and sadness.There is rapid development of delusions, eg baby has died or is deformed, or hallucinations with deepening melancholia.The woman must be admitted to hospital, preferably with her baby.There is limited evidence for the effectiveness of treatment specifically for puerperal psychosis. Treatments used for affective psychoses in general are also appropriate for puerperal psychosis, eg one or more drugs from the antidepressant, mood-stabilising or neuroleptic groups and, occasionally, electroconvulsive therapy (ECT).[3] [4]Postpartum haemorrhage:Primary postpartum haemorrhage is defined as loss of more than 500 ml of blood during the first 24 hours.Normally, 200-600 ml blood are lost before myometrial retraction plus strong uterine contractions stop flow.The majority of cases are associated with either an atonic uterus or placental remnants. The rest of cases are associated with laceration of the genital tract, rarely uterine rupture or blood coagulation defect.Treatment in situations where the placenta is still in the uterus is combining controlled cord traction with fundal pressure. If this fails, manual removal of the placenta under general anaesthetic is carried out.If the placenta has already been expelled, treatment includes massaging the uterus, intravenous (IV) ergometrine or syntocinon, or misoprostol, blood transfusion, correction of coagulation defects, bimanual compression of the uterus; urgent transfer to theatre for surgery may be required.Secondary postpartum haemorrhage is abnormal bleeding after 24 hours up until 6 weeks postpartum.Usual causes are:Poor epithelialisation of placental site.Retained placental fragment and/or blood clots (usually detected by ultrasound).The uterus is often found to be bulky and tender with the cervix open.Initially, it is treated with ergometrine intramuscularly plus antibiotics. Curettage is only necessary if bleeding persists despite this.Postnatal anaemia is common and may easily be overlooked.Puerperal pyrexia:Defined as temperature 38°C or above during the first 14 days after delivery.Most cases are due to anaerobic streptococcithat normally inhabit the vagina. Initially, they infect the placental bed and then spread either into the parametrium or via the uterine cavity to the Fallopian tubes and, occasionally, the pelvic peritoneum.Alternatively. there may be breast infection or UTI, or a non-infective cause such as thrombophlebitis or deep vein thrombosis.Thromboembolism:This occurs in