58: Postpartum Mood Disorders - Part 2

  1. American Psychiatric Association. (2013). In Diagnostic and statistical manual of mental disorders (5th ed.). doi:10.1176/appi.books.9780890425596.744053

  2. Tate G. 1830. “A Treatise on Hysteria.” London: S. Highley, 174 Fleet St & Webb St, Maze Pond, Borough.

  3. Smith TN. 1830. “Observations on hysteria.” The Boston Medical and Surgical Journal. 3(34): 540.

  4. Louden, I. 1988. Puerperal insanity in the 19thCentury. Journal of the Royal Society of Medicine. 81, p 76-79.

  5. Griffen W, Griffen D. 1829. Observations on Functional Disorders of the Spinal Cord, and Their Connexion with Hysterical, Nervous, and Other Diseases. Illustrated by Cases, Selected Chiefly from the Reports of the Pallas, Kenry, and Currah Dispensaries. London Medical and Physical Journal. 7(42) 477-489.

  6. Reid, J. 1848. Dr. Reid on Puerperal Insanity. Journal of Psychological and Medical Mental Pathology. 1(1): 128-151.

  7. Clark AC. 1887. Aetiology, Pathology, and Treatment of Puerperal Insanity. Journal of Mental Science. 33(142): 169-189.

  8. Donkin, AS. 1863. The Pathological Relation between Albuminuria and Puerperal Mania. Journal of Mental Science. 9(47): 401-405.

  9. Barkin V. 1929. Protein therapy in insanity of puerperal origin. British Medical Journal. 1(3549): 67.

  10. Earle P. 1854. Bloodletting in Mental Disorders. American Journal of Insanity. 10(4): 287-405.

  11. Mackenzie FW. 1851. Puerperal Insanity: Especially in Reference to Anaemia. London Journal of Medicine. 3(30): 504-521.

  12. Gordon HL. 1897. Sir James Young Simpson and Chloroform (1811-1870). Masters of Medicine. T. Fisher Unwin, for Great Britain and Longmans Green & Co. for the United States of America.

  13. Dunn, PM. 2002. Sir James Young Simpson (1811-1870) and obstetric anesthesia. Archives of Disease in Childhood-Fetal and Neonatal edition. 86(3): F207-F209.

  14. Koppanyi T, Dille JM, Linegar CR. 1936. Studies on Barbiturates: XVII. The Effect of Prolonged Chloroform Anesthesia on the Duration of Action of Barbiturates. The Journal of Pharmacology and Experimental Therapeutics. 119-127.

  15. Waters ATH. 1857. On the use of chloroform in the treatment of puerperal insanity. American Journal of Psychiatry. 13(4): 341-353.

  16. Ramachandran CT, Subramanyam N, Baker G, et al. 2011. Antidepressants: From MAOIs to SSRIs and more. Indian Journal of Psychiatry. 53(2): 180-182.

  17. Agin HV. 1963. Phenelzine in the treatment of depression. American Journal of Psychiatry. 119(12): 1173-1174.

  18. Blacker KH, Weinstein BJ, Ellman GL. 1962. Mother’s Milk and Chlorpromazine. 119(2): 178-179.

  19. Whalley LJ, Eagles JM, Bowler GMR, et al. 1987. Selective effects of ECT on hypothalamic-pituitary activity. Psychological Medicine. 17(2): 319-328.

  20. Williams RL, Barrera SE. 1950. Observations and opinions concerning complications and contraindications in electric convulsive therapy. Psychiatric Quarterly. 24(4): 800-809.

  21. Matthew JR, Constan E. 1964. Complications following ECT over a three year period in a state institution. American Journal of Psychiatry. 120(11)-1119-1120. 

  22. Sobel DE. 1960. Fetal Damage Due to ECT, Insulin Coma, Chlorpromazine, or Reserpine. AMA Archives of General Psychiatry. 2(6): 606-611.

  23. Langan RC, Goodbred AJ. 2016. Identification and Management of Peripartum Depression.American Family Physician. 93(10): 852-858. 

  24. Information from your family doctor: Postpartum depression. 2010. American Family Physician. 82(8): 939-940.

  25. Schiller CE, Schmidt PJ, Rubinow D. 2014. Allopregnanolone as a Mediator of Affective Switching in Reproductive Mood Disorders. Psychopharmacology. 231(17): 3557-3567.

  26. Bitran D, Hilvers RJ, Kellogg CK. 1991.Anxiolytic effects of 3α-hydroxy-5α[β]-pregnan-20-one:endogenous metabolites of progesterone that are active at the GABAA receptor. Brain Research. 561:157–161.

  27. Ottander U, Poromaa IS, Bjurulf E, et al. 2005. Allopregnanolone and pregnanolone are produced by the human corpus luteum. Molecular and Cellular Endocrinology. 239(1-2): 37-44.

  28. Meltzer-Brody S, Colquhoun H. Reisenberg R, et al. 2018. Brexanolone injection in post-partum depression: two multicentre, double-blind, randomised, placebo-controlled, phase 3 trials. The Lancet. 392(10152): 1058-1070.

57: Postpartm Mood Disorders - Part 1

Medical Student Gregory Kirschen takes us through the history of postpartum depression from hippocrates to present day.


American Psychiatric Association. (2013). Cautionary statement for forensic use of DSM-5. In Diagnostic and statistical manual of mental disorders (5th ed.). doi:10.1176/appi.books.9780890425596.744053 

King, H. 1998. Hippocrates’ Woman: Reading the Female Body in Ancient Greece. London: Routledge, 1st ed. https://doi.org/10.4324/9780203025994


Adams, H. (1984). Comprehensive Handbook of Psychopathology. New York: Springer Science + Business Media. P. 319. ISBN 97814615668.


Louden, I. 1988. Puerperal insanity in the 19th Century. Journal of the Royal Society of Medicine. 81, p 76-79. 


Reid, J. 1848. Dr. Reid on Puerperal Insanity. Journal ofPsychological and Medical Mental Pathology. 1(1): 128-151.


Meltzer HY, Stahl SM. 1976. The dopamine hypothesis of schizophrenia: a review. Schizophrenia Bulletin. 2(1): 19-76.


Hirschfeld, R. 2000. History and evolution of the monoamine hypothesis of depression. The Journal of Clinical Psychiatry. 61(Suppl6), 4-6. 


Winn, JM. 1855. On the Treatment of Puerperal Mania. Journal of Psychological and Medical Mental Pathology.. 8(30): 309-313.


MacLeod, MD. 1886. An address on puerperal insanity. British Medical Journal. 2(1336): 239-242.


Theriot, N. 1989. Diagnosing Unnatrual Motherhood: Nineteenth-century Physicians and ‘Puerperal Insanity.’ American Studies. 30(2): 69-88.


Henry, WO. 1907. To what extent can the gynecologist prevent and cure insanity in women? JAMA. XLVIII(12): 997-1002. 


Boyd, R. 1870. Observations on puerperal insanity. Journal of Mental Science. 16(74): 153-165.


Clark, AC. 1887. Aetiology, Pathology, and Treatment of Puerperal Insanity. Journal of Mental Science. 33(142): 169-189. 


Dunn, PM. 2002. Sir James Young Simpson (1811-1870) and obstetric anesthesia. Archies of Disease in Childhood-Fetal and Neonatal edition. 86(3): F207-F209.


Tuke, JB. 1867. Cases illustrataive of insanity of pregnancy, puerperal mania, and insanity of lactation. Edinburgh Medical Journal. 12(12): 1083-1101.


Donkin, AS. 1863. The Pathological Relation between Albuminuria and Puerperal Mania. Journal of Mental Science. 9(47): 401-405.


Miller GE, Cohen S, Ritchey AK. 2002. Chronic psychological stress and the regulation of pro-inflammatory cytokines: a glucocorticoid-resistance model. Health Psychology. 21(6): 531-541.


Cassidy-Bushrow AE, Peters RM, Johnson DA, et al. 2012. Association between depressive symptoms with inflammatory biomarkers among pregnant African-American women. Journal of Reproductive Immunology. 94(2): 202-209.


O’Mahony SM, Myint AM, van der Hove D, et al. 2006. Gestational stress leads to depressive-like behavioural and immunological changes in the rat. Neuroimmunomodulation. 13: 82-88.


Bamford, CB. 1934. An analytical review of a series of cases of insanity with pregnancy. Journal of Mental Science. 80(328): 58-63.


Ballantyne, JW. 1892. A series of thirteen cases of alleged maternal impression. Edinburgh Medical Journal. 37(11): 1025-1034. 


Fisher GJ. 1870. Does Maternal Mental Influence Have any Constructive or Destructive Power in the Production of Malformations or Monstrosities at any Stage of Embryonic Development? American Journal of Insanity. XXVI(III): 241-295.


Pohlman AG. 1911. Maternal impression. Proceedings of the Indiana Academy of Science. 65-70.


Kundakovic M, Gudsnuk K, Herbstman JB, et al. 2015. DNA methylation of BNDF as a biomarker of early-life adversity.PNAS. 112(22): 6807-6813.


Boersma GJ., Lee RS, Cordner ZA, et al. 2014. Prenatal stress decreases Bdnf expression and increases methylation of Bdnf exon IV in rats. Epigenetics. 9(3): 437-447.


Zajicek-Farber ML. 2009. Postnatal depression and infant health practices among high-risk women. Journal of Child and Family Studies. 18:236.


Ban L, Gibson JE, West J, et al. 2010. Association between perinatal depression in mothers and the risk of childhood infections in offspring: a population-based cohort study. BMC Public Health. 10:799. 


Ertel KA, Koenen KC, Rich-Edwards JW, et al. 2010. Antenatal and postpartum depressive symptoms are differentially associated with early childhood weight and adiposity. Paediatric and Perinatal Epidemiology. 24: 179-189.


Beck CT. 1998. The effects of postpartum depression on child development: A meta-analysis. Archives of Psychiatric Nursing. 12(1): 12-20. 


Tuovinen S, Lahti-Pulkkinen M, Girchenko P, et al. 2018. Maternal depressive symptoms during and after pregnancy and child developmental milestones. Depression and Anxiety. 35(8): 732-741.


Foundeur M, Fixsen C, Tribel WA, et al. 1957. Postpartum Mental Illness: A Controlled Study. AMA Archives of Neurology and Psychiatry. 77(5): 503-512.  

56: Elective Cesarean Delivery

Dr. Bergoy walks us through the risks and benefits of elective cesarean delivery.

neonatal and maternal mortality

55: Post-Delivery IUDs

Dr. Gina Milone takes us through the pros and cons of post-delivery IUD placement.



  1. Blumenthal, P. D., et al. (2018). "Comparative safety and efficacy of a dedicated postpartum IUD inserter versus forceps for immediate postpartum IUD insertion: a randomized trial." Contraception98(3): 215-219. 

  2. Center for Disease Control, U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC), 2016.

  3. Eser, A., et al. (2018). "Clinical experience with a novel anchored, frameless copper-releasing contraceptive device for intra-caesarean insertion." Eur J Contracept Reprod Health Care23(4): 255-259.

  4. Immediate postpartum long-acting reversible contraception. Committee Opinion No. 670. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;128:e32-7.

  5. Jatlaoui, T. C., et al. (2018). "Intrauterine Device Expulsion After Postpartum Placement: A Systematic Review and Meta-analysis." Obstet Gynecol132(4): 895-905.

  6. Kapp, N. and K. M. Curtis (2009). "Intrauterine device insertion during the postpartum period: a systematic review." Contraception80(4): 327-336.

  7. Long-acting reversible contraception: implants and intrauterine devices. Practice Bulletin No 186. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e251-69.

  8. Optimizing postpartum care. ACOG Committee Opinion No. 736. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e140-50.

  9. Singh, S., et al. (2016). "A Dedicated Postpartum Intrauterine Device Inserter: Pilot Experience and Proof of Concept." Glob Health Sci Pract4(1): 132-140.

  10. Unal, C., et al. (2018). "Comparison of expulsions following intracesarean placement of an innovative frameless copper-releasing IUD (Gyn-CS(R)) versus the TCu380A: A randomized trial." Contraception.



54: Monthly Checkup - March 2019

We follow-up last months dicsussion of termination by discussing the challenging stories of women who chose to terminate after 24 weeks and then have a great discsussion about embryo adoption.

53: Journal Club - March 2019

Dr. Lian joins me to discuss "Opioid use after laparoscopic hysterectomy:

prescriptions, patient use, and a predictive calculator" from AJOG.

51: Journal Club - February 2019

50: Why Ob/Gyn?

Join us for this special 50th episode where we get together to discuss why we do what we do.



49: Maternal Mortality - Part 1

Dr. Heather Link starts a new series on Maternal Mortality by discussing what that even means and how we get those numbers.




Maternal mortality is a key indicator of a health system’s strength. Safe Motherhood Week.https://www.safemotherhoodweek.org/maternal-mortality-key-indicator-health-systems-strength/.Published October 30, 2017. Accessed July 19, 2018.

  1. Organization WH, Others. WHO guidance for measuring maternal mortality from a census. 2013.http://apps.who.int/iris/handle/10665/87982.

  2. Knight M, Kenyon S, Brocklehurst P, et al. Saving Lives, Improving Mothers’ Care Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-2012. 2014.http://discovery.ucl.ac.uk/1464330/.

  3. Humphrey MD, Bonello MR, Chughtai A, Macaldowie A, Harris K & Chambers GM.Maternal Deaths in Australia 2008–2012. Maternal Deaths Series No. 5. Canberra: AIHW.; 2015.http://apo.org.au/system/files/55131/apo-nid55131-20636.pdf.

  4. Pregnancy Mortality Surveillance System | Maternal and Infant Health | CDC.https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm.Published August 7, 2018. Accessed August 27, 2018.

  5. New York State Maternal Mortality Review Report.https://www.health.ny.gov/community/adults/women/docs/maternal_mortality_review_2012-2013.pdf.

  6. Maternal mortality ratio (MMR) — MEASURE Evaluation.https://www.measureevaluation.org/prh/rh_indicators/womens-health/sm/maternal-mortality-ratio-mmr.Published November 23, 2010. Accessed October 8, 2018.

  7. Division of Reproductive Health, Family and Reproductive Health.The Sisterhood Method for Estimating Maternal Mortality. World Health Organization ; 1997.http://apps.who.int/iris/bitstream/handle/10665/64007/WHO_RHT_97.28.pdf;jsessionid=ACC253E82A5392CD768522ABE2716AA7?sequence=1.

  8. Wilmoth JR, Mizoguchi N, Oestergaard MZ, et al. A New Method for Deriving Global Estimates of Maternal Mortality.Stat Politics Policy. 2012;3(2).https://www.ncbi.nlm.nih.gov/pubmed/24416714.

  9. Maternal mortality - UNICEF DATA. UNICEF DATA.https://data.unicef.org/topic/maternal-health/maternal-mortality/.Accessed October 30, 2018.

  10. WHO, Department of Reproductive Health and Research.Trends in Maternal Mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. World Health Organization ; 2014.http://apps.who.int/iris/bitstream/handle/10665/112697/WHO_RHR_14.13_eng.pdf;jsessionid=435F8C2D8482EF587423E845839727BC?sequence=1.

  11. Thaddeus S, Maine D. Too far to walk: maternal mortality in context.Soc Sci Med. 1994;38(8):1091-1110.

  12. Montagu D, Yamey G, Visconti A, Harding A, Yoong J. Where do poor women in developing countries give birth? A multi-country analysis of demographic and health survey data.PLoS One. 2011;6(2):e17155.

  13. Somé DT, Sombié I, Meda N. How decision for seeking maternal care is made--a qualitative study in two rural medical districts of Burkina Faso.Reprod Health. 2013;10:8.

  14. Scott S, Chowdhury ME, Pambudi ES, Qomariyah SN, Ronsmans C. Maternal mortality, birth with a health professional and distance to obstetric care in Indonesia and Bangladesh.Trop Med Int Health. 2013;18(10):1193-1201.

  15. Hanson C, Cox J, Mbaruku G, et al. Maternal mortality and distance to facility-based obstetric care in rural southern Tanzania: a secondary analysis of cross-sectional census data in 226 000 households.Lancet Glob Health. 2015;3(7):e387-e395.

  16. Lori JR, Starke AE. A critical analysis of maternal morbidity and mortality in Liberia, West Africa.Midwifery. 2012;28(1):67-72.

  17. Gwilliam F, Archondo-Callao B-G, Nogales S. Roads in Sub-Saharan Africa.Africa Infrastructure Country Diagnostic AICD. 2008.http://documents.worldbank.org/curated/en/938171468194345853/pdf/551050WP0p109210Box349439B01PUBLIC1.pdf.

  18. Amdd WUU.Monitoring Emergency Obstetric Care: A Handbook. World Health Organization; 2009.http://apps.who.int/iris/bitstream/handle/10665/44121/9789241547734_eng.pdf;jsessionid=8894BA499197FB974E66D8624AFCDFEF?sequence=1.

  19. UNICEF, Ministry of Health -Puntland.EmONC Needs Assessment in Selected Health Facilities in NEZ, Puntland- September 2011. UNICEF European Commission; 2011.https://www.unicef.org/somalia/EmONC_needs_Assessment_Report_-_Puntland_Oct._2011.pdf.

  20. Mony PK, Krishnamurthy J, Thomas A, et al. Availability and distribution of emergency obstetric care services in Karnataka State, South India: access and equity considerations.PLoS One. 2013;8(5):e64126.

  21. Rosindale L. Rural Maternal Mortality.Am J Nurs. 2018;118(12):10.

  22. Alkema L, Chou D, Hogan D, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group.Lancet. 2016;387(10017):462-474.

  23. Sustainable Development Goals | UNDP. UNDP.http://www.undp.org/content/undp/en/home/sustainable-development-goals.html.Accessed December 1, 2018.

  24. WHO | Projections of mortality and causes of death, <br>2016 to 2060. November 2018.https://www.who.int/healthinfo/global_burden_disease/projections/en/.Accessed December 1, 2018.

46: Esomeprazole and Preeclampsia w/ Dr. Cluver

I speak with Dr. Cathy Cluver about her article in the October issue of American Journal of Obstetrics and Gynecology.




45: Intrahepatic Cholestasis of Pregnancy

Dr. Sara Kim discusses the etiology, diagnosis, and management of intrahepatic cholestasis of pregnancy.





  1. Fast, B., & Roulston, T. (1963). Idiopathic jaundice of pregnancy. Am J Obstetrics and Gynecology, 314-320.

  2. Geenes, V., & Williamson, C. (2009). Intrahepatic cholestasis of pregnancy. World Journal of Gastroenterology, 2049-2066.

  3. Gynecologists, R. C. (2011). Obstetric Cholestasis.

  4. Jurate, K., Rimantas, Z., Jolanta, S., Vladas, G., & Limas, K. (2017). Sensitivity and specificity of biochemical tests for diagnosis of intrahepatic cholestasis of pregnancy. Annals of Hepatology, 569-573.

  5. Kenyon, A., Piercy, C. N., Girling, J., Williamson, C., RM, T., & Shennan, A. (2002). Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG: an International Journal of Obstetrics and Gynecology, 282-288

  6. Lammert, F., Marschall, H.-U., Glantz, A., & Matern, S. (2000). Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. Journal of Hepatology, 1012-1021.

  7. Lindor, K., & Lee, R. (2018). Intrahepatic cholestasis of pregnancy. Retrieved from UptoDate: https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy?search=cholestasis%20of%20pregnancy&source=search_result&selectedTitle=1~59&usage_type=default&display_rank=1

  8. Pusl, T., & Beuers, U. (2007). Intrahepatic cholestasis of pregnancy. Orphanet Journal of Rare Diseases.