Pregnancy and Electroconvulsive Therapy

Abstract

Objective To scrutinize a series of pregnant women treated with electroconvulsive therapy (ECT) at a tertiary treatment center and combine this data with a literature review to refine the treatment guidelines for ECT during pregnancy. Methods A retrospective chart review of mentally ill pregnant patients treated with ECT since the establishment of a formal women’s mental health program. Results A total of eight pregnant women treated with ECT were identified from 01/2012–08/2014. Information was extracted from the medical record from a total of 30 ECT treatments across this group. Subjects received an average of 3.75 ECT treatments (range 1–7). All women were diagnosed with a mood disorder (either unipolar or bipolar), and five of the eight women had suicidal ideation. The treatment team for ECT was consistent across all treatments. Two women experienced significant complications following the initial treatment: 1) an acute episode of complete heart block; and 2) acute onset of mania following ECT. Obstetrical complications included two women with pre-term delivery – one secondary to premature rupture of membranes. No other complications or adverse outcomes were recorded. The five women with suicidal ideation had symptom resolution, and significant symptom improvement was noted in six of the eight women. Conclusions Electroconvulsive therapy is a safe and effective treatment during pregnancy and of particular benefit in the acute treatment of suicidal ideation.

The Effects of Rocuronium-sugammadex on Fetomaternal Outcomes in Pregnancy Undergoing Electroconvulsive Therapy: A Retrospective Case Series and Literature Review

“…Therefore, propofol can be considered as an ideal agent for ECT during pregnancy [5,12]. Meaningfully, recent reports have indicated that propofol has been the most commonly used agent in anesthetic induction in pregnant women undergoing ECT [5,9,13-14]. In a case report by De Asis et al, ECT was applied at the 23rd gestational week in a patient with bipolar disorder.…”

“…ECT may be a safe procedure in pregnant patients; however, airway management may not be safe. Airway management is usually provided by a face mask in such cases since the majority of the cases have a low gestational week and a short duration of processing, mainly due to the short duration of the effects of neuromuscular blocking agents used and the early return of spontaneous breathing [5,13-14]. In our study, we used the aspiration measures mentioned above and the patients were ventilated manually with 100% oxygen 3 L/min using a face mask.…”

Recent Updates on Electro-Convulsive Therapy in Patients with Depression

“…48 Although the evidences on effectiveness of ECT in pregnant women are mostly based on the results of case reports and there is no prospective controlled study, results from previous studies indicate that use of ECT is generally safe during the entire period of pregnancy. 49,50 Maternal changes such as decreased utero-placental perfusion, risk of aspiration, compression on aortocaval system during pregnancy and other comorbidities and the possibility of fetal heart rate change may need to be considered, but serious adverse events caused by ECT during pregnancy seem to be uncommon. 51 In a retrospective study, the efficacy and safety of ECT in 33 (n=19 MDD; the rest=bipolar disorder or schizophrenia) pregnant patients were evaluated.…”

Continuous Fetal Monitoring During Electroconvulsive Therapy: A Prospective Observation Study

“…Several studies discuss precautions to take in pregnant patients, but there are no consistent guidelines for the performance of ECT in pregnancy. [12][13][14] These precautions include left lateral decubitus positioning, IV hydration, use of proton pump inhibitors or H2 blockers, and intubation. Other precautions include performance of a pelvic exam, avoidance of hyperventilation, and some form of fetal monitoring.…”

“…Other precautions include performance of a pelvic exam, avoidance of hyperventilation, and some form of fetal monitoring. [12][13][14] There is no consistent guideline for fetal monitoring during ECT and no consistent patterns of adverse outcomes. 13 The timing (pre/post ECT) and duration of fetal monitoring are not well described.…”