BABY BLUES SYNDROME Soetrisno Department of Obstetrics and

BABY BLUES SYNDROME Soetrisno Department of Obstetrics and Gynecology Medical Faculty of Sebelas Maret University / Dr. Moewardi Hospital Surakarta 2012 Presented in National Symposium 180 th of UNS Medical Faculty, “Actual Management in Complicated Pregnancy”, July 15, 2012

Outline A. B. C. D. E. F. G. Definition Etiology Symptom Diagnosis and Screening Effect to Infants Management Preventive and Rehabilitative Effect Presented in National Symposium 180 th 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 180 th 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 stressrelated circumstances that occur during pregnancy: a. Chronic conflict in marriage. b. Husband wife's emotional instability. c. Elderly woman who expects the birth of her child. Presented in National Symposium 180 th 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 180 th 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 180 th 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 180 th of UNS Medical Faculty, “Actual Management in Complicated Pregnancy”, July 15, 2012

C. Symptoms v Doornboss, 2008: Time pregnant Estrogen and progesterone increases endorphins work like valium mellowness. v 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. v 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 180 th 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 180 th of UNS Medical Faculty, “Actual Management in Complicated Pregnancy”, July 15, 2012

E. Impact in Infants Ø 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) Ø 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 180 th 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 180 th of UNS Medical Faculty, “Actual Management in Complicated Pregnancy”, July 15, 2012

Pospartum Depression Therapy (ACOG 2011) 1. Therapeutic approach to communications: a. b. c. Encourage the patient to be able to relieve all the emotions. Patients can understand herself. Can support the construction of action. a. Recommended: Class Serotonin Reuptake Inhibitor Selective (SSRI) version, such as fluoxetine, (Stewart, 2003). That is not recommended: valproic acid and carbamazepine groups. 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 go Phase 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. 4. b. Another approach is to use interpersonal psychotherapy that can be done by a colleague of the psychiatrist (Yonkers, 2001). Presented in National Symposium 180 th 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 180 th of UNS Medical Faculty, “Actual Management in Complicated Pregnancy”, July 15, 2012

ALGORITHM Screening of Pospartum Blues/Baby Blues Syndrome using EPDS Score<10 EPDS Score>10 Therapy is not needed Need adequate theraphy Referr Gynecolog Note: For the 10 questionnaire of EPDS and the measurement, please read the full text 1. Theraphy approach communication 2. Family support increasing a. Taking in phase b. Taking hold phase c. Letting go phase Psychiater Medicinal therapy or interpersonal psychotherapy

Always be a HAPPY FAMILY THANK YOU ………