Four days after an uneventful vaginal delivery, a primipara has labile mood, tearfulness and brief episodes of crying without disturbance of sleep when the baby sleeps, delusions or impaired mothering ability. Symptoms appeared on day 3. What is the most likely diagnosis and its usual course?

• A Postpartum thyroiditis, requiring thyroxine replacement
• B Postpartum psychosis, requiring immediate admission and antipsychotics
• C Postpartum major depression, requiring antidepressants for 6 months
• D Postpartum blues, peaking around days 3 to 5 and resolving spontaneously within 2 weeks ✓

Explanation

Postpartum blues affect up to 80 percent of mothers, begin around day 3, peak by day 5, and remit without treatment within 2 weeks. Mood lability and weeping with preserved function are typical. Psychosis is excluded by absence of delusions and hallucinations, and it usually declares itself within the first 2 to 4 weeks with disorganised behaviour and risk to the infant. Major depression persists beyond 2 weeks with pervasive anhedonia, and thyroiditis presents with thyroid function abnormalities rather than pure mood lability.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.