Long term consequences of childbirth

Genital Prolapse

 

• Different types
  • Cystocoele
  • Cystourethrocoele
  • Rectocoele
  • Enterocoele
  • Uterine decent
    • First degree – any decent of cervix into the vagina
    • Second degree – decent of cervix to the introitus
    • Third degree – descent of cervix through the introitus – procidentia

 

• Patient often presents with the feeling of ‘something coming down’ or a feeling of local discomfort
• Urinary symptoms – urinary frequency, incomplete emptying, overflow incontinence, stress incontinence
• Bowel symptom – incomplete emptying
• Uterine decent – symptoms of backache, procidentia may rub and cause bloody purulent discharge

 

• Obstetric factors can predispose to prolapse
  • Prolonged labour
  • Instrumental delivery
  • Fetal macrosomia
  • Increasing parity

 

 

Psychiatric disorders

 

• In the year following childbirth, women have increased risk of developing psychiatric problems
• Pre-existing depression is a strong risk factor for postpartum depression

 

Puerperal psychosis

 

• Affects 1 in 500, to 1 in 1000 pregnancies
• Presents between the 3^rd day and the 4^th week following delivery
• Characteristics
  • Agitation
  • Insomnia
  • Confusion
  • Paranoia
  • Delusions
  • Hallucinations
  • Thoughts of self harm
  • Depressive symptoms
• Patient has increased risk of reoccurrence in successive pregnancies

 

Postpartum depression

 

• Can be minor, mild, moderate and severe
• Distinct from postpartum ‘blues’
• Characteristics
  • Early morning waking
  • Poor appetite
  • Low energy
  • Loss of libido
  • Feelings of guilt
  • Anxiety
  • Thoughts of self harm/suicide
  • Thoughts of harm to baby
• Affects 10-15% of women to some degree
• Increased risk if there has been previous psychiatric problems including that during pregnancy or if there have been obstetric factors such as caesarean section or neonatal/fetal loss
• Usually presents with gradual onset from around week 6 after delivery
• Edinburgh postnatal depression scale  - should be completed at postnatal check