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District General Hospital experience of managing perinatal mental illness
  1. RM Hodnett1,
  2. A Wijesiriwardana2
  1. 1University of Newcastle, Newcastle-upon-Tyne, UK
  2. 2Cumberland Infirmary, Carlisle, UK

Abstract

CEMACH identified mental illness as the leading indirect cause of maternal mortality (44/100 000 maternities).1 NICE Guideline CG452 is essential in the management of such patients.

Background Patients with risk factors for perinatal mental illness are seen in an an obstetrician-led ante-natal clinic. 144 pregnant women with known psychiatric history were identified by clinical coding between June and December 2009. Patients were selected at random from this list; the authors audited the care of 30 randomly selected patients who had attended clinic against NICE Guideline.

Results Of 30 cases, 28 (93%) had a history of non-perinatal mental illness; 15 (50%) of perinatal mental illness. 19 (63%) patients were previously known to mental health services. 8/11 (72%) not known to mental health services had prior history of perinatal mental illness. At first visit, 20 (67%) were symptomatic. 11/28 patients (39%) had stopped psychotropic medication before or in early pregnancy; 2 were unmedicated. Drugs complied with guidance in 17/19 cases (89%). 24 (87%) were referred to mental health services for formulation of management plans. 23/24 (96%) were appropriate according to guidelines. 4 (13%) received no referral, of whom 1 was appropriate for referral.

Conclusion Ante-natal clinic based review of pregnant women with risk factors for mental illness enabled patient-centred care in accordance with NICE guidance. Further work is required to identify if all appropriate patients are referred to the clinic

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