# data[].attributes.body
Select "Click here for Institutional Access" to access via OpenAthens.

Once logged in, select "Guides" -> "Midwifery" to receive step-by-step clinical guidelines.

# data[].attributes.body
Access via your OpenAthens account

# data[].attributes.body
Click on this link to register with us! Registered members may borrow up to 10 books at one time.

# data[].attributes.attachment_link.title
Register - Medway NHS Knowledge and Library Services

# data[].attributes.attachment_link.description
All Medway NHS Foundation Trust staff, students on placement at the hospital and other NHS staff working across the Medway health economy, may apply to register.

# data[].attributes.body
Click on this link to find our Literature Search Request Form, just complete this and one of our Librarians will support.

# data[].attributes.attachment_link.description
The LKS can conduct literature searching to find the evidence you need for an informed decision.

# data[].attributes.headline
MFT Knowledge & Library Services Website

# data[].attributes.subject
MFT Knowledge & Library Services Website

# data[].attributes.attachment_link.title
Medway NHS Knowledge and Library Services (KLS)

# data[].attributes.attachment_link.description
The Medway NHS Knowledge and Library Service KLS offers the best resources to support clinical decision making, research, and lifelong professional development.

# data[].attributes.body
The NHS Knowledge and Library Hub connects NHS staff and learners to high quality knowledge and evidence resources in one place.

Funded by Health Education England, it includes:

journals, books and databases

clinical decision support resources including NICE Guidelines and BMJ Best Practice

policy and management information and research literature

resources purchased nationally and locally

one-click links to full-text, request a copy or contact an NHS library

Full access is free to all NHS staff and learners using your NHS OpenAthens account.

Don’t yet have an account?  Register for NHS OpenAthens

# data[].attributes.attachment_link.readable_text
The NHS Knowledge and Library Hub connects health cares staff and learners to high quality, NHS-funded, knowledge and evidence resources in one place, using a single search.

The 'Hub'

includes all journal articles, e-books, guidelines and evidence summary tools provided nationally and by your local NHS library team

provides seamless access to full text, as an immediate download or on request from an NHS library

avoids the less-reliable sources you might find in a general web search.

Easier access to e-journals

For seamless links, where you want them, install LibKey Nomad on your PC or laptop. Choose your library (or type NHS England) and find your links in PubMed, Google Scholar and many other sites. Or use BrowZine to browse and read the journals you have access to.

# data[].attributes.attachment_link.description
The NHS Knowledge and Library Hub connects health cares staff and learners to high quality, NHS-funded, knowledge and evidence resources in one place, using a single search.

# data[].attributes.body
Log in using your NHS email address to access via Medway NHS Foundation Trust.

# data[].attributes.headline
Writing for nursing and midwifery students, by Julio Gimenez (Book)

# data[].attributes.subject
Writing for nursing and midwifery students, by Julio Gimenez (Book)

# data[].attributes.body
Reserve a copy of this book for loan from Medway Knowledge & Library Services or one of our KSS partner libraries.

# data[].attributes.attachment_link.title
Details for: Writing for nursing and midwifery students / › KSS Knowledge & Library Services catalogue

# data[].attributes.body
Reserve a copy of this book for loan from Medway Knowledge & Library Services or one of our KSS partner libraries.

# data[].attributes.attachment_link.title
Details for: Research recipes for midwives / › KSS Knowledge & Library Services catalogue

# data[].attributes.headline
Fundamentals of maternal anatomy and physiology (Books)

# data[].attributes.subject
Fundamentals of maternal anatomy and physiology (Books)

# data[].attributes.body
Reserve a copy of this book for loan from Medway Knowledge & Library Services or one of our KSS partner libraries.

# data[].attributes.attachment_link.title
Details for: Fundamentals of maternal anatomy and physiology / › KSS Knowledge & Library Services catalogue

# data[].attributes.attachment_link.description
Cookies are small text files placed on your browser by websites. They help make websites work, or work more efficiently. They also "remember" some of your preferences, so you don't have to set a preference again every time you switch to a different page on the same website.

# data[].attributes.attachment_link.readable_text
You'll make progress

You'll have countless opportunities to progress. You'll enjoy continuous professional development, helping you to develop your skills, gain new ones, and progress to roles at a higher pay grade.

And with annual reviews and the support of our team, you'll have career potential that matches your ambitions - whether that's a move into research, teaching, management or a more specialist role.

# data[].attributes.attachment_link.description
You'll make progress You'll have countless opportunities to progress. You'll enjoy continuous professional development, helping you to develop your skills, gain new ones, and progress to roles at a higher pay grade. And with annual reviews and the support of our team, you'll have career potential that matches your ambitions - whether that's a move into research, teaching, management or a more specialist role.

# data[].attributes.headline
Literature Searching - How to Search the Literature Effectively

# data[].attributes.subject
Literature Searching - How to Search the Literature Effectively

# data[].attributes.attachment_link.readable_text
This programme is in partnership with...

About the Literature Searching programme

These modules are designed to help the healthcare workforce (clinical and non-clinical) build confidence to search published literature for articles and evidence relevant to their work, study and research. The modules are short (each taking no more than 20 minutes to complete) and may be 'dipped into' for reference, or completed to obtain a certificate. There are seven modules suitable for novice searchers and those wishing to refresh their knowledge:
Building the foundations Developing the skills Applying the skills
If you require further assistance contact your local healthcare library team. Check the Health Library and Information Services Directory to find your local library.

More information

Select each module below to find out more information:

Thank you

Thank you to the Steering Group, chaired by Helen Bingham, for bringing their expertise and knowledge to the project team. Thanks also to our wonderful team of library staff who made up the Virtual Reference Group, testing, evaluating and informing the development of the modules.

How to access

Available to all

The Literature Searchingprogramme is freely available to access here.
Please note your progress and completion of sessions will not be recorded and you will not be able to generate a record of completion. If you require evidence of learning, please register and then log in to access this programme on the elfh Hub.

If you already have an account with elfh, then you can enrol on to the Literature Searchingprogramme by logging in to the elfh Hub, selecting My Account > Enrolment and selecting the programme. You can then access the programme immediately in the My elearning section.
Register >
To view the Literature Searching programme, select the View button below. If you already have an account with elfh, you will also be able to login and enrol on the programme from the View button.
View >
NHS healthcare staff in England

The Literature Searching programme is also available to NHS healthcare staff via the Electronic Staff Record (ESR). Accessing this elearning via ESR means that your completions will transfer with you throughout your NHS career.

Further details are available here.

Not an NHS organisation?

If you are not an NHS health or care organisation and therefore do not qualify for free access elfh Hub, you may be able to access the service by creating an OpenAthens account.

To check whether or not you qualify for free access via OpenAthens, you can view the eligibility criteria and register on the ' OpenAthens ' portal.

Registering large numbers of users

If you are a HR, IT or Practice Manager and would like to register and enrol large numbers of staff within your organisation for access onto the Literature Searching programme, please contact elfh directly.

Organisations wishing to use their own LMS

For HR departments wanting to know more about gaining access to courses using an existing Learning Management System please contact elfh directly to express interest.

More information

Please select the following link for more information on how to use the elfh Hub.

elfh is a Health Education England programme in partnership with the NHS and professional bodies

© elearning for healthcare 2022

# data[].attributes.attachment_link.title
Literature Searching - elearning for healthcare

# data[].attributes.attachment_link.description
This programme is in partnership with... These modules are designed to help the healthcare workforce (clinical and non-clinical) build confidence to search published literature for articles and evidence relevant to their work, study and research. The modules are short (each taking no more than 20 minutes to complete) and may be 'dipped into' for reference, or completed to obtain a certificate.

# data[].attributes.attachment_link.title
Preterm labor - Symptoms, diagnosis and treatment | BMJ Best Practice US

# data[].attributes.attachment_link.description
Preterm labor can be caused by various factors and occurs between 24 and 37 weeks’ gestation. Spontaneous preterm labor is often associated with infection and inflammation, particularly at early gestations. Only a minority of women who present with preterm contractions progress to actual labor an…

# data[].attributes.attachment_link.title
Placental abruption - Symptoms, diagnosis and treatment | BMJ Best Practice US

# data[].attributes.attachment_link.description
Placental abruption is the separation of the normally located placenta before delivery of the fetus. It may be concealed or overt. Frequently presents as vaginal bleeding associated with abdominal pain and contractions in the second half of pregnancy. Associated with increased perinatal mortality…

# data[].attributes.attachment_link.readable_text
Postpartum hemorrhage (PPH) is an obstetric emergency that is a major contributor to maternal morbidity and mortality. Early recognition relies on accurate quantification of blood loss, together with frequent ongoing assessment of patient-specific risk factors, vital signs, and symptoms of hemorrhage.

Meticulous physical examination of the uterus, cervix, vagina, vulva, and perineum can facilitate an accurate diagnosis and prompt treatment of the underlying cause to prevent progression to hemorrhagic shock.

The four Ts mnemonic highlights the most common causes of PPH: tone (uterine atony, by far the most frequent cause); trauma (obstetric lacerations/expanding hematomas/uterine rupture); tissue (retained products of conception or placenta accreta spectrum disorders); and thrombin (acquired or inherited coagulopathy). Steps to address uterine atony form a routine part of the initial management in every patient with PPH.

First-line treatment for PPH comprises immediate resuscitation with intravenous fluids (and blood product transfusion if needed), along with uterine massage, administration of a uterotonic, and consideration of intravenous tranexamic acid. All of these must ideally be initiated within 15 minutes of a diagnosis. Additional management steps are dependent on the underlying cause of bleeding.

In women with refractory PPH, more aggressive interventions may be needed. Options include: temporary compressive measures; uterine tamponade; uterine artery embolization; surgical interventions, with hysterectomy sometimes necessary as a life-saving intervention.

The use of obstetric hemorrhage care bundles has been shown to improve outcomes in patients with PPH.

Active management of the third stage of labor is the single most important intervention to prevent PPH. Identification of high-risk women in the prenatal period is also paramount.

Primary postpartum hemorrhage (PPH) is characterized by a total blood loss ≥1000 mL (including intrapartum loss) or the presence of signs and symptoms of hypovolemia occurring within 24 hours after childbirth, irrespective of the mode of delivery. This standardized definition of PPH was established in 2014 by the reVITALize program and is endorsed by the American College of Obstetricians and Gynecologists.[1] Menard MK, Main EK, Currigan SM. Executive summary of the reVITALize initiative: standardizing obstetric data definitions. Obstet Gynecol. 2014 Jul;124(1):150-3. http://www.ncbi.nlm.nih.gov/pubmed/24901267?tool=bestpractice.com

Primary PPH occurs within the first 24 hours after delivery. Secondary PPH is defined as excessive blood loss that occurs >24 hours and <12 weeks postpartum.[2] Committee on Practice Bulletins-Obstetrics. Practice bulletin no. 183: postpartum hemorrhage. Obstet Gynecol. 2017 Oct;130(4):e168-86. http://www.ncbi.nlm.nih.gov/pubmed/28937571?tool=bestpractice.com

Prior to publication of the reVITALize definition, PPH was traditionally defined as an estimated blood loss (EBL) >500 mL after a vaginal birth or >1000 mL after a cesarean birth.[2]Committee on Practice Bulletins-Obstetrics. Practice bulletin no. 183: postpartum hemorrhage. Obstet Gynecol. 2017 Oct;130(4):e168-86. http://www.ncbi.nlm.nih.gov/pubmed/28937571?tool=bestpractice.com[3]Main EK, Goffman D, Scavone BM, et al. National partnership for maternal safety: consensus bundle on obstetric hemorrhage. Obstet Gynecol. 2015 Jul;126(1):155-62. https://journals.lww.com/anesthesia-analgesia/fulltext/2015/07000/national_partnership_for_maternal_safety_.22.aspx http://www.ncbi.nlm.nih.gov/pubmed/26241269?tool=bestpractice.com International guidelines still vary in their definition of the EBL required for a diagnosis of PPH.[4]Royal College of Obstetricians and Gynaecologists. Prevention and management of postpartum haemorrhage: green-top guideline no. 52. BJOG. 2017 Apr;124(5):e106-49. https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.14178 http://www.ncbi.nlm.nih.gov/pubmed/27981719?tool=bestpractice.com[5] World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. 2012 [internet publication]. https://www.who.int/publications/i/item/9789241548502 http://www.ncbi.nlm.nih.gov/pubmed/23586122?tool=bestpractice.com

# data[].attributes.attachment_link.title
Postpartum hemorrhage - Symptoms, diagnosis and treatment | BMJ Best Practice US

# data[].attributes.attachment_link.description
Postpartum hemorrhage (PPH) is an obstetric emergency that is a major contributor to maternal morbidity and mortality. Early recognition relies on accurate quantification of blood loss, together with frequent ongoing assessment of patient-specific risk factors, vital signs, and symptoms of hemorr…

# data[].attributes.attachment_link.readable_text
Clinical Director

Maternity Investigation Team

Healthcare Services Investigation Branch

Hampshire

UK

Disclosures

JJW is President of the Baby Lifeline Training Company and Medical Director of Action on Pre-eclampsia. He lectures and teaches on pre-eclampsia and maternal safety both nationally and internationally, and is the author of national and local reports into safety investigations for the Healthcare Services Investigation Branch and national and local bodies.

# data[].attributes.attachment_link.description
Pre-eclampsia is a hypertensive syndrome that occurs in pregnant women, most often after 20 weeks' gestation, which consists of new-onset, persistent hypertension with either proteinuria or evidence of systemic involvement. All pregnant women presenting with hypertension and either proteinuria or...

# data[].attributes.headline
Assessment of abdominal pain in pregnancy

# data[].attributes.subject
Assessment of abdominal pain in pregnancy

# data[].attributes.attachment_link.title
Evaluation of abdominal pain in pregnancy - Differential diagnosis of symptoms | BMJ Best Practice US

# data[].attributes.attachment_link.description
Abdominal pain in pregnancy is common. Many adaptive or physiologic changes of pregnancy affect the presentation. Women tend to visit doctors often as they are concerned about the health of their fetus. Patients require a careful assessment in order to reduce anxiety and give reassurance. If the…

# data[].attributes.attachment_link.title
Breech presentation - Symptoms, diagnosis and treatment | BMJ Best Practice US

# data[].attributes.attachment_link.description
Breech presentation refers to the baby presenting for delivery with the buttocks or feet first rather than head. Associated with increased morbidity and mortality for the mother in terms of emergency cesarean section and placenta previa; and for the baby in terms of preterm birth, small fetal siz…

# data[].attributes.attachment_link.title
Overview of pregnancy complications - Summary of relevant conditions | BMJ Best Practice US

# data[].attributes.attachment_link.description
Complications in pregnancy can result from conditions that are specifically linked to the pregnant state as well as conditions that commonly arise or occur incidentally in women who are pregnant. Serious sequelae might include miscarriage, preterm labor or premature rupture of membranes, prematur…

# data[].attributes.headline
Nonpharmacologic approaches to management of labor pain

# data[].attributes.subject
Nonpharmacologic approaches to management of labor pain

# data[].attributes.attachment_link.title
Nonpharmacologic approaches to management of labor pain - UpToDate

# data[].attributes.attachment_link.description
Nonpharmacologic approaches to management of labor pain

# data[].attributes.headline
Prediction of preeclampsia in asymptomatic pregnant patients

# data[].attributes.subject
Prediction of preeclampsia in asymptomatic pregnant patients

# data[].attributes.attachment_link.title
Prediction of preeclampsia in asymptomatic pregnant patients - UpToDate

# data[].attributes.attachment_link.description
Prediction of preeclampsia in asymptomatic pregnant patients

# data[].attributes.headline
Labor: Overview of normal and abnormal progression

# data[].attributes.subject
Labor: Overview of normal and abnormal progression

# data[].attributes.attachment_link.readable_text
Labor is defined as regular and painful uterine contractions that cause progressive dilation and effacement of the cervix. The rate of cervical dilation becomes faster after the cervix is completely effaced [ 1]. Normal labor results in descent and eventual expulsion of the fetus. Parity affects this process: Parous patients who have had a previous vaginal birth have faster labors than nulliparous patients.

Although determining whether labor is progressing normally is a key component of intrapartum care, determining the time of labor onset, measuring its progress, and evaluating the uterine, fetal, and pelvic factors that affect its course are an inexact science. "Abnormal labor," "dystocia," and "failure to progress" are traditional but imprecise terms that have been used to describe a labor pattern deviating from that observed in most patients who have a spontaneous vaginal birth. These labor abnormalities are best described as protraction disorders (ie, slower than normal progress) or arrest disorders (ie, complete cessation of progress). By convention, an abnormally long active phase is usually described as protracted, whereas an abnormally long latent phase or second stage is usually described as prolonged.

Recognizing abnormal labor progression and initiating appropriate interventions is important because it is associated with increased risks for operative delivery and maternal and neonatal morbidity.

This topic will provide an overview of labor progress and discuss risk factors for abnormal progression. Management of normal labor and delivery; diagnosis and management of abnormalities of the latent phase, first stage, and second stage; and management of the third stage are reviewed separately:

●(See "Labor and delivery: Management of the normal first stage".)

Disclaimer: This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms. 2025© UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.

# data[].attributes.attachment_link.title
Labor: Overview of normal and abnormal progression - UpToDate

# data[].attributes.attachment_link.description
Labor: Overview of normal and abnormal progression

# data[].attributes.attachment_link.title
Retained placenta after vaginal birth - UpToDate

# data[].attributes.attachment_link.description
The third stage of labor is the interval from expulsion of the newborn to expulsion of the placenta. Delayed placental separation and expulsion is a potentially life-threatening event because it impedes normal postpartum myometrial contraction, which can lead to hemorrhage. This topic will discuss the diagnosis and management of a retained placenta after vaginal birth.

# data[].attributes.headline
Trial of labor after cesarean birth: Intrapartum management

# data[].attributes.subject
Trial of labor after cesarean birth: Intrapartum management

# data[].attributes.attachment_link.title
Trial of labor after cesarean birth: Intrapartum management - UpToDate

# data[].attributes.attachment_link.description
Trial of labor after cesarean birth: Intrapartum management

# data[].attributes.headline
Induction of labor: Techniques for preinduction cervical ripening

# data[].attributes.subject
Induction of labor: Techniques for preinduction cervical ripening

# data[].attributes.attachment_link.title
Induction of labor: Techniques for preinduction cervical ripening - UpToDate

# data[].attributes.attachment_link.description
When labor is induced, cervical status has an impact on the duration of induction and the likelihood of vaginal birth. If the cervical status is unfavorable, a ripening process is generally employed prior to induction to shorten the duration of oxytocin administration and maximize the possibility of vaginal birth.

# data[].attributes.attachment_link.title
International Confederation of Midwives | Strengthening midwives and midwives’ associations globally.

# data[].attributes.attachment_link.description
We work with midwives and midwives’ associations globally to ensure that women and gender diverse people have access to a midwife’s care before, during and after childbirth.

# data[].attributes.attachment_link.description
We're the independent regulator for nurses, midwives and nursing associates. We hold a register of nurses and midwives who can practice in the UK, and nursing associates who can practice in England.

# data[].attributes.attachment_link.description
The RCN is the world's largest nursing union and professional body. We represent nursing and offer a range of services and support to our members.

# data[].attributes.body
Access via your OpenAthens account

# data[].attributes.headline
Maternity and pediatric nursing made incredibly easy! / edited by Mikki Meadows-Oliver

# data[].attributes.subject
Maternity and pediatric nursing made incredibly easy! / edited by Mikki Meadows-Oliver

# data[].attributes.attachment_link.title
Details for: Maternity and pediatric nursing made incredibly easy! / › KSS Knowledge & Library Services catalogue

# data[].attributes.attachment_link.description
Cookies are small text files placed on your browser by websites. They help make websites work, or work more efficiently. They also "remember" some of your preferences, so you don't have to set a preference again every time you switch to a different page on the same website.

# data[].attributes.headline
Trauma and birth: a handbook for maternity staff/ by Sheila Broderick and Ruth Cochrane

# data[].attributes.subject
Trauma and birth: a handbook for maternity staff/ by Sheila Broderick and Ruth Cochrane

# data[].attributes.attachment_link.title
Details for: Trauma and birth: a handbook for maternity staff/ › KSS Knowledge & Library Services catalogue

# data[].attributes.attachment_link.description
The online catalogue only uses functional cookies: these are essential to make the site work. Please click the ‘Accept essential cookies’ button to proceed.

# data[].attributes.headline
The Journal of Maternal-Fetal and Neonatal Medicine

# data[].attributes.subject
The Journal of Maternal-Fetal and Neonatal Medicine

# data[].attributes.attachment_link.title
The Journal of Maternal-Fetal & Neonatal Medicine

# data[].attributes.attachment_link.description
Publishes research on pregnancy complications, perinatal and neonatal medicine, covering obstetric, medical, genetic, mental health and surgical complications.

# data[].attributes.attachment_link.title
Gestational diabetes mellitus - Symptoms, diagnosis and treatment | BMJ Best Practice US

# data[].attributes.attachment_link.description
Gestational diabetes mellitus (GDM) develops during pregnancy and is usually diagnosed at 24 to 28 weeks of gestation on the basis of elevated plasma glucose levels on glucose tolerance testing. Goal of therapy is to achieve maternal glucose levels that are as close to normal as possible in order…

# data[].attributes.attachment_link.readable_text
Board-certified in Preventive Medicine

Board Certified in Lifestyle Medicine

Preventive Medicine Consultants, PLLC

Glendale

AZ

Disclosures

AS declares that she has no competing interests.

# data[].attributes.attachment_link.description
Gestational hypertension is defined as a blood pressure (BP) of ≥140/90 mmHg on two occasions (at least 4 hours apart) after 20 weeks' gestation in a previously normotensive woman, without the presence of proteinuria or other clinical features (thrombocytopenia, impaired renal or kidney function,...

# data[].attributes.attachment_link.readable_text
Clinical Director

Maternity Investigation Team

Healthcare Services Investigation Branch

Hampshire

UK

Disclosures

JJW is President of the Baby Lifeline Training Company and Medical Director of Action on Pre-eclampsia. He lectures and teaches on pre-eclampsia and maternal safety both nationally and internationally, and is the author of national and local reports into safety investigations for the Healthcare Services Investigation Branch and national and local bodies.

# data[].attributes.attachment_link.description
Pre-eclampsia is a hypertensive syndrome that occurs in pregnant women, most often after 20 weeks' gestation, which consists of new-onset, persistent hypertension with either proteinuria or evidence of systemic involvement. All pregnant women presenting with hypertension and either proteinuria or...

# data[].attributes.attachment_link.readable_text
Postpartum depression may present with symptoms of depressed mood, anhedonia, weight changes, sleep disturbance, psychomotor problems, low energy, excessive guilt, loss of confidence or self-esteem, poor concentration, or suicidal ideation.

Recognition and effective treatment is vital; untreated postpartum depression causes substantial impairment for the woman, and may also result in impaired behavioral, emotional, and cognitive outcomes for the baby.

Exclude postpartum psychosis and bipolar disorder in all patients.

Treatment is with psychological therapy and/or medication. Antidepressants are recommended for more severe episodes if the woman declines psychological therapy or if psychological therapy is either ineffective or unavailable.

Psychiatric referral may be necessary for patients who do not respond to treatment. Urgent psychiatric assessment is warranted if there is a risk of self-harm or harm to the child at any time, or if a postpartum psychosis, or manic or mixed episode, is suspected.

Episodes of postpartum depression last 3 to 6 months on average, but may last for months or even years.

Postpartum depression refers to the development of a depressive illness following childbirth and may form part of a bipolar or, more usually, a unipolar illness. Postpartum depression is not recognized by current classification systems as a condition in its own right, but the onset of a depressive episode within 4 weeks of childbirth can be recorded via the peripartum-onset specifier in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR).[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text rev (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022. There is evidence that the DSM-5-TR specifier is too narrow.[2]Forty L, Jones L, Macgregor S, et al. Familiality of postpartum depression in unipolar disorder: results of a family study. Am J Psychiatry. 2006 Sep;163(9):1549-53. http://ajp.psychiatryonline.org/doi/full/10.1176/ajp.2006.163.9.1549 http://www.ncbi.nlm.nih.gov/pubmed/16946179?tool=bestpractice.com Hence, in common usage, depressive episodes occurring within 6 to 12 months of delivery may be considered to be postpartum depression. This topic defines the postpartum period as up to 12 months after delivery, in accordance with several international guidelines.​[3]Austin MP; Marcé Society Position Statement Advisory Committee. Marcé International Society position statement on psychosocial assessment and depression screening in perinatal women. Best Pract Res Clin Obstet Gynaecol. 2014 Jan;28(1):179-87. http://www.ncbi.nlm.nih.gov/pubmed/24138943?tool=bestpractice.com[4]American College of Obstetricians and Gynecologists. ACOG clinical practice guideline no. 4: screening and diagnosis of mental health conditions during pregnancy and postpartum. Jun 2023 [internet publication]. https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/06/screening-and-diagnosis-of-mental-health-conditions-during-pregnancy-and-postpartum[5]National Institute for Health and Care Excellence (UK). Antenatal and postnatal mental health: clinical management and service guidance. Feb 2020 [internet publication]. https://www.nice.org.uk/guidance/cg192 ​ Symptom onset in pregnancy (and before pregnancy) is not uncommon; therefore, the term "perinatal depression" may be strictly more accurate.​​[6]Wisner KL, Sit DK, McShea MC, et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry. 2013 May;70(5):490-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440326 http://www.ncbi.nlm.nih.gov/pubmed/23487258?tool=bestpractice.com[7] Biaggi A, Conroy S, Pawlby S, et al. Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord. 2016 Feb;191:62-77. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879174 http://www.ncbi.nlm.nih.gov/pubmed/26650969?tool=bestpractice.com

This topic focuses on postpartum depression within a unipolar illness. For more information on postpartum depression in the context of a bipolar illness, see Bipolar disorder in adults. For information on depression during pregnancy, see Depression in adults.​

# data[].attributes.attachment_link.title
Postpartum depression - Symptoms, diagnosis and treatment | BMJ Best Practice US

# data[].attributes.attachment_link.description
Postpartum depression may present with symptoms of depressed mood, anhedonia, weight changes, sleep disturbance, psychomotor problems, low energy, excessive guilt, loss of confidence or self-esteem, poor concentration, or suicidal ideation. Recognition and effective treatment is vital; untreated…

# data[].attributes.attachment_link.readable_text
Group B streptococcal infection is the most common cause of early, severe infection in newborns.

It is also a cause of infection in pregnancy, people with diabetes, immunocompromised people, and older adults.

Presentation depends on the age of the patient and the underlying risk factor.

Diagnosis is confirmed by isolation of group B streptococci (GBS) from usually sterile body fluid.

Targeted antibiotic therapy is the mainstay of therapy in patients with demonstrated GBS infection.

Incidence and mortality are highest in older people.

Group B streptococci (GBS), also known as Streptococcus agalactiae, are gram-positive bacteria that normally colonize the gastrointestinal tract, perineum, and vagina.[1]Edwards MS, Baker CJ. Streptococcus agalactiae (Group B Streptococci). In: Bennett JE, Dolin R, Blaser MJ (eds). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 9th edition. Philadelphia, US: Elsevier; 2020. They can cause invasive infections at any age, but infections are most common in the neonatal period, in older people, and in adults with predisposing factors (i.e., pregnancy, diabetes, immunocompromised).[1]Edwards MS, Baker CJ. Streptococcus agalactiae (Group B Streptococci). In: Bennett JE, Dolin R, Blaser MJ (eds). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 9th edition. Philadelphia, US: Elsevier; 2020. GBS can cause a range of infections including sepsis, cellulitis, pneumonia, and meningitis.[1] Edwards MS, Baker CJ. Streptococcus agalactiae (Group B Streptococci). In: Bennett JE, Dolin R, Blaser MJ (eds). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 9th edition. Philadelphia, US: Elsevier; 2020. This topic deals with confirmed group B streptococcal infection only.

# data[].attributes.attachment_link.description
Group B streptococcal infection is the most common cause of early, severe infection in newborns. It is also a cause of infection in pregnancy, people with diabetes, immunocompromised people, and older adults. Presentation depends on the age of the patient and the underlying risk factor. Diagnosis...