skip to main content

Preconception PP Planning — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePerinatal PsychiatryPreconception PP PlanningMRCPsych Paper B

A 32-year-old woman experienced severe postpartum psychosis after her first delivery and required admission to a mother and baby unit. She made a full recovery and has remained well on maintenance psychotropic medication. She and her partner now wish to try for another pregnancy. Which is the most appropriate preconception advice?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Explain that recurrence is about 50% and arrange specialist preconception review and a written perinatal care plan

A previous episode of postpartum psychosis confers a high recurrence risk following another birth, commonly estimated at approximately 50%. NICE recommends preconception counselling through secondary mental health services, preferably a specialist perinatal service, for anyone with previous severe mental illness. Review should cover individual relapse risk, the risks and benefits of continuing, changing or stopping medication, and prevention during pregnancy and particularly after delivery. A collaborative written plan should cover pregnancy, birth, early warning signs, postpartum prophylaxis, monitoring and emergency contacts. Routine care alone is inadequate, but pregnancy is not contraindicated. Psychotropics should not be stopped abruptly or indiscriminately because this may precipitate relapse. Valproate is not an appropriate preconception switch because of its substantial teratogenic and adverse neurodevelopmental risks.

Reference: Royal College of Psychiatrists. Postpartum psychosis: sections on preconception planning and recurrence risk. Current webpage checked 2026. https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/postpartum-psychosis