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The Primary Care Companion For CNS... Jan 2023Psychosis is a psychiatric emergency that affects up to 1 in 500 women postpartum and can result from various etiologies. We present a case vignette and review of the...
Psychosis is a psychiatric emergency that affects up to 1 in 500 women postpartum and can result from various etiologies. We present a case vignette and review of the relevant literature to highlight the broad differential diagnosis of postpartum psychosis with atypical features. Recommendations for evaluation, diagnosis, and treatment of patients with complex neuropsychiatric symptoms in the postpartum period are discussed. This case of postpartum psychosis with malignant catatonia highlights the role of immunology in the development and treatment of postpartum psychosis and the need for future research to more accurately define the etiology and best tailor treatment.
Topics: Humans; Female; Puerperal Disorders; Psychotic Disorders; Postpartum Period; Catatonia; Diagnosis, Differential
PubMed: 36638535
DOI: 10.4088/PCC.22nr03269 -
Journal de Gynecologie, Obstetrique Et... May 2008Postpartum endocrine syndromes occur in the year after delivery. They are due to immunologic and vascular modifications during pregnancy. The Sheehan syndrome is the... (Review)
Review
Postpartum endocrine syndromes occur in the year after delivery. They are due to immunologic and vascular modifications during pregnancy. The Sheehan syndrome is the first described postpartum endocrine syndrome and consists on a hypophyse necrosis in relation with a hypovolemic shock during delivery. The immunologic consequences of the pregnancy are the most frequent, sometimes discrete and transitory. The physiological evolution of the endocrine glands during pregnancy and the most frequent post-partum endocrine syndromes are discussed: postpartum lymphocytic hypophysitis, thyroiditis and Sheehan' syndrome.
Topics: Endocrine Glands; Endocrine System Diseases; Female; Humans; Pregnancy; Puerperal Disorders; Syndrome
PubMed: 18314279
DOI: 10.1016/j.jgyn.2008.01.004 -
Archives of Women's Mental Health Feb 2017Despite perinatal depression (PND) being a common mental disorder affecting pregnant women and new mothers, limited attention has been paid to the heterogeneous nature... (Review)
Review
Despite perinatal depression (PND) being a common mental disorder affecting pregnant women and new mothers, limited attention has been paid to the heterogeneous nature of this disorder. We examined heterogeneity in PND symptom profiles and symptom trajectories. Literature searches revealed 247 studies, 23 of which were included in the final review. The most common statistical approaches used to explore symptom and trajectory heterogeneity were latent class model and growth mixture model. All but one study examined PND symptom trajectories and provided collective evidence of at least three heterogeneous patterns: low, medium, or chronic-high symptom levels. Social and psychological risk factors were the most common group of predictors related to a higher burden (high sum of score) of depressive symptoms. These studies were consistent in reporting poorer health outcomes for children of mothers assigned to high burden symptom trajectories. Only one study explored heterogeneity in symptom profile and was the only one to describe the specific constellations of depressive symptoms related to the PND heterogeneous patterns identified. Therefore, there is limited evidence on the specific symptoms and symptom configurations that make up PND heterogeneity. We suggest directions for future research to further clarify the PND heterogeneity and its related mechanisms.
Topics: Adult; Depression; Female; Humans; Mothers; Pregnancy; Pregnancy Complications; Puerperal Disorders
PubMed: 27796597
DOI: 10.1007/s00737-016-0691-8 -
Acta Medica Portuguesa 2009In the post-partum period the immune alterations are associated with the multiple autoimmune diseases relapse. After birth, immune-tolerance variation slowly disappear,... (Review)
Review
In the post-partum period the immune alterations are associated with the multiple autoimmune diseases relapse. After birth, immune-tolerance variation slowly disappear, and is observed a return to a normal state - after an exacerbation period - of autoimmune reactivity, during which a great increase in T cells and autoantibodies is observed. In this period - 3 to 9 months after birth - the thyroid autoimmune disease relapses or reappears. The reactivation of the immune system in the post-partum period unchains an acute phase of celular destruction which characterizes the post-partum thyroiditis.
Topics: Female; Humans; Puerperal Disorders; Thyroiditis
PubMed: 19944044
DOI: No ID Found -
Heart (British Cardiac Society) Mar 2019Peripartum cardiomyopathy (PPCM) is a rare form of pregnancy-associated heart failure and is considered to be a diagnosis of exclusion. There are many hypotheses on the... (Review)
Review
Peripartum cardiomyopathy (PPCM) is a rare form of pregnancy-associated heart failure and is considered to be a diagnosis of exclusion. There are many hypotheses on the aetiology of PPCM; however, the exact pathophysiological mechanism remains unknown. It shows many resemblances to other conditions, such as familial dilated cardiomyopathy or myocarditis, and therefore it can be hard to make a definite diagnosis. We describe four cases of peripartum-onset heart failure in women who were suspected of having PPCM. We discuss the differential diagnosis, pathophysiological mechanisms and various diagnostic modalities.
Topics: Adult; Cardiomyopathies; Diagnosis, Differential; Female; Heart Failure; Humans; Peripartum Period; Predictive Value of Tests; Pregnancy; Prognosis; Puerperal Disorders; Risk Factors
PubMed: 31693481
DOI: 10.1136/heartjnl-2018-314252 -
Journal of Pregnancy 2012Hypertension is the most common medical disorder encountered during pregnancy. Hypertensive disorders are one of the major causes of pregnancy-related maternal deaths in... (Review)
Review
Hypertension is the most common medical disorder encountered during pregnancy. Hypertensive disorders are one of the major causes of pregnancy-related maternal deaths in the United States. We will present a comprehensive update of the literature pertinent to hypertension in pregnancy. The paper begins by defining and classifying hypertensive disorders in pregnancy. The normal vascular and renal physiological changes which occur during pregnancy are detailed. We will summarize the intriguing aspects of pathophysiology of preeclampsia, emphasizing on recent advances in this field. The existing diagnostic tools and the tests which have been proposed for screening preeclampsia are comprehensively described. We also highlight the short- and long-term implications of preeclampsia. Finally, we review the current management guidelines, goals of treatment and describe the potential risks and benefits associated with various antihypertensive drug classes. Preeclampsia still remains an enigma, and the present management focuses on monitoring and treatment of its manifestations. We are hopeful that this in depth critique will stimulate the blossoming research in the field and assist practitioners to identify women at risk and more effectively treat affected individuals.
Topics: Antihypertensive Agents; Biomarkers; Breast Feeding; Female; Humans; Hypertension, Pregnancy-Induced; Pregnancy; Puerperal Disorders; Relaxin; Renin-Angiotensin System
PubMed: 22685661
DOI: 10.1155/2012/105918 -
Frontiers in Bioscience (Landmark... Mar 2020Women may present with psychiatric disorders during pregnancy, normal labor, following delivery by caesarean section, or in the postpartum period. The accumulating... (Review)
Review
Women may present with psychiatric disorders during pregnancy, normal labor, following delivery by caesarean section, or in the postpartum period. The accumulating evidence suggests that these disorders may be due to changes in immune responses. During pregnancy complications such as the prolongation of cervical ripening or descent, placental abruption, premature labor, and preeclampsia increase the risk of postpartum psychiatric disorders. Women may exhibit depression and postpartum psychosis following either normal birth or caesarean section. Since psychiatric disorders like schizophrenia, major depression, and bipolar disorder are associated with both alterations in the immune response and changes in immune cell subpopulations, in this study we have chosen to examine whether the psychiatric disorders in women during labor or postpartum also lead to aberrant immune responses.
Topics: Adult; Female; Humans; Immunity; Mental Disorders; Obstetric Labor Complications; Postpartum Period; Pregnancy; Pregnancy Complications; Puerperal Disorders
PubMed: 32114440
DOI: 10.2741/4863 -
BMJ (Clinical Research Ed.) May 2002
Topics: Delivery, Obstetric; Female; Humans; Pregnancy; Puerperal Disorders; Urinary Incontinence
PubMed: 12028960
DOI: 10.1136/bmj.324.7348.1227 -
Animal : An International Journal of... May 2014Up to half of dairy cows are affected by at least one of metritis, purulent vaginal discharge, endometritis or cervicitis in the postpartum period. These conditions... (Review)
Review
Up to half of dairy cows are affected by at least one of metritis, purulent vaginal discharge, endometritis or cervicitis in the postpartum period. These conditions result from inadequate immune response to bacterial infection (failure to clear pathogenic bacteria from the uterus) or persistent inflammation that impairs rather than enhances reproductive function. The degree of mobilization of fat and how effectively it is used as a metabolic fuel is well recognized as a risk factor for metabolic and infectious disease. Release of non-esterified fatty acids has direct effects on liver and immune function but also produces pro-inflammatory cytokines (tumor necrosis factor α and interleukin-6), which contribute to systemic inflammation and to insulin resistance. Therefore, reproductive tract inflammatory disease may be a function of both local and systemic inflammatory stimuli and regulation as well as regulation of fat metabolism. Better understanding of variables associated with insulin resistance and inflammatory regulation in the liver and adipose tissue may lead to improvement of reproductive tract health. This paper reviews factors that may contribute to postpartum reproductive tract inflammatory diseases in dairy cows and their inter-relationships, impacts and treatment.
Topics: Animal Husbandry; Animals; Bacterial Infections; Cattle; Cattle Diseases; Dairying; Endometritis; Female; Postpartum Period; Puerperal Disorders
PubMed: 24679404
DOI: 10.1017/S1751731114000524 -
Acta Medica Portuguesa 2007The Peripartum Cardiomyopathy is a rare form of heart disease, of uncertain etiology, more common in black and multiparous women, older than thirty years old. Is defined...
The Peripartum Cardiomyopathy is a rare form of heart disease, of uncertain etiology, more common in black and multiparous women, older than thirty years old. Is defined as development of maternal congestive heart failure, in the last month of pregnancy or within five months after delivery, with documented left ventricular systolic dysfunction, in the absence of a demonstrable cause for heart failure in a previously healthy woman. The diagnosis is commonly established with chest radiography, electrocardiogram and echocardiography. Treatment consist in medical therapy with inotropic support, afterload and preload redution, and anticoagulation. Surgical care with cardiac transplantation is indicated in severe cases with progressive left ventricular dysfunction, despite medical therapy. Prognosis seems dependent on recovery of left ventricular function and maternal mortality rates could reach 50%. Future pregnancy is not recommended in woman with persistent ventricular dysfunction. The authors present a case report in a black nuliparous woman at term, with 33 years old, without previous heart disease that presents a sudden heart failure, with ventricular dysfunction on echocardiography, after the caesarean, with recovery of normal ventricular function at 11th day of puerperium.
Topics: Adult; Female; Heart Failure; Humans; Puerperal Disorders; Ventricular Dysfunction
PubMed: 18282442
DOI: No ID Found