A. Maternity blues
B. Postpartum depression
C. Postpartum mania
D. Postpartum psychosis
E. Poststerilization depression
The correct answer is
A. Maternity blues is the term used to describe a common postpartum reaction that occurs in 50 to 70% of postpartum patients. It is characterized by tearfulness, restlessness, and anxiety. Symptoms typically start in the first few days postpartum and resolve within 2 weeks. However, certain patients continue to have the symptoms for several weeks. Many symptoms may be seen in association with this disorder including headache, backache, fatigue, forgetfulness, insomnia, weeping, depression, anxiety, and negative feelings toward the newborn infant. Interestingly, another component of the syndrome may be episodes of elation, and such mood lability can be especially distressing for the new mother. It is unclear what the etiology of these symptoms is. Certainly, the postpartum period with a newborn can be stressful and life changing, which can certainly lead to mood changes and a number of emotional responses. Some researchers have argued that changes in hormone levels are at the root of the maternity blues, but this has never been definitively proven. This patient does not have evidence of a true postpartum depression (e.g., insomnia, lack of appetite, or anhedonia) or postpartum psychosis (e.g., bizarre thoughts) and she does not have any thoughts of hurting herself or her baby. Therefore, the most likely diagnosis is maternity blues and she should be given support and reassurance. The patient must also be cautioned, however, that if her symptoms do not resolve, or if they worsen, then she must call or return.
Postpartum depression (choice B) is a depression that occurs in about 10% of postpartum women and it is more serious than the maternity blues. Symptoms may include sleep disturbances and changes in appetite. Postpartum mania (choice C) or postpartum psychosis (choice D) is a psychiatric disorder that occurs in about 1 per 1,000 deliveries. It is characterized by severe anxiety, agitation, disordered thoughts, and confusion. Hospitalization is required. Poststerilization depression (choice E) is a depression that is seen in women following a tubal ligation or other form of permanent sterilization. This patient did not have a sterilization procedure.