Perinatal mental health

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 5 – A N T E N ATA L C A R E

Perinatal Mental Health: An Overview of Pathology, Services and the Law Medland V et al. Perinatal mental health: an overview of pathology, services and the law. TOG 2025;27:57–67. doi:10.1111/tog.12963

1 in 5 1–2/1000 1.5/100,000 WOMEN AFFECTED IN PERINATAL PERIOD PUERPERAL PSYCHOSIS INCIDENCE MATERNAL SUICIDE RATE (2020, ×3 VS 2017–19)

DO N' T-M IS S FA C TS

  1. Puerperal psychosis: 1–2/1000 births; psychiatric emergency – NICE mandates assessment within 4 hours of referral for sudden-onset psychosis

  2. Maternal suicide leading direct cause of death 6 weeks–1 year postpartum; 2020 rate 1.5/100,000 (×3 vs 2017–19); 40% of 1st-year deaths were mental-health related

  3. BPAD relapse risk in puerperium: 1/1000 (no history) up to 1/2 (previous postpartum psychosis or affected 1st-degree relative)

  4. Lithium: fetal cardiac defect risk 1%→2%; monitor levels closely; avoid breastfeeding

  5. Valproate: MHRA – avoid in women of childbearing potential unless no alternative; accidental conception = urgent MDT + stop + fetal medicine referral

  6. MHA Section 2 = assessment ≤28 days; Section 3 = treatment ≤6 months; Section 5(2) holding power = ≤72 hours, no treatment allowed, F2+ only, not in ED/outpatients

  7. Whooley questions: 95% sensitivity (negative rules out depression), 65% specificity (positive)

  8. Red flags: violent self-harm, severe sleep disturbance, "maternal incompetence" thought content, trauma/social complexity even without formal diagnosis

LAW AT A GLANCE

MCA: capacity test – understand/retain/weigh/communicate MHA S2: 28 days assessment MHA S3: 6 months treatment

S5(2): 72h hold, no treatment, F2+

ABBREVIATION KEY

PNMH — perinatal mental health SSRI — selective serotonin reuptake inhibitor

MDT — multidisciplinary team SNRI — serotonin–noradrenaline reuptake inhibitor

ICD-11 — International Classification of Disease, 11th revision MCA — Mental Capacity Act 2005

OCD — obsessive-compulsive disorder MHA — Mental Health Act 1983

BPAD — bipolar affective disorder DASH — Domestic Abuse, Stalking and Harassment (risk assessment) cPTSD — complex post-traumatic stress disorder VCSE — voluntary and community sector enterprise EPDS — Edinburgh Postnatal Depression Scale MBRRACE — Mothers and Babies: Reducing Risk through Audits GAD7 — 7-item Generalized Anxiety Disorder scale and Confidential Enquiries PHQ9 — Patient Health Questionnaire (9-item) LTP — NHS Long Term Plan MBU — mother and baby unit NAS — neonatal adaptation syndrome PICU — psychiatric intensive care unit

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — doi:10.1111/tog.12963

Clinically reviewed by NHS obstetricians and gynaecologists

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