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The spate of medicolegal inquiries following the disqualification of Parlodel (bromocriptine mesylate) by the Food and Drug Administration for postpartum ablactation, uncovered previously unreported side effects associated with its postpartum administration. In 1994, bromocriptine mesylate was withdrawn from the market as a milk suppressant. Since this time, over a dozen cases of postpartum intracranial hemorrhages associated with its use have been reported. We describe three additional cases of postpartum intracranial hemorrhage related to bromocriptine usage. One patient, previously normotensive, developed hypertension and a headache; initial CT was normal, but CT 24 h later demonstrated intracranial hemorrhage. This suggests that the blood-pressure elevation was drug-induced and was the cause, rather than the consequence, of bromocriptine-related intracranial hemorrhage.

We report three recent cases of severe acute cerebral accident which occurred in the puerperium in women who received bromocriptine for milk suppression. Two patients experienced mild pregnancy-induced hypertension antepartum. Marked blood pressure elevation, above that which had prevailed previously, occurred postpartum in each case. The cerebral accidents manifested between the 6th and 14th days of the puerperium, the typical time for the occurrence of severe side effects from bromocriptine. These complications entailed lasting neurological sequelae in the three mothers who, based on their age, medical history and general state of health, were not significantly predisposed to cerebral accidents.

Recent literary case reports indicate that bromocriptine mesylate, when used for the suppression of lactation in the puerperium, can cause serious and even lethal side effects. The untoward sequelae are attributed to generalized or focal vasospasm affecting the cardiac and/or cerebral bold vessels. Apart from pre-existing hypertension and use in association with other ergot derivatives, the factors predisposing to such complications have not been elucidated, The authors present three atypical bromocriptine related postpartum accidents which may expand the understanding both of the predisposing factors and the potential consequences of bromocriptine related severe side effects. One of the cases raises the suspicion that the manifestations of hyperthyroidism may be aggravated by this method of pharmacologic ablactation. Another observation appears to imply that the drug may trigger the onset of chronic hypertension in women so predisposed. The development of cerebral infarcts, identified by MRI, in a clinically asymptomatic woman, exemplifies the threat of recurrent seizure activity in cases of bromocriptine related stroke.

Serial malpractice reviews offer an opportunity for the study of the effects of various practice patterns. In the specialty of obstetrics, the usefulness of this approach has been demonstrated repeatedly: (a) Much of the data indicating that bromocriptine, when given postpartum for milk suppression, has life endangering propensities have derived from medico-legal reviews. (b) Important new information about factors predisposing to or associated with neonatal brachial plexus injuries have emerged from critical analysis of malpractice claims. There is reason to anticipate that objective evaluation of the background of other prenatal birth injuries can provide more useful clinical information than traditional randomized prospective studies.

Three cases of cerebral hemorrhage that occurred in the puerperium in normotensive women who used bromocriptine for milk suppression postpartum are described. Unlike in some other instances reported in the past, the extent of the bleeding was limited in these patients and the long range outcome was relatively benign. All episodes were associated with the development of hypertension. These incidents occurred between the 10th and 17th days postpartum; somewhat later than the usually observed peak time period (6th to 8th day) for the development of severe bromocriptine related side effects.