///2014 Abstract Details
2014 Abstract Details2019-07-18T14:34:47-06:00

Electroconvulsive Therapy during Pregnancy

Abstract Number: S-21
Abstract Type: Case Report/Case Series

Nisha Pinto MD1 ; Tonia Greenwood MD2; Laurie Chalifoux MD3

Introduction: Major depressive disorder (MDD) is the most common mental illness during pregnancy. 20% of pregnant women report symptoms of depression and 9% suffer with an episode of major depression.1 MDD refractory to medical management and psychotherapy does occur and electroconvulsive therapy (ECT) remains perhaps the single most effective psychiatric intervention. Antenatal depression has been associated with higher rates of poor pregnancy outcomes including preeclampsia, preterm delivery, impaired fetoplacental function, decreased fetal growth, and neonatal complications.1

Case: We report the case of a 32 yo G2P1 presenting at 28 weeks for ECT due to MDD with increasing suicidal ideation. Her psychiatrist recommended a course of twice weekly ECT. We discussed the implications of the pregnant airway and agreed she should be intubated for each session. She was premedicated with famotidine, metoclopramide, and sodium citrate. Twenty minutes of fetal heart tone (FHT) monitoring was performed pre and post procedure. She was placed in left uterine tilt and preoxygenated prior to rapid sequence induction with methohexital and succinylcholine. Cricoid pressure was applied until tracheal intubation was confirmed with auscultation and end-tidal CO2. Utilizing mild hyperventilation, the ECT was performed and an adequate seizure was induced. Upon awakening and following commands, she was extubated. During the first ECT session, the patient had an episode of laryngospasm immediately after extubation, which resolved quickly with CPAP. To reduce secretions, glycopyrrolate was given for the subsequent procedures and laryngospasm did not recur. Acetaminophen, rather than ketorolac, was given for the discomfort associated with ECT. A total of 12 ECTs were performed from 28 to 34 weeks gestation. As she developed severe procedural anxiety, we began administering post-ECT midazolam. No FHR decelerations or premature contractions occurred during the process, despite them being the most common fetal and maternal adverse events in ECT.1

Discussion: ECT is considered a safe and effective treatment for pregnant patients with MDD. Airway management and fetal monitoring are key components for ECT during pregnancy. Providers must consider both increased aspiration risk and the challenges inherent to the pregnant airway. The psychiatry team should be aware of the unique risks to both mother and fetus when offering ECT. Deviating from our normal practice of mask ventilation for non-pregnant ECT necessitated much discussion with the psychiatry and nursing staff, along with additional equipment, monitoring and personnel to ensure maternal and fetal safety. Not only was the patient intubated twice a week, but preparations were in place to mobilize for a crash cesarean delivery in a non-obstetric pavilion. Our patient’s depression greatly improved and was followed by an uncomplicated term delivery of a healthy baby.

1. Anderson and Reti. Psychosom Med. 2009. 71:235-242

SOAP 2014