Induction of Labor for Psychiatric Indications: A Case Series and Literature Review

Spada, Meredith; Simpson, Monique; Gopalan, Priya; Azzam, Pierre N.

doi:10.1016/j.psym.2018.05.006

Cited by 4 publications

(5 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Pregnant people may rapidly face a series of complex, anguishing decisions, most of them time-sensitive. In our case, the patient developed gestational hypertension, an indication for induction of labor and, if needed, a Cesarean section (2,4).…”

Section: How Are Decisions Made?mentioning

confidence: 76%

“…The team formally asked a judge to allow the clinicians to administer non-psychotropic medications and obstetric treatment over objection, given that she was deemed to lack capacity. However, while no ruling was in sight, the patient developed gestational hypertension, an obstetric indication for delivery to avoid potentially disastrous outcomes for the pregnant woman and the fetus (2,4,13). Once labor is induced, vaginal delivery would ensue, but in some instances, due to obstetric reasons, a Cesarean section might be needed.…”

Section: Example Casementioning

confidence: 99%

“…-Larger studies are needed to identify and characterize systematically those for whom induction of labor has been attempted for psychiatric reasons to provide future guidelines for the psychiatric consultant (4,24).…”

Section: Recommendationsmentioning

confidence: 99%

“…Patients with psychotic illness are less likely to receive prenatal care and more likely to present later in pregnancy; which leads to worse outcomes, including missed opportunities for prenatal diagnosis and treatment, intrauterine growth restriction, and lower Apgar scores (1)(2)(3). These patients have an increased need for interventions (i.e., amniotomy, pharmacologic induction or augmentation of labor, and emergency Cesarean section) (4,5). Their postpartum experiences are often marked by psychotic relapse, parenting difficulties, and high rates of custody loss (6).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Ethical challenges in the treatment of psychotic pregnancy denial

John,

Tudose,

Kuo

et al. 2024

Front. Psychiatry

View full text Add to dashboard Cite

BackgroundThere is a paucity of literature regarding ethical strategies for treating pregnant people with psychosis. While not uncommon, psychotic pregnancy denial is a psychotic illness in which patients have the delusion that they are not pregnant. The authors provide a literature review regarding psychotic pregnancy denial, present an unpublished case and its questions and dilemmas, and offer recommendations for resolving the ethical challenges these cases raise.CaseA 26-year-old, single, unemployed woman of no fixed residence was admitted for suicidal ideation. She had a history of psychosis, had multiple ER visits and at least one previous hospitalization, had minimal contact with psychiatric outpatient clinics, and had been poorly compliant with treatment recommendations. She was discovered to be about 31 weeks pregnant in the emergency room. Ultrasound exams revealed no fetal anomalies. This was the patient’s second pregnancy; her previous pregnancy resulted in an abortion. Her sole psychotic symptom was the delusional belief that she was not pregnant. On the rare occasions when the patient acknowledged being pregnant, she requested termination of pregnancy. Despite intensive pharmacological treatment of her psychosis, the patient continued believing that she was not pregnant and repeatedly said she would not participate in the labor and delivery process. She disagreed with the induction of labor or a cesarean section if needed. The patient developed gestational hypertension, an obstetric indication for delivery. Induction of labor was offered to avoid potentially disastrous outcomes for the pregnant woman and the fetus.ConclusionPsychotic pregnancy denial is potentially life-threatening. Delivery of the fetus requires carefully weighing risks and benefits and thoroughly considering the ethical framework.Teaching pointsTreatment of birthing people with psychotic denial of pregnancy is complex; it requires special clinical and ethical skills to determine the patient’s level of decision-making impairment and to find a middle ground between the pregnant person’s right to autonomy and the physicians’ beneficence-based duties. Using a well-coordinated, interdisciplinary approach and a solid ethical framework, the decision to deliver the fetus while engaging the pregnant person, to the extent possible, in the decision-making process is essential.

show abstract

Section: How Are Decisions Made?mentioning

confidence: 76%

Section: Example Casementioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ethical challenges in the treatment of psychotic pregnancy denial

John,

Tudose,

Kuo

et al. 2024

Front. Psychiatry

View full text Add to dashboard Cite

show abstract

“…However, there was a significantly higher rate of reported psychiatric illness among women with an unplanned pregnancy. According to a literature review from Spada et al, there are few studies exploring induction of labor in women with psychiatric conditions [ 49 ]. In a Swedish study by Sydsjö et al, induction of labor was more frequent in women with fear of childbirth, a group of women that are characterized by a lower degree of planned pregnancies [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Unplanned pregnancy and the association with maternal health and pregnancy outcomes: A Swedish cohort study

Carlander,

Hultstrand,

Reuterwall

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

Objectives Unplanned pregnancies are common and associated with late initiation and inadequate antenatal care attendance, which may pose health risks to mother and child. How pregnancy planning relates to maternal health and delivery in Sweden, a country with free antenatal care and free abortion, has not been studied previously. Our aims were to study whether pregnancy planning was associated with antenatal care utilization and pregnancy outcomes in a Swedish setting. Methods Data for 2953 women, who answered a questionnaire when recruited at antenatal clinics in Sweden and later gave birth, was linked to the Swedish Medical Birth Register. The degree of pregnancy planning was estimated using the London Measure of Unplanned Pregnancy. Unplanned (comprising unplanned and ambivalent intention to pregnancy) was compared to planned pregnancy. Differences between women with unplanned and planned pregnancy intention and associated pregnancy outcomes were analyzed using Fisher’s exact test and logistic regression. Results There were 31% unplanned (2% unplanned and 29% ambivalent) pregnancies, whereas most woman (69%) reported their pregnancy to be planned. Women with an unplanned pregnancy enrolled later to antenatal care, but there was no difference in number of visits compared with planned pregnancy. Women with an unplanned pregnancy had higher odds to have induced labor (17% versus 13%; aOR 1.33 95% CI 1.06–1.67) and a longer hospital stay (41% versus 37%; aOR 1.21 95% CI 1.02–1.44). No associations were found between pregnancy planning and pregnancy-induced hypertension, gestational diabetes mellitus, preeclampsia, epidural analgesia use, vacuum extraction delivery, Caesarean section or sphincter rupture. Conclusions Unplanned pregnancy was associated with delayed initiation of antenatal care, higher odds for induction of labor and longer hospital stay, but not with any severe pregnancy outcomes. These findings suggest that women with an unplanned pregnancy cope well in a setting with free abortion and free health care.

show abstract