associated with the onset of OCD or worsening of symptoms in those with preexisting disorder. In addition, there appears to be continuity between OCD onset and/or exacerbation across the reproductive life cycle, at least with menstruation and pregnancy.
Topics: Acute Disease; Adolescent; Adult; Age of Onset; Aged; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Male; Menarche; Middle Aged; Obsessive-Compulsive Disorder; Parturition; Pregnancy; Pregnancy Complications; Premenstrual Syndrome; Psychiatric Status Rating Scales; Puerperal Disorders; Reproductive History; Retrospective Studies; Severity of Illness Index
PubMed: 20492843
DOI: 10.4088/JCP.09m05381blu -
Journal of Dairy Science Sep 1988Incidence, predisposing factors, and implications of various reproductive disorders (dystocia, twinning, stillbirth, retained placenta, cystic ovaries, anovulation,... (Review)
Review
Incidence, predisposing factors, and implications of various reproductive disorders (dystocia, twinning, stillbirth, retained placenta, cystic ovaries, anovulation, infections of the reproductive tract, metritis, and abnormal health status) are reviewed as to their inter-relationships and collective impact on reproductive performance, milk yield and predisposition to other diseases or disorders in the periparturient dairy cow. All reproductive disorders reviewed reviewed reduce reproductive performance either directly or indirectly. Concurrent milk yield was reduced marginally in a few studies as a consequence of twinning, retained placenta, cystic ovaries, metritis, or other uterine disorders, and in cows with an abnormal health status. There is strong evidence for associated losses in milk yield following surgical delivery of a stillborn calf. We conclude that most periparturient disorders occur as a complex, rather than as a single abnormality. Cows with one disorders are at increased risk for other disorders, including metabolic ones. In contrast, actual milk yield or potential for high production generally does not predispose cows to increased risk for any of the reproductive disorders. The literature suggests that prophylactic measures to prevent occurrence of the one disorder might decrease the risk and incidence of other related disorders, either directly or indirectly.
Topics: Animals; Cattle; Cattle Diseases; Female; Genital Diseases, Female; Pregnancy; Puerperal Disorders
PubMed: 3053814
DOI: 10.3168/jds.S0022-0302(88)79846-X -
PloS One 2023Postpartum psychosis (PP) is a severe psychiatric disorder, with incomplete consensus on definition and diagnostic criteria. The Massachusetts General Hospital...
OBJECTIVE
Postpartum psychosis (PP) is a severe psychiatric disorder, with incomplete consensus on definition and diagnostic criteria. The Massachusetts General Hospital Postpartum Psychosis Project (MGHP3) was established to better ascertain the phenomenology of PP in a large cohort of diverse women spanning a wide geographical range (primarily in the US), including time of onset, symptom patterns, and associated comorbidities, psychiatric diagnoses pre- and post- the episode of PP, and also to identify genomic and clinical predictors of PP. This report describes the methods of MGHP3 and provides a status update.
METHOD
Data are collected from women who experienced PP within 6 months of childbirth and who provided this information within ten years of the study interview. Subject data are gathered during a one-time structured clinical interview conducted by phone, which includes administration of the Mini International Neuropsychiatric Interview for Psychotic Disorders Studies (Version 7.0.2), the MGHP3© Questionnaire, and other information including lifetime mental health history and use of psychiatric medications both prior to the episode of PP and during the subsequent time period prior to study interview. Subjects also provide a saliva sample to be processed for genomic analyses; a neuroimaging assessment is also conducted for a subset of participants.
RESULTS
As of July 1, 2022, 311 subjects from 44 states and 7 countries were enrolled in MGHP3. Recruitment sources include social media, online advertisements, physician referral, community outreach, and partnership with PP advocacy groups.
CONCLUSIONS
The rigorous phenotyping, genetic sampling, and neuroimaging studies in this sample of women with histories of PP will contribute to better understanding of this serious illness. Findings from MGHP3 can catalyze ongoing discussions in the field regarding proper nosologic classification of PP as well as relevant treatment implications.
Topics: Pregnancy; Female; Humans; Risk Factors; Psychotic Disorders; Puerperal Disorders; Parturition; Postpartum Period
PubMed: 36758024
DOI: 10.1371/journal.pone.0281133 -
Schizophrenia Bulletin Jul 2013
Review
Topics: Female; Humans; Psychotic Disorders; Puerperal Disorders
PubMed: 23690649
DOI: 10.1093/schbul/sbt073 -
BMC Psychiatry Mar 2019Unwanted, intrusive thoughts of harm-related to the infant are reported by the vast majority of new mothers, with half of all new mothers reporting unwanted, intrusive...
BACKGROUND
Unwanted, intrusive thoughts of harm-related to the infant are reported by the vast majority of new mothers, with half of all new mothers reporting unwanted, intrusive thoughts of harming their infant on purpose. Thoughts of intentional harm, in particular, are distressing to women, their partners and the people who care for them. While maternal, unwanted and intrusive thoughts of infant-related harm are known to be associated with obsessive compulsive disorder (OCD) and depression, preliminary evidence suggests that they are not associated with an increased risk of harm to infants. Perinatal care providers and policy makers, as well as new mothers and their partners require evidence-based information in order to respond appropriately to these types of thoughts. The purpose of this research is to address important gaps regarding the (a) prevalence and characteristics of intrusive, unwanted thoughts of baby-related harm, (b) their association (or lack thereof) with child abuse, and (c) the prevalence and course of obsessive-compulsive disorder and depression in the perinatal period.
METHODS
Participant were 763 English-speaking women and recruited during pregnancy. In this province-wide study in British Columbia, participants were recruited proportionally from hospitals, city centers and rural communities between January 23, 2014 and September 09, 2016. Participants were administered online questionnaires and diagnostic interviews over the phone at 33-weeks gestation, 7-weeks postpartum and 4-months postpartum. The study assessed intrusive and unwanted thoughts of harm related to the infant, obsessive-compulsive disorder (OCD) and major depressive episode (MDE) disorders and symptomatology, sleep, medical outcomes, parenting attitudes, and infant abuse.
DISCUSSION
There is a scarcity of literature concerning maternal unwanted, intrusive, postpartum thoughts of infant-related harm and their relationship to child harming behaviors, OCD and depression. This longitudinal cohort study was designed to build on the existing research base to ensure that policy developers, child protection workers and health-care providers have the guidance they need to respond appropriately to the disclosure of infant-related harm thoughts. Thus, its main goals will be to investigate whether intrusive postpartum thoughts of infant-related harm are a risk factor for child abuse or the development of OCD.
Topics: Adult; British Columbia; Child Abuse; Depression, Postpartum; Depressive Disorder, Major; Female; Humans; Infant; Longitudinal Studies; Male; Mothers; Obsessive-Compulsive Disorder; Postpartum Period; Pregnancy; Puerperal Disorders; Risk Factors; Surveys and Questionnaires; Thinking; Young Adult
PubMed: 30898103
DOI: 10.1186/s12888-019-2067-x -
BMJ (Clinical Research Ed.) Apr 1991
Topics: Child Development; Child, Preschool; Cognition; Depressive Disorder; Female; Humans; Infant, Newborn; Mother-Child Relations; Pregnancy; Puerperal Disorders
PubMed: 2039891
DOI: 10.1136/bmj.302.6783.978 -
JSLS : Journal of the Society of... 2011Ovarian vein thrombosis (OVT) is a rare but potentially serious postpartum complication, which occurs in 0.05% to 0.18% of pregnancies and is diagnosed on the right side...
BACKGROUND
Ovarian vein thrombosis (OVT) is a rare but potentially serious postpartum complication, which occurs in 0.05% to 0.18% of pregnancies and is diagnosed on the right side in 80% to 90% of the cases.
CASE REPORT
A 32-year-old woman presented at 15 days postpartum to our emergency department with severe abdominal pain, fever, and abdominal distension. Abdominal examination revealed right lower quadrant pain with rebound tenderness. The plain abdominal radiography evidenced a diffuse fecal stasis; abdominal ultrasound showed the presence of free fluid in the Douglas' pouch and between small bowel loops. Diagnosis of acute appendicitis was made. The patient immediately underwent explorative laparoscopy; at surgery, a woody tumoration consistent with right ovarian vein thrombosis was found. Laparoscopic ultrasound confirmed the diagnosis. Anticoagulation therapy and antibiotics were instituted. CT-scan confirmed the presence of thrombosis up to the vena cava. The patient was discharged on postoperative day 4. At 1-month follow-up, she remained stable and symptom free.
DISCUSSION
Even though postpartum ovarian vein thrombosis is rare, recognition and treatment is needed to institute adequate therapy and avoid potential serious sequelae. The diagnosis can be established by ultrasound, CT scan, and MRI examinations, although, as in the case described, the limitation of ultrasound includes obscuration of the gonadic vein by overlying bowel gas.
CONCLUSION
OVT should be considered in any woman in the postpartum period with lower abdominal pain, fever, and leucocytosis.
Topics: Adult; Endosonography; Female; Humans; Ovary; Puerperal Disorders; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color; Venous Thrombosis
PubMed: 21902992
DOI: 10.4293/108680811X13071180406673 -
Psychiatric Services (Washington, D.C.) Dec 2018Up to 20% of women who screen positive for depression in the perinatal period in primary care and obstetric settings may have bipolar disorder, but little is known about...
Up to 20% of women who screen positive for depression in the perinatal period in primary care and obstetric settings may have bipolar disorder, but little is known about best practices for this population. This column describes clinical programs that support identification and management of depression and bipolar disorder among women in non-mental health settings. The programs use diverse management strategies, including referral to specialty mental health, collaborative care, and consultation and care coordination. Most mental health programs based in primary care and obstetric settings are designed for depression treatment. Assessment and treatment strategies need to be refined to ensure that women with bipolar disorder receive appropriate care.
Topics: Adult; Bipolar Disorder; Delivery of Health Care, Integrated; Female; Humans; Massachusetts; Mental Health Services; Perinatal Care; Pregnancy; Pregnancy Complications; Program Development; Puerperal Disorders; Washington
PubMed: 30122137
DOI: 10.1176/appi.ps.201800133