- Email: [email protected]
Spontaneous pneumomediastinum presenting as jaw pain during labor
4. Schneider J, Blea C, Hendricks SK. Increased familial incidence of multiple sclerosis: Genetics and epidemiology in pregnancy. Am J Obstet Gynecol 1996;174:445. 5. Rudick RA. Multiple sclerosis and related conditions. In: Bennett JC, Plum F, eds. Cecil textbook of medicine. 20th ed. Philadelphia: Saunders, 1995–1996:2106 –12. 6. Matera L. Endocrine, paracrine and autocrine actions of prolactin on immune cells. Life Science 1996;59:599. 7. Yen S, Jaffe R, Barbieri R. Reproductive endocrinology. 4th ed. Philadelphia: Saunders, 1999:267.
8. Yamasaki K. Hyperprolactinemia in optico-spinal multiple sclerosis. Intern Med 2000;39:272. 9. Erkkila H, Raitta C, Livanainen M, Taskinen E, Unnerus H, Gummerus M. Optic neuritis during lactation. Graefe’s Arch Clin Exp Ophthalmol 1985;222:134 – 8. 10. Walsh FB, Hoyt WF, eds. Clinical neuro-ophtholmology. 3d ed. Baltimore: Williams & Wilkins, 1969:625– 6.
Spontaneous Pneumomediastinum Presenting as Jaw Pain During Labor
developed jaw pain during labor and was found to have a pneumomediastinum.
Janice C. Raley, MD, and Janet I. Andrews, MD Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa
BACKGROUND: Pneumomediastinum, or presence of free air within the mediastinum, is a rare complication of labor. Common symptoms of this condition include chest pain, dyspnea, and subcutaneous emphysema. CASE: A woman complained of right jaw pain 90 minutes after the onset of her second stage of labor. On examination, she was found to have swelling and crepitus over her face, neck, and supraclavicular region. A chest radiograph demonstrated a pneumomediastinum, which resolved spontaneously. CONCLUSION: Pneumomediastinum is associated with Valsalva maneuvers such as those seen during the second stage of labor. We report jaw pain as an unusual presenting symptom of this rare condition. Familiarity with the presenting symptoms of a pneumomediastinum is imperative for appropriate treatment and monitoring for significant complications. (Obstet Gynecol 2001;98:904 – 6. © 2001 by the American College of Obstetricians and Gynecologists.)
Pneumomediastinum, or Hamman’s syndrome, is the presence of air or gas within the mediastinum. It can be caused by sustained Valsalva maneuvers such as coughing, vomiting, forceful defecation, and strenuous exercise. A Valsalva maneuver is commonly used during the second stage of labor. We present a healthy woman who Address reprint requests to: Janet I. Andrews, MD, Department of Obstetrics and Gynecology, University of Iowa College of Medicine, SW 44-14 GH, 200 Hawkins Drive, Iowa City, IA 52242; E-mail: [email protected].
904
Received February 5, 2001. Received in revised form April 20, 2001. Accepted June 21, 2001.
CASE A nulliparous white woman presented at 41 weeks’ gestation with regular contractions, and her cervix was dilated 2 cm. Her pregnancy was complicated by a viral illness at 9 weeks’ gestation and an episode of vaginal bleeding at 34 weeks. She was a nonsmoker with no drug abuse, and her medical and surgical histories were unremarkable. Her membranes were artificially ruptured, and lightly stained meconium fluid was noted. Labor was augmented with oxytocin. An epidural catheter was placed without complication. Eighteen hours after admission, her cervix was fully dilated. After pushing for 90 minutes, she began complaining of right-sided jaw pain and a cracking sensation. Examination revealed right lower facial swelling. She was able to move her jaw in all directions and bite down without difficulty. She did not exhibit any shortness of breath or chest pain. Thirty minutes later, the jaw swelling progressed throughout the right side of her face and eye, and she complained that her voice was sounding different. A 3410-g male infant was delivered by vacuum extraction 50 minutes after the onset of the jaw pain. The Apgar scores were 3 and 7 at 1 and 5 minutes, respectively. The pediatrician later found that the neonate had a small spontaneous pneumothorax. After delivery, crepitus was noted bilaterally over the mother’s face and neck. Her lungs were clear to ausculation, and she denied dyspnea. A chest radiograph showed air on the left adjacent to the aortic arch with large amounts of soft tissue air along the neck and lateral chest wall consistent with a pneumomediastinum (Figure 1). Two hours after delivery, she experienced dyspnea and pressure under her sternum with inspiratory effort. On physical exam, her cardiac rate and rhythm were regular with the presence of Hamman’s sign, a crepitant sound that is synchronous with cardiac systole. Crepitus
VOL. 98, NO. 5, PART 2, NOVEMBER 2001 © 2001 by The American College of Obstetricians and Gynecologists. Published by Elsevier Science Inc.
0029-7844/01/$20.00 PII S0029-7844(01)01514-9
Figure 1. Posteroanterior view of the chest radiograph reveals pneumomediastinum (transparent arrows) and subcutaneous emphysema (black arrows). Raley. Pneumomediastinum During Labor. Obstet Gynecol 2001.
extended to her shoulders, upper abdomen, face, and right eye. Her lungs remained clear to auscultation. She was given high-flow oxygen. A cardiothoracic surgery specialist was consulted and recommended continuing oxygen to reduce the partial pressure of the tissue nitrogen and increase the gradient for resorption. If her symptoms worsened or her oxygen saturation decreased, a chest radiograph was recommended to diagnose a pneumothorax and consider a tube thoracostomy. Although she developed an episode of worsening dyspnea postpartum, a chest radiograph demonstrated a decrease in the size of pneumomediastinum and no pneumothorax. The crepitus and facial swelling decreased over the next 2 days without worsening symptoms. She was discharged on the third postpartum day and has been without recurrence of her symptoms. The infant was also discharged on the third day of life after recovering from the spontaneous pneumothorax without the placement of a chest tube. COMMENT Pneumomediastinum is also called Hamman’s syndrome because it was first formally described by Louis Hamman in 1939.1 He characterized the syndrome by the following symptoms: 1) chest pain, 2) subcutaneous and retroperitoneal emphysema, 3) obliteration of heart sounds or cardiac dullness, 4) crepitant sound heard over the heart (Hamman’s sign), 5) evidence of increased mediastinal pressure (including dyspnea, cyanosis, engorged veins, and circulatory failure), 6) pneumothorax,
VOL. 98, NO. 5, PART 2, NOVEMBER 2001
and 7) roentgenographic evidence of air in the mediastinum.2 Hamman’s sign, which was present in our patient, is a particular sound, which consists of crackles, bubbles, or churning sounds heard with each contraction of the heart. Abolnik et al reported that in his series of 25 patients, 88% complained of chest pain, 60% complained of dyspnea, and 60% had subcutaneous emphysema.3 Many other signs and symptoms can accompany pneumomediastinum including voice change, sore throat, cough, tachycardia, dysphagia, anxiety, and facial swelling.4 However, the presence of subcutaneous emphysema or a Hamman’s sign is virtually diagnostic of pneumomediastinum.5 If symptoms are found, which are consistent with pneumomediastinum, the diagnosis is confirmed by a chest x-ray. A pneumomediastinum is suspected when multiple thin, lucent streaks are seen that outline mediastinal structures, elevate mediastinal pleura, and often extend into the neck or chest wall.6 A lateral radiograph is critically important because up to 50% of cases of pneumomediastinum will be missed on a standard posteroanterior view of the chest.5 The lateral view is more sensitive in making the diagnosis. The pathophysiology of a pneumomediastinum was initially described by Macklin and Macklin in 1944.7 Using animal models, they delineated that air enters the interstitium when there is a pressure gradient set up between the alveoli and adjacent structures. Alveoli abutting other alveoli have the same pressure and therefore maintain structure. However, when alveoli abut vascular sheaths, overinflation of alveoli without corresponding expansion of the vascular sheath permits the establishment of a pressure gradient. The alveoli then rupture, and air flows into the vascular sheath. Because of the lower mean pressure in the mediastinum compared with the lung parenchyma, air dissects along the vascular sheath into the mediastinum. Air may then enter the cervical and subcutaneous tissues. Identification of pneumomediastinum is important because potential complications can be severe. Macklin and Macklin7 reported the following serious complications: 1) pneumothorax, both tension and bilateral, 2) tension pneumomediastinum causing cardiac compression and reducing cardiac output, 3) air block consisting of increased air within the pulmonary interstitial tissue causing splinting and a decrease in the patient’s ability to exchange air, and 4) decreased vessel diameter from air compression within the vascular sheaths causing decreased blood flow to and from the heart. Patients with pneumomediastinum should be monitored for the development of these problems. To avoid such complications, shortening the second stage of labor by the use of forceps
Raley and Andrews
Pneumomediastinum During Labor
905
or vacuum extraction is recommended when a pneumomediastinum has been diagnosed.4,8 After delivery, the treatment of pneumomediastinum primarily consists of supportive measures. In two studies of spontaneous pneumomediastinum nearly a decade old, the mean length of hospital stay was 2– 6 days.3,5 However, Panacek et al recommended that, unless there are medical complications, inpatient care for spontaneous pneumomediastinum was unnecessary.5 Therefore, the development of a pneumomediastinum should not always increase postpartum hospital stay. Panacek et al also recommended follow-up with chest radiographs, but only for worsening of symptoms.5 The repeat chest radiograph is used to diagnose a pneumothorax, which may require treatment with tube thoracostomy to relieve pressure. Only three of 42 patients in the previous studies developed a pneumothorax, and only one required a chest tube. Therefore, a pneumothorax is an uncommon complication of pneumomediastinum. In fact, only six cases of pneumothorax have been reported in association with pregnancy.4 In general, most patients with spontaneous pneumomediastinum respond to bed rest and oxygen therapy, which may accelerate the resorption of the air.3 Spontaneous pneumomediastinum is a rare occurrence and generally occurs in young adults.3 Pneumomediastinum as a complication of labor has been reported in approximately 200 cases over the last two centuries, all with diverse clinical manifestations.8 We report jaw pain as an unusual presenting symptom of this uncommon condition. Jaw pain, or other common presenting symptoms previously mentioned, should increase one’s suspicion for pneumomediastinum and lead
one to look for subcutaneous emphysema or Hamman’s sign. It is imperative that physicians are able to recognize the presenting symptoms of a pneumomediastinum in order to properly treat the disease and prevent severe complications.
Neuroleptic Malignant Syndrome in Pregnancy
CASE: A young woman was admitted to the intensive care unit with worsening varicella pneumonia. After being given haldol for agitation, she developed fever, increasing agitation, rigidity, tachycardia, and tremors; she was diagnosed as having neuroleptic malignant syndrome. She was treated successfully with bromocriptine and dantrolene.
C. Scott Russell, MD, Christine Lang, MD, Matthew McCambridge, MD, and Byron Calhoun, MD Womack Army Medical Center, Fort Bragg, North Carolina
BACKGROUND: Neuroleptic malignant syndrome can be a serious neurologic complication of drug therapy during pregnancy. Address reprint requests to: C. Scott Russell, MD, Department of Obstetrics and Gynecology, Womack Army Medical Center, Fort Bragg, NC 28307; E-mail: [email protected].
906
REFERENCES 1. Hamman L. Spontaneous mediastinal emphysema. Bull John Hopkins Hosp 1939;64:1–21. 2. Hamman L. Mediastinal emphysema. JAMA 1945;128: 1– 6. 3. Abolnik I, Lossos IS, Breuer R. Spontaneous pneumomediastinum. A report of 25 cases. Chest 1991;100:93–5. 4. Reeder SR. Subcutaneous emphysema, pneumomediastinum, and pneumothorax in labor and delivery. Am J Obstet Gynecol 1986;154:487–9. 5. Panacek EA, Singer AJ, Sherman BW, Prescott A, Rutherford WF. Spontaneous pneumomediastinum: Clinical and natural history. Ann Emerg Med 1992;21:1222–7. 6. Bejvan SM, Godwin JD. Pneumomediastinum: Old signs and new signs. Am J Roentgenol 1996;166:1041– 8. 7. Macklin MT, Macklin CC. Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: An interpretation of the clinical literature in the light of laboratory experiment. Medicine 1944;23:281–352. 8. Karson EM, Saltzman D, Davis MR. Pneumomediastinum in pregnancy: Two case reports and a review of the literature, pathophysiology, and management. Obstet Gynecol 1984;64:39S– 43S. Received January 16, 2001. Received in revised form March 14, 2001. Accepted June 15, 2001.
CONCLUSION: Despite the common use of antipsychotic medications, neuroleptic malignant syndrome is seen infrequently during pregnancy. The diagnosis can be difficult to make, but if suspected, it can be treated successfully. (Obstet Gynecol 2001;98:906 – 8. © 2001 by the American College of Obstetricians and Gynecologists.)
Neuroleptic malignant syndrome is a potentially lethal complication of treatment with antipsychotic drugs.
VOL. 98, NO. 5, PART 2, NOVEMBER 2001 © 2001 by The American College of Obstetricians and Gynecologists. Published by Elsevier Science Inc.
0029-7844/01/$20.00 PII S0029-7844(01)01442-9
8. Yamasaki K. Hyperprolactinemia in optico-spinal multiple sclerosis. Intern Med 2000;39:272. 9. Erkkila H, Raitta C, Livanainen M, Taskinen E, Unnerus H, Gummerus M. Optic neuritis during lactation. Graefe’s Arch Clin Exp Ophthalmol 1985;222:134 – 8. 10. Walsh FB, Hoyt WF, eds. Clinical neuro-ophtholmology. 3d ed. Baltimore: Williams & Wilkins, 1969:625– 6.
Spontaneous Pneumomediastinum Presenting as Jaw Pain During Labor
developed jaw pain during labor and was found to have a pneumomediastinum.
Janice C. Raley, MD, and Janet I. Andrews, MD Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa
BACKGROUND: Pneumomediastinum, or presence of free air within the mediastinum, is a rare complication of labor. Common symptoms of this condition include chest pain, dyspnea, and subcutaneous emphysema. CASE: A woman complained of right jaw pain 90 minutes after the onset of her second stage of labor. On examination, she was found to have swelling and crepitus over her face, neck, and supraclavicular region. A chest radiograph demonstrated a pneumomediastinum, which resolved spontaneously. CONCLUSION: Pneumomediastinum is associated with Valsalva maneuvers such as those seen during the second stage of labor. We report jaw pain as an unusual presenting symptom of this rare condition. Familiarity with the presenting symptoms of a pneumomediastinum is imperative for appropriate treatment and monitoring for significant complications. (Obstet Gynecol 2001;98:904 – 6. © 2001 by the American College of Obstetricians and Gynecologists.)
Pneumomediastinum, or Hamman’s syndrome, is the presence of air or gas within the mediastinum. It can be caused by sustained Valsalva maneuvers such as coughing, vomiting, forceful defecation, and strenuous exercise. A Valsalva maneuver is commonly used during the second stage of labor. We present a healthy woman who Address reprint requests to: Janet I. Andrews, MD, Department of Obstetrics and Gynecology, University of Iowa College of Medicine, SW 44-14 GH, 200 Hawkins Drive, Iowa City, IA 52242; E-mail: [email protected].
904
Received February 5, 2001. Received in revised form April 20, 2001. Accepted June 21, 2001.
CASE A nulliparous white woman presented at 41 weeks’ gestation with regular contractions, and her cervix was dilated 2 cm. Her pregnancy was complicated by a viral illness at 9 weeks’ gestation and an episode of vaginal bleeding at 34 weeks. She was a nonsmoker with no drug abuse, and her medical and surgical histories were unremarkable. Her membranes were artificially ruptured, and lightly stained meconium fluid was noted. Labor was augmented with oxytocin. An epidural catheter was placed without complication. Eighteen hours after admission, her cervix was fully dilated. After pushing for 90 minutes, she began complaining of right-sided jaw pain and a cracking sensation. Examination revealed right lower facial swelling. She was able to move her jaw in all directions and bite down without difficulty. She did not exhibit any shortness of breath or chest pain. Thirty minutes later, the jaw swelling progressed throughout the right side of her face and eye, and she complained that her voice was sounding different. A 3410-g male infant was delivered by vacuum extraction 50 minutes after the onset of the jaw pain. The Apgar scores were 3 and 7 at 1 and 5 minutes, respectively. The pediatrician later found that the neonate had a small spontaneous pneumothorax. After delivery, crepitus was noted bilaterally over the mother’s face and neck. Her lungs were clear to ausculation, and she denied dyspnea. A chest radiograph showed air on the left adjacent to the aortic arch with large amounts of soft tissue air along the neck and lateral chest wall consistent with a pneumomediastinum (Figure 1). Two hours after delivery, she experienced dyspnea and pressure under her sternum with inspiratory effort. On physical exam, her cardiac rate and rhythm were regular with the presence of Hamman’s sign, a crepitant sound that is synchronous with cardiac systole. Crepitus
VOL. 98, NO. 5, PART 2, NOVEMBER 2001 © 2001 by The American College of Obstetricians and Gynecologists. Published by Elsevier Science Inc.
0029-7844/01/$20.00 PII S0029-7844(01)01514-9
Figure 1. Posteroanterior view of the chest radiograph reveals pneumomediastinum (transparent arrows) and subcutaneous emphysema (black arrows). Raley. Pneumomediastinum During Labor. Obstet Gynecol 2001.
extended to her shoulders, upper abdomen, face, and right eye. Her lungs remained clear to auscultation. She was given high-flow oxygen. A cardiothoracic surgery specialist was consulted and recommended continuing oxygen to reduce the partial pressure of the tissue nitrogen and increase the gradient for resorption. If her symptoms worsened or her oxygen saturation decreased, a chest radiograph was recommended to diagnose a pneumothorax and consider a tube thoracostomy. Although she developed an episode of worsening dyspnea postpartum, a chest radiograph demonstrated a decrease in the size of pneumomediastinum and no pneumothorax. The crepitus and facial swelling decreased over the next 2 days without worsening symptoms. She was discharged on the third postpartum day and has been without recurrence of her symptoms. The infant was also discharged on the third day of life after recovering from the spontaneous pneumothorax without the placement of a chest tube. COMMENT Pneumomediastinum is also called Hamman’s syndrome because it was first formally described by Louis Hamman in 1939.1 He characterized the syndrome by the following symptoms: 1) chest pain, 2) subcutaneous and retroperitoneal emphysema, 3) obliteration of heart sounds or cardiac dullness, 4) crepitant sound heard over the heart (Hamman’s sign), 5) evidence of increased mediastinal pressure (including dyspnea, cyanosis, engorged veins, and circulatory failure), 6) pneumothorax,
VOL. 98, NO. 5, PART 2, NOVEMBER 2001
and 7) roentgenographic evidence of air in the mediastinum.2 Hamman’s sign, which was present in our patient, is a particular sound, which consists of crackles, bubbles, or churning sounds heard with each contraction of the heart. Abolnik et al reported that in his series of 25 patients, 88% complained of chest pain, 60% complained of dyspnea, and 60% had subcutaneous emphysema.3 Many other signs and symptoms can accompany pneumomediastinum including voice change, sore throat, cough, tachycardia, dysphagia, anxiety, and facial swelling.4 However, the presence of subcutaneous emphysema or a Hamman’s sign is virtually diagnostic of pneumomediastinum.5 If symptoms are found, which are consistent with pneumomediastinum, the diagnosis is confirmed by a chest x-ray. A pneumomediastinum is suspected when multiple thin, lucent streaks are seen that outline mediastinal structures, elevate mediastinal pleura, and often extend into the neck or chest wall.6 A lateral radiograph is critically important because up to 50% of cases of pneumomediastinum will be missed on a standard posteroanterior view of the chest.5 The lateral view is more sensitive in making the diagnosis. The pathophysiology of a pneumomediastinum was initially described by Macklin and Macklin in 1944.7 Using animal models, they delineated that air enters the interstitium when there is a pressure gradient set up between the alveoli and adjacent structures. Alveoli abutting other alveoli have the same pressure and therefore maintain structure. However, when alveoli abut vascular sheaths, overinflation of alveoli without corresponding expansion of the vascular sheath permits the establishment of a pressure gradient. The alveoli then rupture, and air flows into the vascular sheath. Because of the lower mean pressure in the mediastinum compared with the lung parenchyma, air dissects along the vascular sheath into the mediastinum. Air may then enter the cervical and subcutaneous tissues. Identification of pneumomediastinum is important because potential complications can be severe. Macklin and Macklin7 reported the following serious complications: 1) pneumothorax, both tension and bilateral, 2) tension pneumomediastinum causing cardiac compression and reducing cardiac output, 3) air block consisting of increased air within the pulmonary interstitial tissue causing splinting and a decrease in the patient’s ability to exchange air, and 4) decreased vessel diameter from air compression within the vascular sheaths causing decreased blood flow to and from the heart. Patients with pneumomediastinum should be monitored for the development of these problems. To avoid such complications, shortening the second stage of labor by the use of forceps
Raley and Andrews
Pneumomediastinum During Labor
905
or vacuum extraction is recommended when a pneumomediastinum has been diagnosed.4,8 After delivery, the treatment of pneumomediastinum primarily consists of supportive measures. In two studies of spontaneous pneumomediastinum nearly a decade old, the mean length of hospital stay was 2– 6 days.3,5 However, Panacek et al recommended that, unless there are medical complications, inpatient care for spontaneous pneumomediastinum was unnecessary.5 Therefore, the development of a pneumomediastinum should not always increase postpartum hospital stay. Panacek et al also recommended follow-up with chest radiographs, but only for worsening of symptoms.5 The repeat chest radiograph is used to diagnose a pneumothorax, which may require treatment with tube thoracostomy to relieve pressure. Only three of 42 patients in the previous studies developed a pneumothorax, and only one required a chest tube. Therefore, a pneumothorax is an uncommon complication of pneumomediastinum. In fact, only six cases of pneumothorax have been reported in association with pregnancy.4 In general, most patients with spontaneous pneumomediastinum respond to bed rest and oxygen therapy, which may accelerate the resorption of the air.3 Spontaneous pneumomediastinum is a rare occurrence and generally occurs in young adults.3 Pneumomediastinum as a complication of labor has been reported in approximately 200 cases over the last two centuries, all with diverse clinical manifestations.8 We report jaw pain as an unusual presenting symptom of this uncommon condition. Jaw pain, or other common presenting symptoms previously mentioned, should increase one’s suspicion for pneumomediastinum and lead
one to look for subcutaneous emphysema or Hamman’s sign. It is imperative that physicians are able to recognize the presenting symptoms of a pneumomediastinum in order to properly treat the disease and prevent severe complications.
Neuroleptic Malignant Syndrome in Pregnancy
CASE: A young woman was admitted to the intensive care unit with worsening varicella pneumonia. After being given haldol for agitation, she developed fever, increasing agitation, rigidity, tachycardia, and tremors; she was diagnosed as having neuroleptic malignant syndrome. She was treated successfully with bromocriptine and dantrolene.
C. Scott Russell, MD, Christine Lang, MD, Matthew McCambridge, MD, and Byron Calhoun, MD Womack Army Medical Center, Fort Bragg, North Carolina
BACKGROUND: Neuroleptic malignant syndrome can be a serious neurologic complication of drug therapy during pregnancy. Address reprint requests to: C. Scott Russell, MD, Department of Obstetrics and Gynecology, Womack Army Medical Center, Fort Bragg, NC 28307; E-mail: [email protected].
906
REFERENCES 1. Hamman L. Spontaneous mediastinal emphysema. Bull John Hopkins Hosp 1939;64:1–21. 2. Hamman L. Mediastinal emphysema. JAMA 1945;128: 1– 6. 3. Abolnik I, Lossos IS, Breuer R. Spontaneous pneumomediastinum. A report of 25 cases. Chest 1991;100:93–5. 4. Reeder SR. Subcutaneous emphysema, pneumomediastinum, and pneumothorax in labor and delivery. Am J Obstet Gynecol 1986;154:487–9. 5. Panacek EA, Singer AJ, Sherman BW, Prescott A, Rutherford WF. Spontaneous pneumomediastinum: Clinical and natural history. Ann Emerg Med 1992;21:1222–7. 6. Bejvan SM, Godwin JD. Pneumomediastinum: Old signs and new signs. Am J Roentgenol 1996;166:1041– 8. 7. Macklin MT, Macklin CC. Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: An interpretation of the clinical literature in the light of laboratory experiment. Medicine 1944;23:281–352. 8. Karson EM, Saltzman D, Davis MR. Pneumomediastinum in pregnancy: Two case reports and a review of the literature, pathophysiology, and management. Obstet Gynecol 1984;64:39S– 43S. Received January 16, 2001. Received in revised form March 14, 2001. Accepted June 15, 2001.
CONCLUSION: Despite the common use of antipsychotic medications, neuroleptic malignant syndrome is seen infrequently during pregnancy. The diagnosis can be difficult to make, but if suspected, it can be treated successfully. (Obstet Gynecol 2001;98:906 – 8. © 2001 by the American College of Obstetricians and Gynecologists.)
Neuroleptic malignant syndrome is a potentially lethal complication of treatment with antipsychotic drugs.
VOL. 98, NO. 5, PART 2, NOVEMBER 2001 © 2001 by The American College of Obstetricians and Gynecologists. Published by Elsevier Science Inc.
0029-7844/01/$20.00 PII S0029-7844(01)01442-9