Obsgynaecritcare

Case History (*hypothetical patient) A 33yr old woman presents to a GP complaining of hair loss, cold intolerance, dizziness, extreme fatigue and weight gain. On further questioning the patient states this is her third attempt to seek help over a number of years. She initially sought help for amenorrhoea after her second delivery and was started on oestrogen / progesterone tablets. The second doctor gave her a diagnosis of postpartum depression after eliciting a history of anxiety, tachycardia and feelings of stress and started her on an antidepressant. However the medication didn't help and she tapered them off and didn't return. On close questioning she recounts that her first delivery was uncomplicated but the second was an emergency caesarean after failure to progress and fetal distress. The surgery was complicated by blood loss of 4 litres and she remembers being told by staff "that the blood was coming out as fast as it was going in". She spent a number of days in the HDU / ICU and her child was b