An Obstetric and Psychiatric Emergency: Managing Acute Agitation Among Pregnant Patients in the Emergency Department

Abstract

New onset of agitation during pregnancy is an obstetric and behavioral emergency that demands careful evaluation and prompt treatment. This article provides an overview of clinical evaluation and types of nonpharmacologic and pharmacologic interventions when managing acute agitation during pregnancy. Rapid clinical evaluation and behavioral management are keys to preventing detrimental maternal and fetal complications. Clinicians must seek out medical etiologies of agitation and always attempt verbal de-escalation before initiating chemical or physical restraints. Should medication be necessary, first-generation antipsychotics, second-generation antipsychotics, antihistamines, or benzodiazepines may be considered. Managing agitation in pregnancy is a challenging dilemma due to the fear of adverse maternal and neonatal outcomes as well as the legal risk involved. Nevertheless, clinicians should continue to assess the patient without delay, differentiate underlying causes of agitation, treat the mother and fetus aggressively, and consult obstetric and psychiatric services early.