Postpartum psychosis: Management rarely with extreme doses of drugs

Abstract

A 26-year-old, 155 cm height, 72 kg primigravid female was admitted for safe confinement on December 3, 2015. She was posted for emergency lower segment cesarean section under regional anesthesia for the indication, cephalopelvic disproportion nonprogression of labor. The patient and her husband had given their consent for surgery owing to the patients' fear that she may pass out if she wept start due to pain during induced labor. Spinal anesthesia was performed at L3L4space using 27-gauge needle and 0.5% heavy bupivacaine 1.9 ml along with buprenorphine 0.1 ml. The patient was very stable hemodynamically throughout the surgical procedure which lasted for 50 min and gave birth to male baby weighing 3.2 kg. The immediate postoperative period was uneventful with stable vital signs except the patient was under deep sleep. Three hours after shifting, the patient had vomiting and three more hours later, she neither recalled having given birth nor did she recognize her baby. She exhibited violent psychiatric behavioral movements at the intervals of 3 h thereafter. Hence, the diagnosis of postpartum psychosis was suspected and managed meticulously. The patient was discharged on 7th postoperative day.