Tests
Your Organizational Guidance
ebpracticenet urges you to prioritize the following organizational guidance:
Multidisciplinaire richtlijn Postpartumzorg in de eerste lijn (deel 1)Published by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2022Guideline multidisciplinaire des soins postnatals dans la première ligne de soins (partie 1)Published by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2022Multidisciplinaire richtlijn Postpartumzorg in de eerste lijn (deel 2)Published by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2024Guideline multidisciplinaire des soins postnatals dans la première ligne de soins (partie 2)Published by: Groupe de Travail Développement de recommmandations de première ligneLast published: 20241st tests to order
Depression identification questions
Test
Although they have not been investigated specifically in the postpartum population, the following questions are recommended by UK guidelines (as a screening tool for all women in the perinatal period), at her first prenatal appointment, and postpartum (first year after childbirth):[5]
"During the past month, have you often been bothered by feeling down, depressed, or hopeless?" and "During the past month, have you often been bothered by having little interest or pleasure in doing things?"
Result
identification of patients requiring further clinical assessment for depression
Edinburgh Postnatal Depression Scale (EPDS)
Test
One of a number of self-reported measures specifically designed to screen for depression in the postpartum period; of these, the EPDS has been the most widely studied.[131]
Psychometrically tested extensively in postpartum women and used throughout the world. Sensitivity and specificity of cutoff points showed marked heterogeneity between different studies. Sensitivity results ranged from 34% to 100% and specificity from 44% to 100%.[110]
The cutoff score of >12 has an overall positive predictive value of 57% and negative predictive value of 99%.
Result
score >11 suggestive of depression, warranting a need for further clinical assessment for depression, although lower cutoff values may be used if the intention is to avoid false negatives; the American College of Obstetricians and Gynecologists notes that a score of 10-14 often represents mild symptomatology, 15-19 often represents moderate symptomatology, and that a score higher than 19 is consistent with severe symptomatology as well as an increased risk for bipolar disorder
Patient Health Questionnaire-9 (PHQ-9)
Test
In one large meta-analysis of studies comparing the PHQ-9 and EPDS, operating characteristic characteristics were nearly identical.[111]
Result
score >11 suggestive of depression, warranting a need for further clinical assessment for depression, although lower cutoff values may be used if the intention is to avoid false negatives; the American College of Obstetricians and Gynecologists notes that a score of 10-14 often represents mild symptomatology, 15-19 often represents moderate symptomatology, and that a score higher than 19 is consistent with severe symptomatology as well as an increased risk for bipolar disorder
Mood Disorder Questionnaire (MDQ)
Test
Routinely screen women with postpartum depression for past and current symptoms of mania and hypomania. Screening should include questions about a family history of bipolar disorder. Until a validated assessment tool is established, the MDQ is considered one of the most promising tools for screening for bipolar disorder in perinatal women.[15][126] It incorporates all pertinent information included in the other scales, with the addition of an assessment of irritability and impulsive behavior.
Result
identification of patients requiring further clinical assessment for bipolar disorder
Tests to consider
Thyroid function tests
Test
Required in patients with symptoms suggestive of hypothyroidism.
Elevated serum thyroid-stimulating hormone level suggests hypothyroidism.
The time frame for postpartum (painless/lymphocytic) thyroiditis, which is characterized by transient hyper- and hypothyroid phases, may overlap with that for postpartum depression, although no causal relationship has been established between the two conditions.[132]
Result
normal
CBC
Test
Required if anemia is suspected; excludes anemia as a cause of fatigue.
Result
normal
urine drug screen
Test
Required if substance misuse is suspected; a positive result identifies the substance taken.
Drug screens are not definitive for drug misuse.
Result
normal
brain CT or MRI
Test
May be used to identify a structural neurologic abnormality if this is suspected as a cause of symptoms.
Result
normal
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