Ergotism: A possible etiology for puerperal psychosis

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Citations from the Literature

nature and varied presentation of this condition. Mortality or neurological morbidity may occur more frequently during pregnancy, but in general correlate closely with delay in diagnosis and initiation of appropriate therapy. Treatment often needs to be started empirically, and neuiosurgical intervention may prove life saving.

PERINATOLOGY Ergottsm: A possible etiology for puerperal psychosis Iffy L: Lindenthal JJ; McArdle JJ; McNamara RE; Szodi Z; Ganesh V Department of Obstetrics and Gynecology, University Hospital. Newark, NJO7IO3; USA Obstetrics and Gynecology/7313 II (475-477)/1989/ Some reports in the medical literature have mentioned the occurrence of psychotic reactions in response to the use of certain ergot alkaloids in therapeutic doses. Prompted by these observations, we undertook a search for cases of ‘pure’ puerperal psychosis (ie, typical manifestations 3-14 days postpartum) in order to evaluate the clinical background of this phenomenon. Special attention was paid to the medications that the patients had received peripartum. In the last 10 years, out of eight perinatai centers, we found only three cases that fuifiiied the criteria of the quoted entity. In all instances, the manifestations of puerperal psychosis had been preceeded by the administration of ergot derivatives. Based on the presented data, we hypothesize that typical postpartum psychosis may represent an idiosyncratic reaction to potent vasoactive drugs including ergot derivatives. The similarities between the clinical manifestations of ergotism and puerperal psychosis, and some of the epidemiologic features of the latter condition, appear to implicate ergot alkaloids as potential causative agents. Although the validity of the suggested interpretation requires further evaluation, we believe that the currently available data warrant caution with regard to the administration of ergot derivatives postpartum. These drugs should not be used in the absence of clear indication or in unnecessarily high doses. We suggest that ergotism be included in the differential diagnosis in cases of pure puerperai psychosis. A new funipuncture technique: Two-needle ultrasound- and needle biopsy-guided procedure Boviceiii L; Orsini LF; Grannum PAT; Pittaiis MC; Toffoli C; Dolcini B Prenatal Pathophysiology Unit, Department of Obstetrics and Gynecology, Bologna University School of Medicine, Bologna; Italy Obstetrics and Gynecoiogy/73/3 I (428-431)/1989/ A new technique is presented for funipuncture under uitrasound guidance using a biopsy guide and a 20/25-gauge needle combination. The 20-gauge needle was used for uterine entry and the 25-gauge needle for the actual cord puncture. The method was used for sampling fetal blood in 262 pregnancies with 264 fetuses (two sets of twins) between 17-39 weeks, at Int J Gynecol Obstet 30

risk for beta-thalassemia, chromosomal disorders, TORCH infection, fetal hypoxia, and Rh-isoimmunization. Pure blood was aspirated from 241 fetuses (91.3s70), including the twins. The procedure lasted less than 5 minutes in 76.5% of the cases and less than 10 minutes in 90.1% of the cases. Intra-aminiotic bleeding was seen in only 23.1% of the cases, and fetal bradycardia was not noted. Forty-four pregnancies were terminated after the diagnosis of genetic or infectious disease. Seven fetuses at risk for Rh-isoimmunization found to be Rhpositive and anemic, were transfused immediately after blood sampling using the same needle. Of the 220 continuing pregnancies, there were 14 fetal losses (three before 28 weeks and 11 after 28 weeks or during the perinatal period). A probable etiology for the loss was found in 11 cases. These included one severely Rh-isoimmunized hydropic fetus who died in utero after transfusion at 26 weeks, one fetus who died in utero at 31 weeks following a car accident, and nine malformed newborns. The corrected rate for fetal losses probably related to the procedure was thus 0.9% before 28 weeks and 0.8% after 28 weeks. This new funipuncture technique seems to have several advantages over the freehand and/or biopsy-guided singieneedle techniques. The prevalence and distribution of acute placental ioflammation in uncomplicated term pregnancies Salafia CM; Weigi C, Siiberman L Department of Laboratory Medicine, Danbury Hospital, Danbury, CT 06810; USA Obstetrics and Gynecoiogy/73/3 I (383-389)/1989/ The clinical relevance of histologic evidence of acute ascending intrauterine infection has been called into question by descriptions of ‘silent’ choriomnionitis. The described frequencies of silent chorioamnionitis in normal and abnormal pregnancies vary widely because of differences in the definition of a normal pregnancy, methods of placental examination, and pathologic criteria. Therefore, we examined placentas from 161 uncomplicated gestations for the presence and severity of acute inflammation in the amnion, chorion-decidua, chorionic plate, and umbilical cord using strict gross and microscopic protocols. Indicators of amniotic fluid infection, specifically umbilical cord inflammation, amnionitis, and inflammation within the chorionic plate were present in 0, 1.2, and 4% of the cases, respectively. Silent chorioamnionitis was rare. There was a statistical association between the presence of acute inflammation and the occurrence of labor at term. Methods of tissue sampling that included a more extensive examination of the site of membrane rupture resulted in an increased frequency of diagnosis of acute inflammation at the site of rupture in vaginal deliveries at term. A combined historic and sonograpbic score for the detection of intrauterine growth retardation Hill LM; Guzick D; Beifar HL; Peterson C; Rive110D; Hixsom J Department of Ultrasound, University of Pittsburgh Health System, Pittsburgh, PA; USA Obstetrics and Gynecoiogy/73/2 (291-296)/1989/ Sonographic analysis of fetal biometry has been useful in