Postpartum disorder

A postpartum disorder or puerperal disorder is a disease or condition which presents primarily during the days and weeks after childbirth called the postpartum period. The postpartum period can be divided into three distinct stages: the initial or acute phase, 6–12 hours after childbirth; subacute postpartum period, which lasts two to six weeks, and the delayed postpartum period, which can last up to six months.^[1] In the subacute postpartum period, 87% to 94% of women report at least one health problem.^[2][3] Long term health problems (persisting after the delayed postpartum period) are reported by 31% of women.^[4]

Postpartum disorder
Specialty	Obstetrics

The World Health Organization (WHO) describes the postpartum period as the most critical and yet the most neglected phase in the lives of mothers and babies; most maternal and newborn deaths occur during the postpartum period.^[5]

Physical disorders

Diastasis recti

Diastasis recti is a gap between the two sides of the rectus abdominis muscle that can occur in the antenatal and postnatal periods.^[6] This condition has no associated morbidity or mortality.^[7] Treatment is physiotherapy.

Haemorrhage

Main article: Postpartum bleeding

Primary postpartum haemorrhage is blood loss following childbirth of more than 500ml (minor) or 1000ml (major).^[8] Secondary postpartum haemorrhage is abnormal or excessive bleeding after 24 hours and before 12 weeks postnatally.^[8]

Incontinence

Urinary incontinence and fecal incontinence have been linked to all methods of childbirth, with the incidence of urinary incontinence at six months postpartum being 3–7% and fecal incontinence 1–3%.^[4]

Infection

Postpartum infections, also known as childbed fever and puerperal fever, are any bacterial infections of the female reproductive tract following childbirth or miscarriage. Signs and symptoms usually include a fever greater than 38.0 °C (100.4 °F), chills, lower abdominal pain, and possibly bad-smelling vaginal discharge. It usually occurs after the first 24 hours and within the first ten days following delivery.

Mastitis

Puerperal mastitis is inflammation of the breast usually associated with breastfeeding. Symptoms typically include local pain and redness.^[9] There is often an associated fever and general soreness.^[9] Onset is typically fairly rapid and usually occurs within the first few months of delivery.^[9] Complications can include abscess formation.^[10]

Obstetric fistula

Obstetric fistula is a medical condition in which a hole develops in the birth canal as a result of childbirth, typically after a prolonged obstructed labour^[11][12] and is preventable with timely access to Cesarean section. The fistula can occur between the vagina and rectum, ureter, or bladder.^[12][13] It can result in incontinence of urine or feces.^[12]

Perineal tearing

Perineal tearing is the spontaneous (unintended) tearing of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tearing occurs in 85% of vaginal deliveries.^[14] At six months postpartum, 21% of women still report perineal pain^[4] and 11–49% report sexual problems or painful intercourse.^[4]

Peripartum cardiomyopathy

Peripartum cardiomyopathy is decrease in heart function which occurs in the last month of pregnancy, or up to six months post-pregnancy. It increases the risk of congestive heart failure, heart arrhythmias, thromboembolism, and cardiac arrest.^[15]

Postpartum thyroiditis

Postpartum thyroiditis is a phenomenon observed following pregnancy^[16] and may involve hyperthyroidism, hypothyroidism or the two sequentially. It affects about 5% of all women within a year after giving birth.

Pelvic organ prolapse

Pelvic organ prolapse occurs when the uterus, bladder or rectum drop lower in the pelvis creating a bulge in the vagina. Approximately half of all women who have given birth experience some degree of pelvic organ prolapse, most frequently as they age and go through menopause.^[17]

Psychological disorders

See also: Psychiatric disorders of childbirth

Postpartum depression

Postpartum depression is a moderate to severe depressive episode starting anytime during pregnancy or within the four weeks following delivery. It occurs in 4–20% of pregnancies, depending on its definition.^[4] Without treatment, postpartum depression can last for months or years. In addition to affecting the mother’s health, it can interfere with her ability to connect with and care for her baby and may cause the baby to have problems with sleeping, eating, and behavior as he or she grows.^[18] In 38% of the cases of postpartum depression, women are still depressed three years postpartum.^[19] In 0.2% of pregnancies, postpartum depression leads to psychosis.^[20]

Postpartum psychosis

Postpartum psychosis is one of the many conditions that may occur following pregnancy or within the six week postpartum period. It is listed under mental and behavioral disorders associated with pregnancy, childbirth or the puerperium with psychotic symptoms, and involves significant mental and behavioural features, including psychotic symptoms such as delusions and hallucinations. Mood symptoms associated with depression or mania are also typically present.^[21]

Posttraumatic stress disorder (PTSD)

Main article: Childbirth-related posttraumatic stress disorder

Research shows that symptoms of Posttraumatic stress disorder are common following childbirth, with prevalence of 24–30.1%^[22] at six weeks, dropping to 13.6% at six months.^[23] PTSD is rarer; a review found that following normal childbirth (excluding stillbirth and some other complications) rates of PTSD ranged from 2.8–5.6% after six weeks, dropping to 1.5% at six months.^[22]

See also

• Postpartum physiological changes
• Postpartum care
• Postpartum confinement, a period of rest

References

1. Romano, Mattea; Cacciatore, Alessandra; Giordano, Rosalba; La Rosa, Beatrice (2010). "Postpartum period: three distinct but continuous phases". Journal of Prenatal Medicine. 4 (2): 22–25. PMC 3279173. PMID 22439056.
2. Glazener, Cathryn M. A.; Abdalla, Mona; Stroud, Patricia; Templeton, Allan; Russell, Ian T.; Naji, Simon (April 1995). "Postnatal maternal morbidity: extent, causes, prevention and treatment". BJOG. 102 (4): 282–287. doi:10.1111/j.1471-0528.1995.tb09132.x. PMID 7612509. S2CID 38872754.
3. Thompson, Jane F.; Roberts, Christine L.; Currie, Marian; Ellwood, David A. (June 2002). "Prevalence and Persistence of Health Problems After Childbirth: Associations with Parity and Method of Birth". Birth. 29 (2): 83–94. doi:10.1046/j.1523-536x.2002.00167.x. PMID 12051189.
4. Borders, Noelle (8 July 2006). "After the Afterbirth: A Critical Review of Postpartum Health Relative to Method of Delivery". Journal of Midwifery & Women's Health. 51 (4): 242–248. doi:10.1016/j.jmwh.2005.10.014. PMID 16814217.
5. WHO. . WHO. Archived from the original on March 7, 2014. Retrieved 22 December 2014.
6. Benjamin, D.R.; van de Water, A.T.M.; Peiris, C.L. (March 2014). "Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review". Physiotherapy. 100 (1): 1–8. doi:10.1016/j.physio.2013.08.005. PMID 24268942.
7. Norton, Jeffrey A. (2003). Essential practice of surgery: basic science and clinical evidence. Berlin: Springer. pp. 350. ISBN 978-0-387-95510-0.
8. "Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52". BJOG. 124 (5): e106–e149. April 2017. doi:10.1111/1471-0528.14178. PMC 2393195. PMID 27981719.
9. Berens, Pamela D. (December 2015). "Breast Pain: Engorgement, Nipple Pain, and Mastitis". Clinical Obstetrics and Gynecology. 58 (4): 902–914. doi:10.1097/GRF.0000000000000153. PMID 26512442. S2CID 13006527.
10. Spencer, Jeanne P. (15 September 2008). "Management of Mastitis in Breastfeeding Women". American Family Physician. 78 (6): 727–731. PMID 18819238.
11. "10 facts on obstetric fistula". WHO. May 2014. Retrieved 12 December 2017.
12. "Obstetric fistula". UNFPA - United Nations Population Fund. 8 May 2017. Retrieved 12 December 2017.
13. Setchell, Marcus E.; Hudson, C. N. (2013). Shaw's Textbook of Operative Gynaecology - E-Book. Elsevier Health Sciences. p. 370. ISBN 978-8131234815.
14. McCandlish, Rona; Bowler, Ursula; Asten, Hedwig; Berridge, Georgina; Winter, Cathy; Sames, Lesley; Garcia, Jo; Renfrew, Mary; Elbourne, Diana (December 1998). "A randomised controlled trial of care of the perineum during second stage of normal labour". BJOG. 105 (12): 1262–1272. doi:10.1111/j.1471-0528.1998.tb10004.x. PMID 9883917. S2CID 23788896.
15. Pearson, Gail D.; Veille, Jean-Claude; Rahimtoola, Shahbudin; Hsia, Judith; Oakley, Celia M.; Hosenpud, Jeffrey D.; Ansari, Aftab; Baughman, Kenneth L. (1 March 2000). "Peripartum Cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) Workshop Recommendations and Review". JAMA. 283 (9): 1183–8. doi:10.1001/jama.283.9.1183. PMID 10703781.
16. Muller, Alex F.; Drexhage, Hemmo A.; Berghout, Arie (1 October 2001). "Postpartum Thyroiditis and Autoimmune Thyroiditis in Women of Childbearing Age: Recent Insights and Consequences for Antenatal and Postnatal Care". Endocrine Reviews. 22 (5): 605–630. doi:10.1210/edrv.22.5.0441. PMID 11588143.
17. . Hysterectomy Association. Archived from the original on 2019-02-02. Retrieved 2018-04-03.
18. "Postpartum Depression Facts". National Institute of Mental Health. Retrieved May 5, 2018.
19. Vliegen N.; Casalin S.; Luyten P. (2014). "The course of postpartum depression: a review of longitudinal studies". Harvard Review of Psychiatry. 22 (1): 1–22. doi:10.1097/hrp.0000000000000013. PMID 24394219. S2CID 13126272.
20. Sit D.; Rothschild A. J.; Wisner K. L. (2006). "A review of postpartum psychosis". Journal of Women's Health. 15 (4): 352–368. doi:10.1089/jwh.2006.15.352. PMC 3109493. PMID 16724884.
21. "ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Retrieved 12 March 2022.
22. Olde, E; Vanderhart, O; Kleber, R; Vanson, M (January 2006). "Posttraumatic stress following childbirth: A review". Clinical Psychology Review. 26 (1): 1–16. doi:10.1016/j.cpr.2005.07.002. hdl:1874/16760. PMID 16176853. S2CID 22137961.
23. Montmasson, H.; Bertrand, P.; Perrotin, F.; El-Hage, W. (October 2012). "Facteurs prédictifs de l'état de stress post-traumatique du postpartum chez la primipare" [Predictors of postpartum post-traumatic stress disorder in primiparous mothers] (PDF). Journal de Gynécologie Obstétrique et Biologie de la Reproduction (in French). 41 (6): 553–560. doi:10.1016/j.jgyn.2012.04.010. PMID 22622194.

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