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Psychological Manifestations in Puerperal Women

Journal of Research in Medical and Dental Science
eISSN No. 2347-2367 pISSN No. 2347-2545

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Research Article - (2021) Volume 9, Issue 12

Psychological Manifestations in Puerperal Women

Satya Deepti Surala and K. Saraswathi*

*Correspondence: K. Saraswathi, Department of Obstetrics and Gynaecology, Affiliated to Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India, Email:

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Abstract

The current study brings out various factors which are suggestive of emotional (mood) disturbances which are not uncommon among women after childbirth. In the present study, no significant relevance was found between psychological stress and age. Literate women were 5.5 times more prone for depression than illiterate women and there is more chances of depression of women in socioeconomic class 4. It was found that depression was fairly common in Nuclear families as compared to Extended families. No significant relevance was found between psychological stress and parity. Women were 333. 8 times more prone for depression if there were not Booked and Immunised. The Obstetricians are in a unique position where they can help women in the better experience of motherhood for both the woman and her family just by being aware of the psychological manifestations in puerperal women as "the eye cannot see what the mind does not know".

Keywords

Perinatal mental illness, postpartum blues, postpartum period

Introduction

Childbirth is a happy major life event in the life of a woman where she steps into blissful motherhood as a fulfilment of her womanhood but for some new mothers who suffer from postpartum depression it can also be a disconcerting time. 1 Women are at an increased risk for first onset of major depression from early adolescence until their mid- 50s. They have a lifetime rate of major depression 1.7 to times greater than that for men in the National Comorbidity Survey. Depression has been identified by the World Health Organization as a major cause of morbidity in the 21st century. The Global Burden of Disease study states that major depression will become the second leading worldwide cause of disease burden by 20 20.

Risk of depression increases 1n some periods of a woman's life and the Puerperium is one of these. Puerperium also termed "fourth trimester" is the period following child birth during which the body tissues, specially the pelvic organs revert back approximately to the pre pregnant stage both anatomically and physiologically, which lasts for approximately 6 weeks. The woman in this period is termed "puerpera" (Datta). In short, during this time complete physiologic involution and psychological adjustment7a,b (RCOG) takes place.

During the puerperium, about 85% of women experience some type of mood disturbance 8, for most the symptoms are mild and short-lived. Approximately 10%-15% of all new mothers get postpartum dep ression , which most frequently occurs within the first year after the birth of a child.< 9 Postpartum psychological disorders lead to maternal disability and disturbed mother-baby relationships.11

Postpartum psychiatry illnesses are typically divided into 3 categories

  1. Postpartum blues
  2. Postpartum depression
  3. Postpartum psychosis

Postpartum blues is the mildest and postpartum psychosis the most severe form of postpartum psychiatric illness. The presentation of these disorders does not very much in different parts of the world; however, prevalence, incidence and the risk factors associated with these disorders vary depending upon the characteristics of different study populations. This study was designed to evaluate the determinants and prevalence of postpartum psychological disorders in women during the first few days of puerperium who have no previous psychiatric illness and obvious risk factors. The study also helps to find out risk factors thereby preventing the other major psychological manifestations.

Material and Method

This study was conducted in 500 women delivered in about an one year especially during the labour ward postings at the Department of Obstetrics and Gy na eco logy , Sree Balaji Medical College and Hospital , Chro mpet , Chennai - 44 in collabouration with the Department of Psychiatry, Sree Balaji Medical College and Hospital, Chrompet, Chennai – 44. 500 Womendelivered1nSBMCHconsecutivelywhetherNormalVaginalDelivery,Instrumental Deliveries or Caesarean Sections were selected for the present study. Those with the following one or a combination of Known case of previous psychiatric disorders, High risk cases like ecl amps ia, uncontrolled GDM, Intrauterine death, Babies born with congenital anomalies, Bad obstetric history, Conception after treatment for infertility were exluded from the study. 500 Women delivered in SBMCH including normal vaginal deliveries, instrumental deliveries or Caesarean sections were chosen leaving out women from the exclusion criteria. The data related to Demographic details, Clinical Assessment which included detailed History Taking and Physical Examination and Psychological assessment were recorded. The patients were analysed by General Health Questionnaire – 12 (Screening Questionnaire), Edinburgh Postpartum depression scale (EPDS).

Results

In this case study of 500 women, the frequency of various factors had been considered and analysed. This frequency table (Table. 1) showed the variables which have been considered and the number and percentage of women which comprised in each variable. None amongst the 500 women had any family history of mental illness (Table. 2- 5). These frequency tables show the number and percentage of women had raised GHQ score and EPDS score respectively along with the number and percentage of women with high scores on both the scales. The same are reflected in the Figure 1.

FACTORS FREQUENCY PERCENT
Woman's Literacy
Illiterate 388 77.6
Literate 112 22.4
SE status
Class 2 12 2.4
Class 3 34 6.8
Class 4 92 18.4
Class 5 362 72.4
Family type
Extended 122 24.4
Nuclear 378 75.6
Parity
Primi 341 68.2
Multi 159 31.8
B & I
Yes 420 84
No 80 16
KICIO past illness
No 353 70.6
Yes 147 29.4
Mode of Delivery
Normal 270 54
LSCS 224 44.8
Instrumental 6 1.2
Sex of present baby
Boy 238 47.6
Girl 262 52.4

Table 1: Frequency Tables

No of Girl children
None 238 47.6
One 208 41.6
2 or more 54 10 .8
PNIPOSTOP Complications
No 244 48.8
Yes 256 51.2
Breast Feeding
Yes 458 91.6
Problems 41 8.2
No 1 0.2

Table 2: Family History of Mental Illness.

GHQ class

Frequency

Percent

Normal

394

78.8

Psychological Stress

106

21.2

Total

500

100

Table 3: Proportion of sample with raised GHQ scores.

EPDS class Frequency Percent
Normal 377 75.4
Depressed 123 24.6
Total 500 100

Table 4: Proportion of sample with raised EPD Sscores.

GHQ+ EPDS Frequency Percent
Women with raised scores on both GHQ and EPDS 52 10.4

Table 5: Proportion of sample with both GHQ & EPDS raised.

journal-research-proportion

Figure 1: Proportion of sample with raised GHQ scores.

EPDS Raised

n

%

GHQ Normal

394

71

18.02

GHQ Raised

106

52

49.05

Table 6: Relationship of GHQ scores with EPDS scores.

The table 6 showed the relationship of GHQ score with EPDS scores. In the sa mp le of mothers with raised GHQ score (106) , 52 (49 .05 %) had elevated EPDS scor es. But in the sample of mothers with normal GHQ scores (394), only 71(1 8.02 %) of women had elevated EPD s scores (Table. 7 - 11).

GHQ class N Mean
Age Normal 394 23.46
(years) Depressed 106 23.76

Table 7: Independent samples T-Test to compare the mean age between normal and depressed mothers based on GHQ score classification.

EPDS class N Mean Std. Dev t-Value
Age Normal 377 23.59 3.047 0.842
(years) Depressed 123 23.33 3.039

Table 8: Independent samples T-Test to compare the mean age between normal and depressed mothers based on EPDS score classification.

Depression

Status

N

Mean

Std. Dev

Normal

323

23.59

3.037

Only GHQ

54

23.57

3.136

Only EPDS

71

22.86

2.934

Both

52

23.96

3.093

Total

500

23.53

3.044

Table 9: One way ANOVA to compare the mean age between normal and depressed mothers based on both scores classification.

In this study, puerpera from age 17 to 37 were present. This table shows the mean age of normal women was 23.59, the mean age for women with raised GHQ scores is 23.57 but the mean age of raised EPDS scores is 22.86. Figure 2.

journal-research-study

Figure 2: Mean age of women in this study.

WOMAN'S LITERACY GHQ EPDS BOTH
n % n % n %
Illiterate 87 22.4 74 19.1 39 10.1
Literate 19 17 49 43.8 13 11.6
Total 106 21.2 123 24.6 52 10.4

Table 10: Association of raised GHQ and EPDS scores with the puerpera's literacy.

Chi-Square Test Value P-Value
Pearson Chi-Square 41.082 <0.001

Table : 10A

This table shows the association of women's literacy to raised GHQ scores and raised EPDS scores (Table. 10, 10A). Depression is more common in literate women (p value <0.001 hence statistically significant). The same are reflected in the Figure. 3

 journal-research-association

Figure 3: Association of women's literacy to raised GHQ scores and raised EPDS scores.

SE STATUS GHQ EPDS BOTH
n % n % n %
CLASS 2 4 33.3 7 58.3 4 33.3
CLASS 3 10 29.4 11 32.4 7 20.6
CLASS 4 29 31.5 38 41.3 10 10.9
CLASS 5 63 17.4 67 18.5 31 8.6
TOTAL 106 21.2 123 24.6 52 10.4

Table 11: Association of raised GHQ and EPDS scores with the Socioeconomic Status (SE Status).

Chi-Square Test

Value

p-Value

Pearson Chi-Square

59.28

<0.001

Table : 11A

This table showed (Table. 11 and 11A) the relationship of socio economic status to raised GHQ scores and raised EPDS scores. Depression is more common in greater socio economic status. (p value <0.001 hence statistically significant). The same are reflected in the Figure 4.

 journal-research-economic

Figure 4 : the relationship of socio economic status to raised GHQ scores and raised EPDS scores.

TYPE OF FAMILY GHQ EPDS
n % n
Nuclear 50 41 34
Extended 56 14.8 89
Total 106 21.2 123

Table 12: Association of raised GHQ and EPDS scores with the Type of Family.

Chi-Square Test

Value

p-Value

Pearson Chi- Square

39.325

<0.001

Table : 12A

This table shows the relationship of type of family to raised GHQ scores and raised EPDS scores. Depression is more common in Nuclear fami lies (Table. 12 and 12A). (p value <0.001 hence statistically significant). The same are reflected in the Figure 5

journal-research-family

Figure 5: Depression in Nuclear family.

PARITY GHQ EPDS BOTH
n % n % n %
Primi 55 16.1 80 23.5 27 7.9
Multi 51 32.1 43 27 25 15. 7
Total 106 21.2 123 24 .6 52 10.4

Table 13: Association of raised GHQ and EPDS scores with the Parity.

Chi-Square Test

Value

p-Value

Pearson Chi-Square

16.676

0.001

Table : 13A

This table shows the relationship of parity to raised GHQ scores and raised EPDS scores (Table. 13 and 13A). Depression is more common in multigravida. (p value 0.001 hence statistically significant). The same are reflected in the Figure 6

Chi-Square Test Value p-Value
Pearson Chi-Square 16.676 0.001

journal-research-relationship

Figure 6: relationship of parity to raised GHQ scores and raised EPDS scores.

B & I GHQ EPDS BOTH
n % n % n
Yes 41 9.8 85 20.2 18
No 65 81.3 38 47.5 34
Total 106 21.2 123 24.6 52

Table 14: Association of raised GHQ and EPDS scores with mothers who are Booked and Immunised in the antenatal period.

Chi-Square Test Value p-Value
Pearson Chi-Square 20.7.046 < 0.001

Table : 14A

This table shows the relationship of women who were booked and immunised (regular antenatal care) to raised GHQ scores and raised EPDS scores (Table. 14 and 14A). Depression is more common in women who were not booked and immunised. (p value <0.001 hence statistically significant). The same are reflected in the Figure 7.

H/O PAST

GHQ

EPDS

BOTH

ILLNESS

n

%

n

%

n

No

101

28 .6

101

28.6

51

Yes

5

3.4

22

15

1

Total

106

21.2

123

24.6

52

Table 15: Association of raised GHQ and EPDS scores with History of Past Illnesses.

Chi -Square Test Value p-Value
Pearson Chi-Square 41.611 <0.001

Table: 15A

 journal-research-women

Figure 7: Depression is more common in women who were not booked and immunised.

In the present stu dy , Depression 1s more common m women with no history of past illness (Table 15 and 15A). (p value <0.001 hence statistically significant). This could because 143 out of the 147 women with a h/o past illness had hypothyroidism and were on regular treatment. This table shows the relationship of history of past illness to raised GHQ scores and raised EPDS scores. The same are reflected in the Figure 8

MODE OF DELIVERY GHQ EPDS BOTH
n % n % n %
Normal 55 20.4 58 21.5 30 11.1
LSCS 51 10.2 65 13 22 4.4
Instrumental 0 0 0 0 0 0
Total 106 21.2 123 24.6 52 10.4

Table 16: Association of raised GHQ and EPDS scores with Mode of Delivery.

Chi-Square Test Value p-Value
Pearson Chi-Square 89.056 <0.062

Table : 16A

 journal-research-past

Figure 8: History of past illness to raised GHQ scores and raised EPDS scores

This table shows the relationship of mode of delivery to raised GHQ scores and raised EPDS scores (Table. 16 and 16A). Women who underwent instrumental delivery (total of 6 women out of 500) showed no signs of psychological manifestations. (p value not <0.05 hence statistically not significant). The same are reflected in the Figure 9

SEX OF PRESENTBABY GHQ EPDS BOTH
n % n % n %
Boy 43 18.1 53 18.1 18 7.6
Girl 63 24.0 70 24.0 34 13.0
Total 106 21.2 123 24.6 52 10.4

Table 17: Association of raised GHQ and EPDS scores with Sex of Present Baby.

Chi-Square Test Value p-Value
Pearson Chi-Square 4.119 0.249

Table : 17A

journal-research-mode

Figure 9: Relationship of mode of delivery to raised GHQ scores and raised EPDS scores.

This table shows the relationship of sex of the present baby to raised GHQ scores and raised EPDS scores (Table. 17 and 17A). Depression is more common in women with girl babies. (p value >0.05 hence statistically not significant). The same are reflected in the Figure 10

No. of Girl Children GHQ EPDS BOTH
n % n % n %
None 43 18.1 53 22.3 18 7.6
One 43 20.7 55 26.4 24 11.5
2 or more 20 37 15 27.8 10 18.5
Total 106 21.2 123 24.6 52 10.4

Table 18: Association of raised GHQ and EPDS scores with Number of Girl Children.

Table : 18A

Chi-Square Test Value p-Value
Pearson Chi-Square 11.347 0.078

journal-research-baby

Figure 10: The relationship of sex of the present baby to raised GHQ scores and raised EPDS scores.

This table shows the relationship of number of girl children to raised GHQ scores and raised EPDS scores (Table 18 and 18A). Depression is more common in women with 2 or more girl babies, least common in women with one girl child and the lesser in women with no girl babies. (p value >0.05 hence statistically not significant). The same are reflected in the Figure 11.

PN/Post-op Complications GHQ EPDS BOTH
n % n % n %
No 41 16.8 32 13.11 13 5.3
Yes 65 25 89 34 39 15.23
Total 106 21.2 123 24.6 52 10.4

Table 19: Association of raised GHQ and EPDS scores with Post Natal / Post Operative Complications.

Chi-Square Test Value P-Value
Pearson Chi-Square 142.074 <0.001

Table : 19A

journal-research-girl

Figure 11: Number of girl children to raised GHQ scores and raised EPDS scores.

This table shows the relationship of history of postnatal or post operative complications to raised GHQ scores and raised EPDS scores (Table. 19 and 19A). Depression is more common in women with history of postnatal or post operative complications. (p value <0.001 hence statistically significant). The same are reflected in the Figure 12

BREAST FEEDING GHQ EPDS BOTH
n % n % n %
Yes 88 19.2 84 18.3 37 8.1
Problems present 17 41.5 39 95.1 15 36.6
No 1 100 0 0 0 0
Total 106 21.2 123 24.6 52 10.4

Table 20: Association of raised GHQ and EPDS scores with Breastfeeding.

Chi-Square Test

Value

P-Value

Pearson Chi-Square

129.776

<0.001

Table: 20A

journal-research-history

Figure 12: The relationship of history of postnatal or post operative complications to raised GHQ scores and raised EPDS scores.

This table shows the relationship of breast feeding and raised GHQ scores and raised EPDS scores (Table. 20 and 20A). In women with breast feeding problems, depression 1s more common. One woman chose not to breast feed as she was hepatitis B affected and she scored high on GHQ but not on EPDS . (p value <0.001 hence statistically significant). The same are reflected in the Figure 13

journal-research-breast

Figure 13: the relationship of breast feeding and raised GHQ scores and raised EPDS scores.

Factors

OR

95% CI

p-Value

SE status

Class 5

1

Class 2

2.373

0.693

8.123

0.169

Class 3

1.978

0.901

4.34

0.089

Class 4

2.185

1.303

3.664

0.003

Family type

Extended

1

Nuclear

3.993

2.523

6.319

<0.001

Parity

Primi

1

Multi

2.456

1.58

3.815

<0.001

B & I

Yes

1

No

40.057

20.968

76.525

<0.001

KICIO past illness

Yes

1

No

11.383

4.531

28.597

<0.001

Sex of new baby

Boy

1

Girl

1.436

0.929

2.218

0.103

Number of Girl children

None

1

One

1.182

0.738

1.892

0.487

2 or more

2.668

1.402

5.077

0.003

PNIPOSTOP COMPL

No

1

Yes

3.922

2.132

7.215

<0.001

Breast Feeding

Yes

1

Problems

3.153

1.64

6.064

0.001

Table 21: Uni-variatelogisticregressionforGHQ Score.

Factors AOR 95% CI P-Value

SE status

Class 5

1

Class 2

0.858

0.045

16.435

0.919

Class 3

2.393

0.579

9.891

0.228

Class 4

4.613

1.937

10.989

0.001

Family type

Extended

1

Nuclear

12.063

5.103

28.519

<0.001

Parity

Primi

1

Multi

2.239

0.926

5.413

0.044

B & I

Yes

1

No

333.82

98.2

1134.82

<0.001

KI C I O past illness

Yes

1

No

150.71

26.48

857.71

<0.001

Sex of new baby

Boy

1

Girl

3.666

1.044

12 .872

0.043

Number of Girl children

None

1

One

0.427

0.036

2.917

0.137

2 or more

1.668

1.029

3.789

0.047

PNI POSTOP COMPL

No

1

Yes

22.722

1.563

330.38

0.022

Breast Feeding

Yes

1

Problems

0.333

0.02

5.512

0.442

Table 22: Uni-variatelogisticregressionforGHQ Score.

Factors OR 95% CI P-Value
Woman's Education
Illiterate 1.00
Literate 3.300 2.102 5.182 <0.001
SE status
Class 5 1.00
Class 2 6.164 1.898 20.018 0.002
Class 3 2.106 0.979 4.529 0.057
Class 4 3.098 1.893 5.070 <0.001
B & I
Yes 1.00
No 3.566 2.164 5.874 <0.001
KICIO past illness
Yes 1.00
No 2.277 1.369 3.787 0.002
PNIPOSTOP COMPL
No 1.00
Yes 74.476 22.58 245.64 <0.001
Breast Feeding
Yes
Problems 57.881 17.47 191.77 <0.001

Table 23: Uni-variateLogisticRegression forEPDS Score.

Score

Factors

AOR

95% CI

P-Value

Woman's Education

Illiterate

1.00

Literate

5.599

1.877

16.699

0.002

SE status

Class 5

1.00

Class 2

0.814

0.121

5.468

0.832

Class 3

0.264

0.060

1.166

0.079

Class 4

1.068

0.378

3.019

0.902

B & I

Yes

1.00

No

5.347

2.934

9.745

<0.001

KI CI O past illness

Yes

1.00

No

2.148

1.126

4.099

0.020

PNIPOSTOP COMPL

No

1.00

Yes

97.411

9.765

971.72

<0.001

Breast Feeding

Yes

1.00

Problems

1.081

0.096

12.109

0.950

Table 24: Multi-variate Logistic Regression for EPDS

NOTE: For logistic regression analysis the factors which has a p-value <0.20 (Association with outcome) will be considered. Forced entry method is used to calculate the OR and it 95% Confidence intervals.

Discussion

Labour and child birth are natural events. It is a unique experience in a woman’s life. But, due to any number of reasons ranging from support of the family, course of the antenatal period to the delivery itself and the adjustments that need to be made to accommodate the baby into the daily schedule can make the woman stressed out. Our study demonstrates the prevalence of psychological manifestations 1n puerperal women with various variables. In 500 puerperal women, 106 (21.2%) had raised GHQ scores indicating psychological stress, 123 (24.6%) had raised EPDS scores indicating depression and 52 (10.4%) had raised scores on both the questionnaires. In the 394 women with GHQ normal scores, 71 (18.02%) had raised EPDS scores. p-Values <O. 05 are statistically significant. were present and the mean age of normal women was 23.59, the mean age for women with raised GHQ scores is 23.57 but the mean age of raised EPDS scores is 22.86. 1n our study was > 0.001 this data was not statistically significant. partum depression in a cohort of women from a rural area of Tamilnadu, the mean age of the 384 women was 22.8 yrs (s.d. 3.7,range 17-37). Research which has examined the rates of postpartum depression in mothers aged 14 - 18 years (n=l28) showed a much higher 19 rate of illness, approximately 26% (Troutman & Cutrona, 1990) however stating that this is a population which requires further research to establish specific risk factors as within this younger population there may be risk factors which predispose not only to postpartum depress1•on. 10 had higher scores on the the International Journal of GHQ than illiterate women Social Psychiatry Jan 2010 - but slightly less number of Post partum depression in the illiterate women had raised community - A qualitative EPDS score as compared to study from rural south India , literate women. p Value the following factors were <0.001 associated with post-partum. In the present study, more women who were literate fact that they being well age and education: age less educated are well read than 20 or over 30 years, and form unrealistic schooling less than five expectations which when years55 .they do not transpire pushes them to become anxious and depressed. In another study Gender, Poverty, and Postnatal Depression: In the multi variate logistic regression of the EPDS score, no significant result was arrived. P values > 0.05 This finding is similar to many other findings. public hospitals in Southern India. In the present study, in the 1. In a study done in multi variate logistic Marmara Medical School regression for GHQ score, Department of Psychiatry women in nuclear families Consultation- Istanbul, were 12 times more prone Turkey - Early adverse for psychological emotional response to manifestation. P value child birth in Turkey: the <0.001. Impact of maternal It was found that the new attachment styles and mothers who live 1n family support by Kuscu extended families had MK et al 59 , it was found significantly lower that the mean EPDS score incidence of psychological of mothers who live in stress and depression than others who live in nuclear families. This is correlating with other studies. This may be due to the reason that the need for emotional and physical support after a child birth in a puerperal woman is met by the other members of the family. extended families is found to be significantly lower than others who live in nuclear families. In a study published by Dr. Nimisha Desai 60 found that absence of someone other than mother and partner in whom the woman could confide [OR 8.909, CI(l.869,42.473)] were found to be the strongest predictors for developing postpartum depression. In the present study, the However, in a study done in multi variate logistic Kaohsiung Medical regression for GHQ score University Hospital, showed that, multipara were Kaohsiung, Taiwan - The 2.2 times more prone for Psychosocial Consequences psychological stress than For Primiparas And primipara with a p-value of Multiparas, Chich-Hsiu 0.044. Multiparity may act as an attainment, as well as for additional burden for the measures of social support, postpartum woman as she family support, and friend has to cater, not only to the support. needs of the newborn but also look after her other children. The extra support and care from the family too is not as much as given to a pnm1para.

The National Family Health multi variate logistic Survey-2 from Ind ia 12 has regression for GHQ score reported that nearly 34% of showed women were 333. 8 pregnant women do not times more prone for receive even a single depression if there were not antenatal check-up and only Booked and Immunised (did 35% of deliveries are not undergo regular antenatal conducted 1n health check up). P value <0.001 facilities. In some states up This might be because of the to 65% mothers did not get confidence that everything even one antenatal check-up. will be safe due to the fact Both antenatal and postnatal that they are going to check-ups were reported to Regular Antenatal Checkups be less among low-income and also may be due to the women and those who had mental preparation through low literacy levels, both of counselling they get through which have been identified the course of the same.

Conclusion

The literature has rich evidence of having association between post partum period and psychological disturbances, very often, depressive stage. Our present study also throws more light to this fact. It is found 1n our study that psychological manifestations are a fairly common and sizeable problem as significant numbers of puerperal women were suffering from psychological manifestations. Diagnosing any psychological manifestations, as early as 3 to 5 days post-partum enables prompt and timely support and counselling to these needy women. The family can be counselled to give support so that the woman can adjust better and sooner to the new phase in her life. This support will improve the patients' attitude, the mother­ child bond along with interpersonal relations within the family especially the partner as well as long term mental health. Referral to a specialist should be considered, if essential.

Acknowledgements

The encouragement and support from Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India is gratefully acknowledged for providing the laboratory facilities to carry out the research work.

Declaration Of Conflict Of Interest

The authors declare no conflict of interest.

Funding

No funding sources.

The study was approved by the Institutional Ethics Committee.

References

Author Info

Satya Deepti Surala and K. Saraswathi*

Department of Obstetrics and Gynaecology, Affiliated to Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
 

Citation: Satya Deepti Surala, K. Saraswathi Psychological Manifestations in Puerperal Women, J Res Med Dent Sci, 2021, 9(9):1-14

Received: 01-Dec-2021 Accepted: 15-Dec-2021 Published: 22-Dec-2021

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