Educationals

Pregnancy And Related Events

Pregnancy

Psychiatric disorder is more common in the first and third trimester of pregnancy than in the second. In the first, unwanted pregnancies are associated with anxiety and depression. In the third trimester, there may be fears about the normality of the foetus. Up to 10% of women become clinically depressed during pregnancy. Young motherhood may be a time of heightened risk for depression, due to the stress and demands it imposes. They are also more common in women with a previous psychiatric disorder and also in those with serious medical problems affecting pregnancy eg. diabetes.

Hyperemesis gravidarum

About half of all pregnant women experience nausea and vomiting in the first trimester. Psychological symptoms may substantially influence the severity and course of symptoms.

Pseudocyesis

Pseudocyesis is a rare condition in which the lady believes that she is pregnant when she is not, and develops ammenorrhoea, abdominal distension, and other changes similar to those of early pregnancy. The condition is common in younger women. It usually resolves quickly once diagnosed, but some patients persist.

Unwanted Pregnancy & Therapeutic Abortions

Therapeutic abortions usually have mild and transient psychological consequences, but they are greater for mothers who have cultural or religious beliefs against abortion. Psychiatric morbidity is high at one month. At follow-up there are significant improvements in psychiatric symptoms, guilt, and interpersonal and sexual adjustments. There is an increased risk of depression in women with history of termination in past.

Spontaneous Abortion

Depressive symptoms are present in large number of women especially in those with previous history of spontaneous abortion. Many women show features typical of grief.

Antenatal Death

Antenatal death causes an acute bereavement reaction, long term psychiatric problems, and concern about future pregnancy. Parents need to be helped to mourn and should be encouraged to see and hold the baby, to name it, and have a proper funeral. The next pregnancy needs to be handled delicately.

Caesarean Section

Caesarean section is extremely frequent and can have adverse psychological consequences for the mother and infants. It is important to pay particular attention to support and initial bonding between the mother and the child.

Post-Partum Disorders

Maternity Blues

About half of all post partum women experience baby blues. It is usually lasts for the first few days. The mother is usually depressed and irritable. Crying spells and liability of moods may be frequent. There is minor fatigue and insomnia. There is spontaneous decrease in symptoms within 3 to 14 days. The blues may recur in subsequent pregnancies. The mother may have difficulty in caring for the infant due to the blues, and it may place a strain on the marriage. Support from family and friends along with short acting benzodiazepines can help remit the symptoms.

Post Partum Depression

This occurs several weeks to several months after delivery. The symptoms are identical to those of a depressive episode. Obsessions, including "horrific temptations" to kill the infant, may occur. Patients complain of a depressed mood, anxiety, anhedonia, anorexia and insomnia.

Patients experience difficulty in establishing a satisfying bond with the infant. In some cases, suicide may occur and rarely infanticide. It may recover within months to a year. In some cases symptoms become chronic.

There is a significant chance of recurrence during subsequent post-partum periods. The patient needs to be treated with antidepressant medication. Institution of preventive treatment during subsequent postpartum periods may be required.