On postpartum day 4, a primigravida who had a normal delivery is tearful, irritable, and anxious despite a healthy baby and good family support. She sleeps adequately, eats, and has no delusions or thoughts of self harm. What is the most appropriate management?
- A Reassurance and supportive follow up, as symptoms usually resolve within 2 weeks ✓
- B Admit for observation of postpartum psychosis
- C Start fluoxetine immediately
- D Withhold breastfeeding until psychiatric evaluation
Correct answer: A. Reassurance and supportive follow up, as symptoms usually resolve within 2 weeks
Explanation
Postpartum blues affect up to 80 percent of mothers, peak around days 3 to 5, and resolve spontaneously within 2 weeks without drug treatment. The absence of delusions, hallucinations, or suicidal ideation excludes postpartum psychosis, which typically presents within the first 2 weeks but requires urgent psychiatric care. Antidepressants are reserved for postpartum depression, defined by symptoms persisting beyond 2 weeks or functional impairment. Breastfeeding continues safely; fluoxetine is relatively avoided in nursing mothers if an SSRI is ever needed.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.