Plan delivery in BPAD

Katy King is 30 years old. She is 30 weeks pregnant.

Four years ago, at age 26 years, her son Max was born by an emergency caesarean section because of breach presentation. Then she developed a severe postpartum psychosis with manic features. She was admitted to a Mother & Baby Unit. She improved with Olanzapine. She came off Olanzapine three months later.

Three years ago, at age 27 years, she had a manic episode. She was diagnosed with Bipolar Affective Disorder. She improved with Olanzapine and Lithium.  She came off Olanzapine three months later. She has been stable on Lithium 800 mg.

One year ago, at age 29, she stopped her Lithium and contraception. She is now 30 weeks pregnant. She is awaiting an elective caesarean section at 39 weeks. Her GP has referred her to the Perinatal Mental Health Team. You are the only doctor in the team today.

Find out her plans and preferences for delivery and postnatal period

Discuss risks and develop a management plan