ABSTRACT
The liaison psychiatrist may become involved when termination has been refused and the patient is angry and upset. The greatest reassurance derives from getting to know the midwife, obstetrician and ward sister at the hospital, or their equivalent with a domiciliary delivery. Although obstetric factors are accountable in some cases, others are largely psychogenic and occur usually in women of immature, hysterical personality feeling insecure perhaps because of an inadequate, culturally different or much older husband. Nevertheless, external foetal monitoring and obstetric liaison are needed with ECT in pregnancy. Menstrual irregularities, in the absence of clear gynaecological pathology, are used as a reason to press for early hysterectomy. Every psychiatrist can expect referrals from the gynaecologists of difficult women often in their thirties said to be suffering from the premenstrual syndrome but unresponsive to the usual ploys of progesterone or an oral contraceptive. Gynaecologists sometimes ask for an assessment of the likelihood of depression in a particular case.
