Guidelines for the identification and treatment of perinatal mental health conditions from ACOG

Last month, the American College of Obstetricians and Gynecologists (ACOG) launched a new patient safety package for perinatal mental health conditions. The current review addresses the gaps in the 2016 security package. Patient safety packages are a structured way to improve care processes and patient outcomes. They are specific to the clinical condition and follow an evidence-based 5R framework that, when implemented collectively and reliably, has been shown to improve patient outcomes. According to ACOG, “PSBs aim to improve the way care is delivered to improve outcomes. The package includes actionable steps that can be adapted to different facility and resource levels.”

It Perinatal mental health conditions Patent Security Pack and other PSBs can be found SAFERBIRTH.ORG.

Greater clarity of recommendations

ACOG first recommended screening for perinatal mental health conditions in 2015. Although this was a breakthrough in supporting mothers’ mental health, the initial recommendations were tentative. Incorporating what we’ve learned since the original recommendation began, the new PSB is more specific in its guidelines and includes more resources for caregivers of pregnant and postpartum patients. More specifically, the new PSB.

  • Expands the scope of perinatal mental health conditions to include more clinical information on anxiety disorders and post-traumatic stress disorder
  • Highlights the importance of identifying women at high risk for perinatal mental health conditions
  • Includes information on validated screening tools for mood and anxiety disorders in pregnant and postpartum women
  • Provides very specific information on screening for bipolar disorder before starting medication
  • Outlines how to connect patients with specific mental health resources

In collaboration with Dr. Nancy Byatt and other experts in perinatal mental health, ACOG has developed guidelines that detail: guidance on how to implement these guidelines.

At a time when a Canadian task force recommended delaying universal and instrument-based screening, it’s a relief to see the ACG not follow suit.

New ACOG Guidelines Ruta Nonacs, MD PhD

For each patient, ACOG recommends the following:

Consistent screening for perinatal mental health conditions throughout the perinatal period, including but not limited to:

  • Obtain individual and family mental health history at intake, reviewing and updating as necessary.
  • Screen for depression and anxiety at the initial antenatal visit, later in pregnancy and at postnatal visits, ideally including well-baby visits.
  • Before starting medication for anxiety and depression, get screened for bipolar disorder.

Examine structural and social drivers of health that may influence clinical recommendations or treatment plans and provide linkage to resources.

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