Postpartum disorder

Diastasis recti is a gap between the two sides of the rectus abdominis muscle that can occur in the antenatal and postnatal periods.{{cite journal |last1=Benjamin |first1=D.R. |last2=van de Water |first2=A.T.M. |last3=Peiris |first3=C.L. |title=Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review |journal=Physiotherapy |date=March 2014 |volume=100 |issue=1 |pages=1–8 |doi=10.1016/j.physio.2013.08.005 |pmid=24268942 |doi-access=free }} This condition has no associated morbidity or mortality.{{cite book|title=Essential practice of surgery: basic science and clinical evidence|url=https://archive.org/details/essentialpractic00nort|url-access=limited|author=Norton, Jeffrey A.|publisher=Springer|year=2003|isbn=978-0-387-95510-0|location=Berlin|pages=[https://archive.org/details/essentialpractic00nort/page/n374 350]}} Treatment is physiotherapy.

{{Main|Postpartum bleeding}}Primary postpartum haemorrhage is blood loss following childbirth of more than 500ml (minor) or 1000ml (major).{{cite journal |title=Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52 |journal=BJOG |date=April 2017 |volume=124 |issue=5 |pages=e106–e149 |doi=10.1111/1471-0528.14178 |pmid=27981719 |pmc=2393195 }} Secondary postpartum haemorrhage is abnormal or excessive bleeding after 24 hours and before 12 weeks postnatally.

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%.

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.

Puerperal mastitis is inflammation of the breast usually associated with breastfeeding. Symptoms typically include local pain and redness.{{cite journal |last1=Berens |first1=Pamela D. |title=Breast Pain: Engorgement, Nipple Pain, and Mastitis |journal=Clinical Obstetrics and Gynecology |date=December 2015 |volume=58 |issue=4 |pages=902–914 |doi=10.1097/GRF.0000000000000153 |pmid=26512442 |s2cid=13006527 |url=https://semanticscholar.org/paper/a3f96251efd59a92f82ed618dda1fea955027fbe }} There is often an associated fever and general soreness. Onset is typically fairly rapid and usually occurs within the first few months of delivery. Complications can include abscess formation.{{cite journal |last1=Spencer |first1=Jeanne P. |title=Management of Mastitis in Breastfeeding Women |journal=American Family Physician |date=15 September 2008 |volume=78 |issue=6 |pages=727–731 |pmid=18819238 |url=https://www.aafp.org/link_out?pmid=18819238 }}

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{{cite web|url=https://www.who.int/features/factfiles/obstetric_fistula/en/|title=10 facts on obstetric fistula|date=May 2014|website=WHO|access-date=12 December 2017}}{{cite web|url=http://www.unfpa.org/obstetric-fistula|title=Obstetric fistula|date=8 May 2017|website=UNFPA - United Nations Population Fund|language=en|access-date=12 December 2017}} and is preventable with timely access to Cesarean section. The fistula can occur between the vagina and rectum, ureter, or bladder.{{cite book|url=https://books.google.com/books?id=XHcWNRVHWsEC&pg=PA370|title=Shaw's Textbook of Operative Gynaecology - E-Book|last1=Setchell|first1=Marcus E.|last2=Hudson|first2=C. N.|date=2013|publisher=Elsevier Health Sciences|isbn=978-8131234815|page=370|language=en}} It can result in incontinence of urine or feces.

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.{{cite journal |last1=McCandlish |first1=Rona |last2=Bowler |first2=Ursula |last3=Asten |first3=Hedwig |last4=Berridge |first4=Georgina |last5=Winter |first5=Cathy |last6=Sames |first6=Lesley |last7=Garcia |first7=Jo |last8=Renfrew |first8=Mary |last9=Elbourne |first9=Diana |title=A randomised controlled trial of care of the perineum during second stage of normal labour |journal=BJOG |date=December 1998 |volume=105 |issue=12 |pages=1262–1272 |doi=10.1111/j.1471-0528.1998.tb10004.x |pmid=9883917 |s2cid=23788896 |doi-access=free }} At six months postpartum, 21% of women still report perineal pain and 11–49% report sexual problems or painful intercourse.

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.{{cite journal |last1=Pearson |first1=Gail D. |last2=Veille |first2=Jean-Claude |last3=Rahimtoola |first3=Shahbudin |last4=Hsia |first4=Judith |last5=Oakley |first5=Celia M. |last6=Hosenpud |first6=Jeffrey D. |last7=Ansari |first7=Aftab |last8=Baughman |first8=Kenneth L. |title=Peripartum Cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) Workshop Recommendations and Review |journal=JAMA |date=1 March 2000 |volume=283 |issue=9 |pages=1183–8 |doi=10.1001/jama.283.9.1183 |pmid=10703781 |doi-access=free }}

Postpartum thyroiditis is a phenomenon observed following pregnancy{{cite journal |last1=Muller |first1=Alex F. |last2=Drexhage |first2=Hemmo A. |last3=Berghout |first3=Arie |title=Postpartum Thyroiditis and Autoimmune Thyroiditis in Women of Childbearing Age: Recent Insights and Consequences for Antenatal and Postnatal Care |journal=Endocrine Reviews |date=1 October 2001 |volume=22 |issue=5 |pages=605–630 |doi=10.1210/edrv.22.5.0441 |pmid=11588143 |doi-access=free }} 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 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.{{Cite news|url=https://www.hysterectomy-association.org.uk/information/why-do-i-need-a-hysterectomy/prolapse/|title=Pelvic organ prolapse|work=Hysterectomy Association|access-date=2018-04-03|language=en-GB|archive-date=2019-02-02|archive-url=https://web.archive.org/web/20190202134138/https://www.hysterectomy-association.org.uk/information/why-do-i-need-a-hysterectomy/prolapse/|url-status=dead}}

{{See also|Psychiatric disorders of childbirth}}

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. 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.{{cite web|title=Postpartum Depression Facts|url=https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml|website=National Institute of Mental Health|access-date=May 5, 2018}} In 38% of the cases of postpartum depression, women are still depressed three years postpartum.{{cite journal|author1=Vliegen N.|author2=Casalin S.|author3=Luyten P.|year=2014|title=The course of postpartum depression: a review of longitudinal studies|journal=Harvard Review of Psychiatry|volume=22|issue=1|pages=1–22|doi=10.1097/hrp.0000000000000013|pmid=24394219|s2cid=13126272|doi-access=free}} In 0.2% of pregnancies, postpartum depression leads to psychosis.{{cite journal|author1=Sit D.|author2=Rothschild A. J.|author3=Wisner K. L.|year=2006|title=A review of postpartum psychosis|journal=Journal of Women's Health|volume=15|issue=4|pages=352–368|doi=10.1089/jwh.2006.15.352|pmid=16724884|pmc=3109493}} Research indicates that the location and method of postpartum care delivery may not significantly impact depression or anxiety symptoms. Whether care is provided at home, by telephone, or in a clinical setting, the outcomes for maternal mental health are similar.{{Cite report |url=https://effectivehealthcare.ahrq.gov/products/postpartum-care-one-year/research |title=Postpartum Care up to 1 Year After Pregnancy: A Systematic Review and Meta-Analysis |last=Saldanha |first=Ian J. |last2=Adam |first2=Gaelen P. |last3=Kanaan |first3=Ghid |last4=Zahradnik |first4=Michael L. |last5=Steele |first5=Dale W. |last6=Danilack |first6=Valery A. |last7=Peahl |first7=Alex Friedman |last8=Chen |first8=Kenneth K. |last9=Stuebe |first9=Alison M. |date=2023-06-02 |publisher=Agency for Healthcare Research and Quality (AHRQ) |doi=10.23970/ahrqepccer261}} Additionally, integrated care models involving multiple providers have not shown to reduce postpartum depression rates in the first year after birth.

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.{{cite web |title=ICD-11 for Mortality and Morbidity Statistics |url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/380591392 |website=icd.who.int |access-date=12 March 2022}}

{{Main|Childbirth-related posttraumatic stress disorder}}Research shows that symptoms of Posttraumatic stress disorder are common following childbirth, with prevalence of 24–30.1% at six weeks, dropping to 13.6% at six months.{{cite journal |last1=Montmasson |first1=H. |last2=Bertrand |first2=P. |last3=Perrotin |first3=F. |last4=El-Hage |first4=W. |title=Facteurs prédictifs de l'état de stress post-traumatique du postpartum chez la primipare |trans-title=Predictors of postpartum post-traumatic stress disorder in primiparous mothers |language=fr |journal=Journal de Gynécologie Obstétrique et Biologie de la Reproduction |date=October 2012 |volume=41 |issue=6 |pages=553–560 |doi=10.1016/j.jgyn.2012.04.010 |pmid=22622194 |url=https://hal-univ-tours.archives-ouvertes.fr/hal-02526438/file/2012_Montmasson_JGYN_VF.pdf }} 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.{{cite journal |last1=Olde |first1=E |last2=Vanderhart |first2=O |last3=Kleber |first3=R |last4=Vanson |first4=M |title=Posttraumatic stress following childbirth: A review |journal=Clinical Psychology Review |date=January 2006 |volume=26 |issue=1 |pages=1–16 |doi=10.1016/j.cpr.2005.07.002 |pmid=16176853 |hdl=1874/16760 |s2cid=22137961 |hdl-access=free }}

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

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{{Pathology of pregnancy, childbirth and the puerperium}}

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Category:Childbirth

Category:Pathology of pregnancy, childbirth and the puerperium

Category:Health issues in pregnancy