2 Simposium Amnion Baby Blues Syndrome English1

7/31/2019 2 Simposium Amnion Baby Blues Syndrome English1

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BABY BLUES SYNDROME

Soetrisno

Department of Obstetrics and Gynecology Medical Faculty ofSebelas Maret University / Dr. Moewardi Hospital Surakarta

2012

Presented in National Symposium 180th of UNS Medical Faculty, Actual Management in Complicated Pregnancy, July 15, 2012


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Outline

A. Definition

B. Etiology

C. SymptomD. Diagnosis and Screening

E. Effect to Infants

F. ManagementG. Preventive and Rehabilitative Effect



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A. Definition

Baby Blues = postpartum distress syndrome =maternity blues, postpartum blues.

Syahrir, 2008: Feeling depressed on women afterchildbirth in the first 14 days, the worst is likelyon the third and fourth (50-80%).

Marshall, 2004: blues syndrome are betweenseven to fourteen days after delivery, usuallydisappear without treatment.

Lopez, et al, 2008: The five-day blues syndromethat will heal in seven to ten days, may be at riskof developing into depression if the labormanagement is not adequate.



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B. Etiology

Psychosocial and Biological Factors

- Psychosocial factors:

1. Pitt, Kumar et al (in Sari LS, 2009): Atypical

Depression / specific disorders that accompanythe birth of a child / subsequent, seeminglymore to be a response to non-specific stress-related circumstances that occur duringpregnancy:

a. Chronic conflict in marriage.

b. Husband and wife's emotional instability.

c. Elderly woman who expects the birth of her child.



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- Biological factors:

1. Papayungan, 2005: post-partum syndrome due

to hormonal changes (especially the decrease inestrogen and progesterone).

2. Other hormones that play a role is cortisol,thyroxin, serotonin, norepinephrin anddopamine

3. In the postpartum blues, there is an increasedreceptor of alpha 2 adrenoceptor (target of

catecholamine), whereas a decline in estrogenand progesterone (lower receptor bindingability) this is what is causing the blues



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4. Sari, 2009: risk factors for postpartum blues:

a. Poor social support.

b. Serious life events and multiple (death of parent,husband, etc. ...)

c. PMS (premenstrual syndrome), menstrual disorders,infertility.

d. History of childhood abuse (physical, emotional,

sexual).e. Thyroid disorders / family history.

f. Chronic fungal infection.

g. Severe morning sickness to malnutrition.

h. Has inharmonious relationship with the parent.i. History of mothers with postpartum depression.

j. Cessation of breastfeeding immediately after birth /not enough milk.



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k. Great increase in weight during pregnancy

and a slight decrease in weight after giving

birth.

l. Trauma of the birth process is not expected

(SC, VE, FE).

m. Marital Discord.

n. Unwanted pregnancy.

o. Old primigravida (> 35 years).



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C. Symptoms

Doornboss, 2008: Time pregnant Estrogen andprogesterone increases increases endorphins worklike valiummellowness.

After giving birth to the contrary, but an increase in

prolactin for lactation, may increase the effect ofendorphins even though prolactin suppress estrogen andprogesterone.

Kennerley, 1989: Symptoms that often arise in the blues:tears / crying continuously, not excited, forgetfulness,anxiety, emotions rise, the spirit of change, tiredness,introverted, empty mind, nervous, sensitive, easy to regret,feel very sad, irritable, unhappy, do not have hope, do notfeel happy, decreased concentration, decreased happiness,not confident.



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D. Diagnosis and Screening

1. Blues questionnaires from Kennerley and Gath,consisting of 28 items of symptoms blues with achoice of "yes" (score 1) and "no" (score 0). Womenpostpartum blues when there is 12 (for more details

about this, read on Kennerly, 1989, British Journal ofPsychiatry, p 155, 356-362)

2. Edinburgh's Postnatal Depression Scale (EPDS), whichis a diagnostic tool with high validity that is used in a

variety of research on post-partum blues anddepression (Adewuya, 2006; Dennis, 2009; Eydie,2010; Stewart, 2003), which consists of 10 questions .



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E. Impact in Infants

Mother can not properly care for the child, cannot provide the needs of their children wouldhave received, both in terms of attention and

nutrition (Syahrir S, 2008) If not properly be managed, continues to

postpartum depression that began with thedisruption in daily activity, dependent arising, can

not stand alone. The most feared complication,the occurrence of schizophrenia arise after thedepression, and suicidal.



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F. Management

ACOG 2011:

1. Suggest mother to rest a lot and does not domuch strenuous activity. Suggest that the

mother to sleep when the baby is asleep.2. Suggest that the mother to not do all the

work of caring for the baby, asked her

husband to help her mother.3. Hold a special time to relax, or interact with

friends.About theraphy, see

algorithm



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Pospartum Depression Therapy (ACOG 2011)

1. Therapeutic approach to communications:a. Encourage the patient to be able to relieve all the emotions.

b. Patients can understand herself.

c. Can support the construction of action.2. Mental support with the aim of the mother can pass through a phase:

Taking in phase

Phase dependence the first and second days after birth.

Taking hold phase.

This phase occurs on day 3-10 days after the birth, the phase the best thingto do counseling and psychotherapy with the goal of mothers is able to care forher baby.

Phase of letting go

Phase after ten days after delivery expected the mother was ready to takecare of the baby on their own.

3. Medicamentosa therapy is recommended at least discretion over thebreastfeeding.

a. Recommended: Class Serotonin Reuptake Inhibitor Selective (SSRI) version, suchas fluoxetine, (Stewart, 2003).

b. That is not recommended: valproic acid and carbamazepine groups.

4. Another approach is to use interpersonal psychotherapy that can be done by

a colleague of the psychiatrist (Yonkers, 2001).Presented in National Symposium 180th of UNS Medical Faculty, Actual Management in Complicated Pregnancy, July 15, 2012


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G. Preventive and Rehabilitative Efforts

1. Yonkers, 2001: only 50% were in remission after treatment

Medicamentosa 8 weeks and 12 weeks of psychotherapy isimportant prevention.

2. Elvira, 2006:

Encourage the mother to care for herselves, convince yourhusband or family to always pay attention to the mother.

Set a balanced diet, because the balanced nutrition needed inthe rehabilitation of the mother after giving birth. Specificnutrients can be given a diet rich of tryptophan, which is anamino acid precursor of serotonin, which has the effect ofpreventing the occurrence of depression.

Regular exercise, it is one factor in reducing the occurrence ofstress. This is because the release of endogenous endorphins,which have the effect of causing a feeling of happiness andimprove mood.

Ask for help from family or husband to care for mother and baby.



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Screening of Pospartum Blues/Baby

Blues Syndrome using EPDS

EPDS Score10

Therapy is not

needed

1.Theraphy communication

approach

2. Family support increasing

aTaking in phase

bTaking hold phase

cLetting go phase

Medicinal therapy or

interpersonal

psychotherapy

Need adequate

theraphy

Referr

Gynecolog Psychiater

Note:

For the 10 questionnaire of

EPDS and the measurement,

please read the full text

ALGORITHM


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2 Simposium Amnion Baby Blues Syndrome English1

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