Electroconvulsive Therapy In Pregnancy Research Articles

Electroconvulsive therapy in pregnancy

Electroconvulsive therapy in pregnancy

Management of Psychiatric Disorders during the Perinatal Period.

Management of Psychiatric Disorders during the Perinatal Period.

Periprocedural Management of Electroconvulsive Therapy in Pregnancy during COVID-19 Outbreak: The First Case Report in Thailand

Objective: To described the periprocedural electroconvulsive therapy (ECT) management of a patient in the 3rd trimester of pregnancy, the ECT complications, and their treatment. Materials and Methods: A retrospective chart review was conducted of a 26-year-old parturient with bipolar I disorder with psychotic features during the coronavirus disease 2019 (COVID-19) outbreak. Case Report: The patient was admitted and scheduled for ECT. Fifteen ECT sessions (eight on her first admission, and another seven on a second admission) were performed. General anesthesia with endotracheal intubation was conducted after sufficient preoxygenation. Complications were observed: prolonged seizure, decreased fetal heart rate, and hypersecretion. Nonetheless, good outcomes were achieved after treated with thiopental to terminate the seizure, intravenous crystalloid loading and left uterine displacement to stabilize the fetus, and suctioning and an antisialagogue for secretion clearance. Conclusion: In ECT during pregnancy, it can be challenging to apply electrical current, induce anesthesia and airway management to achieve safe patient care and ensure adequate seizure duration. Moreover, the ECT is conducted in a non-operating room setting where equipment may be deficient. A prerequisite is good periprocedural collaboration among members of the multidisciplinary team which include a psychiatrist, an anesthesiologist, and an obstetrics-gynecologist, as well as proper protective equipment to prevent the contamination to the environment. Keywords: Coronavirus disease 2019 (COVID-19); Electroconvulsive therapy (ECT); Multidisciplinary team; Periprocedural management; Pregnancy

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

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.

Electroconvulsive Therapy in Pregnancy: Safety, Best Practices, and Barriers to Care.

Approximately 10% to 16% of women meet diagnostic criteria for depression during pregnancy. Untreated maternal depression is associated with adverse pregnancy outcomes including premature birth, low birth weight, and fetal growth restriction. The aim of this study is to review the current safety data on electroconvulsive therapy (ECT) in pregnancy and provide guidance to clinicians on the role of ECT in pregnancy and the special considerations for its use in our population. We reviewed 4 meta-analyses on the use of ECT in pregnancy as well as the source material (case series, etc) for these meta-analyses. We reviewed the official position statements on ECT in pregnancy from obstetric and psychiatric governing bodies as well as clinical best practice information from practitioners of ECT in pregnancy. Electroconvulsive therapy may be underutilized due to stigma and lack of access for these women. Rates of ECT use in pregnancy are difficult to determine. There are physiologic differences in pregnancy that merit additional attention during ECT, including increased risk of aspiration, concern for aortocaval compression, and the possibility of fetal heart rate changes associated with prolonged seizure activity. Serious adverse outcomes associated with ECT use in pregnancy are rare. Electroconvulsive therapy is a highly effective and safe treatment modality for unipolar depression, bipolar disorder, schizophrenia, and other psychiatric illnesses. Electroconvulsive therapy treatment in pregnancy requires a multidisciplinary team approach with obstetrics, maternal-fetal medicine, psychiatry, and anesthesiology, but is overall felt to be safe and effective.

Recommendations for the use of ECT in pregnancy: literature review and proposed clinical protocol.

Psychiatric disorders are common in pregnancy, affecting 15-29% of pregnant women. Untreated depression has negative health consequences for mother and fetus. Electroconvulsive therapy (ECT) is an effective option for the treatment of severe depression, high suicide risk, catatonia, medication-resistant illness, psychotic agitation, severe physical decline, and other life-threatening conditions. To our knowledge, however, there is no literature that consolidates all the evidence on maternal and fetal risks associated with untreated depression, medications, and ECT then translating it into one cohesive protocol that could serve as a management guide and a source of reassurance to health-care providers involved in such practice. Hoping to facilitate ECT access to perinatal patients, the authors combined their multidisciplinary clinical experience (in perinatal psychiatry, neuropsychiatry and neuromodulation, and anesthesiology) at three different centers in the USA (Brigham and Women's Hospital/Harvard Medical School, The University of Chicago, and Brown University) with a careful and critical literature review and propose guidelines for the administration of ECT in pregnancy. A comprehensive review of the relevant literature regarding both ECT and psychotropic medications in pregnancy was performed, including meta-analyses of randomized controlled trials published in general medicine, anesthesiology, psychiatry, and obstetrics journals and guidelines. The indication and appropriateness of ECT in pregnancy must be carefully weighed against the risks of untreated maternal illness and those of alternative treatment options. The safety of ECT in pregnancy has been documented over the last 50years. The adverse effects in pregnancy are similar to the risks of ECT in any individual. The most common risk to the mother is premature contractions and preterm labor, which occur infrequently and are not clearly caused by ECT. The rates of miscarriages were not significantly different from that of the general population. There have been no associations of ECT with congenital anomalies, either morphologic or behavioral, and no neurocognitive disturbances in the child. ECT is a reasonably safe and effective treatment alternative for management of many psychiatric disorders in pregnant patients. The authors provide recommendations for treatment modifications in pregnancy-based physiologic changes that occur during that period and consolidate them into a protocol that can assist clinicians in improving access and safety of ECT for pregnant patients.

A Meta-review of the Safety of Electroconvulsive Therapy in Pregnancy.

Four systematic reviews have examined the safety of electroconvulsive therapy (ECT) in pregnancy. These have varied widely in methods, findings, and conclusions. We compared these reviews with regard to search strategy, study selection criteria, total number of studies identified, total number of patients included, findings related to safety and adverse events, and interpretation of results. The number of studies (number of cases) included in the reviews ranged from 16 (n = 300) to 67 (n = 169) with only one review stating reasons for exclusion of nonselected studies. We provide comparisons about how the reviews described patient characteristics, illness characteristics, ECT characteristics, confounder characteristics, and outcome characteristics; there was wide variation in these regards. We list adverse outcomes that were identified by some but not other reviews. We provide a detailed breakdown of the adverse maternal and fetal outcomes identified in each review. Finally, we examine how different reviews interpreted their findings; whereas some reviews provided reasons for ruling out ECT as an explanation for an adverse outcome, one review adopted the stance that all adverse outcomes were potentially ECT-related. Our meta-review provides readers with comparative information on the strengths and limitations of the 4 systematic reviews, their findings, and their conclusions. It can assist with clinical decision making on the use of ECT in pregnancy by providing a more complete description of the available literature.

Safety of electroconvulsive therapy in pregnancy

Objective: The treatment of psychiatric disorders in pregnancy poses a challenge. Pharmacological treatment of psychiatric disorders in pregnant women is complicated. Electroconvulsive therapy (ECT) has been demonstrated to be effective and safe in the treatment of various psychiatric disorders. In this study, we investigated the safety and the probable complications of either concurrent with or following to ECT treatment among pregnant patients. Method: The 25 pregnancy cases, where ECT was applied between 2006 and 2012, have been reviewed. These patients have been interviewed and their clinical histories have been documented. Both maternal and fetal complications have been followed up. Results: Two patients have been treated with ECT twice during their pregnancies. For this reason, they are treated as two separate cases. The distribution of the cases is as follows: 8 (32%) psychosis, 11 (44%) bipolar disorder, and 6 (24%) depression. Out of these cases, the prognosis distribution is as follows: 10 (40%) full recovery, 11 (44%) partial recovery, and 4 (16%) discharged from hospital prior to the completion of the treatment at the request of their relatives. Two had complications that were early membrane rupture and stillbirth. Conclusion: In our study, no findings were observed regarding unsafe use of ECT during pregnancy.

Fetal Spasms After the Administration of Electroconvulsive Therapy in Pregnancy

Most psychotropic drugs are not approved for use during pregnancy. Electroconvulsive therapy (ECT) might be an effective and safe treatment option for several psychiatric disorders in pregnant women. This study assessed ECT for treating major psychoses during pregnancy, taking all possible adverse effects into account. We scrutinized all biomedical reviews on ECT during pregnancy published within the past 10 years, and present our experience with 3 patients in different phases of pregnancy that were treated with ECT between December 2009 and July 2012. Four to 5 ECT sessions were administered to pregnant women (10th to 28th week of pregnancy) with severe psychoses, and fetal heartbeat and movements were monitored during ECT and for 2 hours afterward. Bizarre fetal spasms occurred in pregnant women treated with ECT. The authors are not aware of any similar description in the published reviews on this topic, to date. Still, all 3 women had successful deliveries, and the infants remained healthy during follow-ups ranging from 1 to 3.5 years. These data fill a lacking gap in the literature regarding long-term infant outcomes after ECT administration to pregnant women. This supports the theory that ECT may be an excellent treatment solution for pregnant women with certain severe mental disorders. Electroconvulsive therapy may be an acceptable approach for preventing pharmacotherapy risks or danger arising from injuries associated with mental illnesses in pregnant women. Nonetheless, careful monitoring of both mother and baby is absolutely necessary when considering ECT during pregnancy.

Electroconvulsive Therapy in Pregnancy Revisited

Electroconvulsive Therapy in Pregnancy Revisited

ECT in Pregnancy: A Review of the Literature From 1941 to 2007

To review the literature on the use of electroconvulsive therapy (ECT) during pregnancy and to discuss its risks and benefits for treating severe mental illness during pregnancy. PubMed and PsycINFO databases were searched for English or English-translated articles, case reports, letters, chapters, and Web sites providing original contributions and/or summarizing prior data on ECT administration during pregnancy. A total of 339 cases were found. The majority of patients were treated for depression and at least partial remission was reported in 78% of all cases where efficacy data were available. Among the 339 cases reviewed, there were 25 fetal or neonatal complications, but only 11 of these, which included two deaths, were likely related to ECT. There were 20 maternal complications reported and 18 were likely related to ECT. Although there are limited available data in the literature, it seems that ECT is an effective treatment for severe mental illness during pregnancy and that the risks to fetus and mother are low.

Electroconvulsive Therapy in Pregnancy

Electroconvulsive therapy for the treatment of depressive and bipolar disorders has been advocated as being safe and effective in pregnancy. A primigravida underwent multiple electroconvulsive treatments during pregnancy for the diagnosis of major depression. The infant was subsequently born with multiple deep interhemispheric infarcts. Despite reassuring statements regarding the safety of electroconvulsive therapy, this case report and a review of the literature suggests that electroconvulsive therapy during pregnancy should be performed with caution.

Recurrent mild abruptio placentae occurring immediately after repeated electroconvulsive therapy in pregnancy

We present a case in which electroconvulsive therapy was performed repeatedly in pregnancy because of severe depression with psychotic features and failure of chemical treatment. Each electroconvulsive treatment was immediately followed by uterine contractions and active uterine bleeding, possibly representing recurrent abruptio placentae occurring in association with the treatment. Transient acute episodes of maternal hypertension between 180190 and 1901100 mm Hg, documented within minutes after application of each electroconvulsive treatment, might explain the abruptio placentae manifested by active uterine bleeding and uterine hyperstimulation.

Safe use of electroconvulsive therapy in pregnancy

A 22-year-old woman who was 32 weeks pregnant was given a course of electroconvulsive therapy (ECT) as a life-saving measure to treat a severe psychotic illness. The ECT was highly effective and careful monitoring of both the mother and the fetus demonstrated that this was a safe procedure.

Electroconvulsive Therapy in Pregnancy

The optimal treatment for depressive disorders in pregnancy remains controversial. Clinicians are often hesitant to prescribe pharmacologic agents during pregnancy, especially in the first trimester, and the effects of electroconvulsive therapy in pregnancy have not been prospectively evaluated. The present case reports on the apparent safety and efficacy of electroconvulsive therapy for the treatment of depression in pregnancy when used in carefully selected and carefully monitored patients. Fetal heart rate monitoring and real-time ultrasonography were performed, and the results suggest that maternal electroconvulsive therapy has little effect on fetal status.

Electroconvulsive Therapy in Pregnancy

The optimal treatment for depressive disorders in pregnancy remains controversial. Clinicians are often hesitant to prescribe pharmacologic agents during pregnancy, especially in the first trimester, and the effects of electroconvulsive therapy in pregnancy have not been prospectively evaluated. The present case reports on the apparent safety and efficacy of electroconvulsive therapy for the treatment of depression in pregnancy when used in carefully selected and carefully monitored patients. Fetal heart rate monitoring and real-time ultrasonography were performed, and the results suggest that maternal electroconvulsive therapy has little effect on fetal status.