Continuous Fetal Monitoring During Electroconvulsive Therapy: A Prospective Observation Study.

Abstract

ObjectiveThe use of electroconvulsive therapy in pregnancy has been limited by concerns about its effects on fetal well-being, despite limited evidence that suggests it is safe and effective. No studies have utilized continuous fetal heart rate monitoring during electroconvulsive therapy sessions. We aimed to describe the fetal heart rate patterns of patients undergoing electroconvulsive therapy.DesignThis study is a prospective case series of pregnant patients undergoing electroconvulsive therapy with continuous fetal heart rate monitoring.SettingUniversity-based hospital.PopulationPregnant patients with a psychiatric indication for electroconvulsive therapy.MethodsPatients underwent fetal heart rate monitoring immediately prior, during and immediately after ECT therapy.Main Outcome MeasuresCharacterization of the fetal heart rate tracing.ResultsFive subjects underwent 44 electroconvulsive therapy sessions. Continuous fetal monitoring was performed on 34 of the sessions. Transient fetal heart rate decelerations occurred in 4 sessions, all self-resolved and none required intervention.ConclusionThis case series is the first to report the results of continuous FHR monitoring during electroconvulsive therapy. The most common finding was a transient, self-resolving bradycardia that was not associated with adverse perinatal outcomes. This supports the opinion that electroconvulsive therapy is a safe treatment option in pregnancy in women with severe mental disease.