We present the case of a 23-year old woman with a history of two hospitalizations in the psychiatric ward of our hospital in the last 8 months. Prior to this age our patient had not required assistance from mental health professionals. The wide variety of symptoms shown by the patient included auditive hallucinations and persecution delusions that led to behavioral alteration and depressive symptoms.

To present a case report of a puerperal psychosis and to review the different kind of psyquiatric disorders that may arise in the puerperium.

Literature review of scientific papers over the last years and classic textbooks on the issue. We included references in English and Spanish languages.

During pregnancy and the puerperium there are biochemical, hormonal, psychological and social changes that cause a vulnerability in women for the appearance of mental disorders. The differential diagnosis of puerperal psychoses must first be made with organic diseases. Once this has been discarded, several studies indicate that there is a high probability that after the onset of puerperal psychosis a cyclical mood disorder is found.

- One of the main characteristics of puerperal psychoses is the great variety of its symptomatic manifestations. They can present characteristics of both mood disorders and schizophreniform disorders. - Deep confusion and delusions are often the most prominent symptoms of psychosis in the puerperal period.

No significant relationships.

A Canadian Stroke Best Practices consensus statement on Acute Stroke Management during pregnancy was published in 2018. The state of individual practice, however, is unknown.

A survey on treatment of acute stroke in pregnant and post-partum women was distributed via the Canadian Stroke Consortium email list. Descriptive statistics (frequencies and proportions) were calculated for demographic and response variables and free-text responses were coded for thematic content.

Thirty-five participants completed the survey; 12 had experience with intravenous tissue plasminogen activator (IV-tPA), endovascular therapy (EVT), or both in pregnant patients. None had treatment-related complications. The majority (92%) of those who had not yet encountered the issue in practice expressed some reservation about giving IV-tPA to an otherwise eligible pregnant woman. In a theoretical scenario where an otherwise eligible pregnant woman was a candidate for both IV-tPA and EVT, 58% of respondents would have opted for EVT alone. Amongst this cohort comprised mainly of stroke sub-specialists, more than a third had treated pregnant patients with reperfusion therapy.

The reported safety experience with both IV-tPA and EVT was reassuring. Overall, there was a hesitancy towards use of IV-tPA in pregnancy that is discordant with the recent consensus statement. Possible barriers to uptake identified through thematic analysis were concerns regarding risks of bleeding in the pregnant patient, presence of EVT as a perceived alternative, and the need for express consent from the patient and family.