BABY BLUES SYNDROME

Soetrisno

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

2012

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

Outline

A. Definition B. Etiology C. Symptom D. Diagnosis and Screening E. Effect to Infants F. Management G. Preventive and Rehabilitative Effect

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

A. Definition• Baby Blues = postpartum distress syndrome = maternity

blues, postpartum blues.• Syahrir, 2008: Feeling depressed on women after

childbirth in the first 14 days, the worst is likely on the third and fourth (50-80%).

• Marshall, 2004: blues syndrome are between seven to fourteen days after delivery, usually disappear without treatment.

• Lopez, et al, 2008: The five-day blues syndrome that will heal in seven to ten days, may be at risk of developing into depression if the labor management is not adequate.

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

B. Etiology

Psychosocial and Biological Factors- Psychosocial factors:1. Pitt, Kumar et al (in Sari LS, 2009): Atypical

Depression / specific disorders that accompany the birth of a child / subsequent, seemingly more to be a response to non-specific stress-related circumstances that occur during pregnancy:

a. Chronic conflict in marriage.b. Husband and wife's emotional instability.c. Elderly woman who expects the birth of her child.

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

- Biological factors:1. Papayungan, 2005: post-partum syndrome due to

hormonal changes (especially the decrease in estrogen and progesterone).

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

3. In the postpartum blues, there is an increased receptor of alpha 2 adrenoceptor (target of catecholamine), whereas a decline in estrogen and progesterone (lower receptor binding ability) this is what is causing the blues

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

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

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).

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

C. Symptoms Doornboss, 2008: Time pregnant Estrogen and progesterone

increases increases endorphins work like valium mellowness.

After giving birth to the contrary, but an increase in prolactin for lactation, may increase the effect of endorphins even though prolactin suppress estrogen and progesterone.

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 not feel happy, decreased concentration, decreased happiness, not confident.

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

D. Diagnosis and Screening

1. Blues questionnaires from Kennerley and Gath, consisting of 28 items of symptoms blues with a choice of "yes" (score 1) and "no" (score 0). Women postpartum blues when there is ≥ 12 (for more details about this, read on Kennerly, 1989, British Journal of Psychiatry, p 155, 356-362)

2. Edinburgh's Postnatal Depression Scale (EPDS), which is a diagnostic tool with high validity that is used in a variety of research on post-partum blues and depression (Adewuya, 2006; Dennis, 2009; Eydie, 2010; Stewart, 2003), which consists of 10 questions .

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

E. Impact in Infants

Mother can not properly care for the child, can not provide the needs of their children would have received, both in terms of attention and nutrition (Syahrir S, 2008)

If not properly be managed, continues to postpartum depression that began with the disruption in daily activity, dependent arising, can not stand alone. The most feared complication, the occurrence of schizophrenia arise after the depression, and suicidal.

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

F. Management

ACOG 2011:1. Suggest mother to rest a lot and does not do

much 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

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

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 thing to do counseling and psychotherapy with the goal of mothers is able to care for her baby.

• Phase of letting goPhase after ten days after delivery expected the mother was ready to take care of the baby on their own.

3. Medicamentosa therapy is recommended at least discretion over the breastfeeding. a. Recommended: Class Serotonin Reuptake Inhibitor Selective (SSRI) version, such as 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

G. Preventive and Rehabilitative Efforts

1. Yonkers, 2001: only 50% were in remission after treatment Medicamentosa 8 weeks and 12 weeks of psychotherapy is important prevention.

2. Elvira, 2006:• Encourage the mother to care for herselves, convince your husband or

family to always pay attention to the mother.• Set a balanced diet, because the balanced nutrition needed in the

rehabilitation of the mother after giving birth. Specific nutrients can be given a diet rich of tryptophan, which is an amino acid precursor of serotonin, which has the effect of preventing the occurrence of depression.

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

• Ask for help from family or husband to care for mother and baby.Presented in National Symposium 180th of UNS Medical Faculty, “Actual Management in Complicated Pregnancy”, July 15, 2012

Screening of Pospartum Blues/Baby Blues Syndrome using EPDS

EPDS Score<10 EPDS Score>10

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

THANK YOU ………

Always be a HAPPY FAMILY