Perinatal Mental Health

Option List:
A. Contact her GP for an immediate assessment and consider admission to a psychiatric unit preferably an MBU.
B. Psychiatric hospital due to the high risk of postnatal relapse.
C. A specialist mother and baby unit where the interactions between the mother and baby can be observed.
D. Home but the baby should be admitted into social care initially to protect it from the mother while the risk of relapse is high.
E. Home as that is where she will get the best family and social support for her and the baby
F. Contact the local perinatal psychiatric unit or liaison service to organise an immediate assessment.
G. Contact the local perinatal psychiatrist to organise a follow-up appointment and discharge her from the antenatal clinic with public midwifery follow-up in the interim.
H. Contact the local psychiatric service to discuss her case to start an antidepressant in the antenatal clinic.
I. Admit her to the MBU immediately.
J. Arrange urgent referral to the perinatal psychiatric team.
K. Find out what happened after her last pregnancy and arrange follow-up to discuss your findings.
L. Discharge for GP follow-up.
M. Discharge her back to midwife-led care.
Each of the following options describes various advice regarding the place of care and management of a postpartum woman with perinatal mental health issues. For each patient, select the single most appropriate option from the list above. Each option may be used once, more than once or not at all.

1. Ms Rosina, 32-year-old woman presents to the antenatal clinic at 32/ 40 weeks of gestation with symptoms suggestive of a depressive episode. She is low in the mood with sleep disturbance, increased anxiety and reduced appetite. She reports feeling hopeless and worthless and discloses suicidal thoughts.  On further questioning, she has thoughts of drinking poison but has not made any definitive suicidal plans. She has a history of postnatal depression and a family history of depression.

2. Ms Jaqueline, single woman has schizophrenia. Experienced her first schizophrenic episode requiring inpatient psychiatric care, 12 months before pregnancy. She has been well controlled on haloperidol depot injections since then. She is currently at 36 weeks of gestation and is well. She lives alone and has very limited social support.

3. Mrs. Lovely, 32-year-old solicitor comes to the antenatal clinic at 20weeks gestation. She tells you that following her previous pregnancy, she was admitted to the MBU for "a few weeks" after delivery of her first child. She is unsure of what her diagnosis was, and is this time she is adamant that "she does not want to go back there again".  She declines an outpatient appointment with the perinatal team. She says that she currently has no psychiatric symptoms and is not on any medication. What is the best management plan in this situation?