OBJECTIVES: Because of the lack of focus on the safety of electroconvulsive therapy (ECT) during the first trimester of pregnancy in current literature, we set out to assess the safety of ECT use during this vital period of fetal development.
METHODS: A systematic review was conducted, and a case where ECT was employed during the first trimester was presented. Cochrane Library, Ovid MEDLINE, PsycINFO, and PubMed were independently searched by 2 authors using the following search terms: "ECT," "electroconvulsive therapy," "electroshock" combined with "pregnancy," "first trimester of pregnancy," and "teratogenicity."
RESULTS: Of the 97 articles reviewed, 13 met inclusion criteria. We identified 32 first-trimester patients as cases or case series. Adverse outcomes, including miscarriage with previous vaginal bleeding, vaginal bleeding, self-limited abdominal pain, and self-limited fetal spasms, were observed. We added 1 case of a pregnant patient at approximately 9 weeks gestation who experienced a threatened abortion after the administration of ECT.
CONCLUSIONS: Although the data are limited, they suggest that ECT is relatively safe when administered during the first trimester of pregnancy. The possible adverse consequences of ECT during the first trimester of pregnancy should be carefully weighed against the potential benefits of ECT on untreated mental illness.
This study aims to explore practice, use, and risk of electroconvulsive therapy (ECT) in pregnancy. A systematic search was undertaken in the databases Medline, Embase, PsycINFO, SveMed and CINAHL (EBSCO). Only primary data-based studies reporting ECT undertaken during pregnancy were included. Two reviewers independently checked study titles and abstracts according to inclusion criteria and extracted detailed use, practice, and adverse effects data from full text retrieved articles. Studies and extracted data were sorted according to before and after year 1970, due to changes in ECT administration over time. A total of 67 case reports were included and studies from all continents represented. Altogether, 169 pregnant women were identified, treated during pregnancy with a mean number of 9.4 ECTs, at mean age of 29 years. Most women received ECT during the 2nd trimester and many were Para I. Main diagnostic indication in years 1970 to 2013 was Depression/Bipolar disorder (including psychotic depression). Missing data on fetus/child was 12 %. ECT parameter report was often sparse. Both bilateral and unilateral electrode placement was used and thiopental was the main anesthetic agent. Adverse events such as fetal heart rate reduction, uterine contractions, and premature labor (born between 29 and 37 gestation weeks) were reported for nearly one third (29 %). The overall child mortality rate was 7.1 %. Lethal outcomes for the fetus and/or baby had diverse associations. ECT during pregnancy is advised considered only as last resort treatment under very stringent diagnostic and clinical indications. Updated international guidelines are urgently needed.
Pharmacological treatment of severe psychiatric disorders during pregnancy is complicated by the potential harmful effects of treatment for the fetus. Electroconvulsive therapy (ECT) has been demonstrated to be effective for the treatment of several mental disorders. The aim of this study was to investigate the safety of ECT in the treatment of psychiatric disorders during pregnancy; to compare its efficacy with medication; and to identify the main indications for use in pregnancy. We performed a careful and systematic review of the literature on ECT and pregnancy was conducted. Almost all patients demonstrated total or at least partial remission of symptoms after ECT treatment. No deaths were reported in ECT-treated pregnant women. We conclude that ECT is probably currently under-used in many psychiatric settings because of its stigmatized perception by patients and by mental health professionals. ECT seems to be effective for treating major psychiatric disorders during pregnancy, and the risks of adverse events are low.
OBJECTIVE: 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.
METHOD: 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.
RESULTS: 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.
CONCLUSIONS: 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.
OBJECTIVE: Untreated major mood disorders during pregnancy pose significant risks. The author reviews case reports of the use of electroconvulsive therapy (ECT) during pregnancy to clarify potential risks and modifications of ECT techniques that make the procedure safer for pregnant women.
METHODS: A total of 300 case reports of ECT during pregnancy drawn from the literature from 1942 through 1991 were reviewed.
RESULTS: Twenty-eight of the 300 cases reported complications associated with ECT during pregnancy, including transient, benign fetal arrhythmias; mild vaginal bleeding; abdominal pain; and self-limited uterine contractions. Without proper preparation, there was also increased likelihood of aspiration, aortocaval compression, and respiratory alkalosis.
CONCLUSIONS: Electroconvulsive therapy is a relatively safe and effective treatment during pregnancy if steps are taken to decrease potential risks. Preparation for ECT during pregnancy should include a pelvic examination, discontinuation of nonessential anticholinergic medication, uterine tocodynamometry, intravenous hydration, and administration of a nonparticulate antacid. During ECT, elevation of the pregnant woman's right hip, external fetal cardiac monitoring, intubation, and avoidance of excessive hyperventilation are recommended. Informed consent for ECT should include the patient's capacity to understand and rationally evaluate risks and benefits to herself and the fetus.
Because of the lack of focus on the safety of electroconvulsive therapy (ECT) during the first trimester of pregnancy in current literature, we set out to assess the safety of ECT use during this vital period of fetal development.
METHODS:
A systematic review was conducted, and a case where ECT was employed during the first trimester was presented. Cochrane Library, Ovid MEDLINE, PsycINFO, and PubMed were independently searched by 2 authors using the following search terms: "ECT," "electroconvulsive therapy," "electroshock" combined with "pregnancy," "first trimester of pregnancy," and "teratogenicity."
RESULTS:
Of the 97 articles reviewed, 13 met inclusion criteria. We identified 32 first-trimester patients as cases or case series. Adverse outcomes, including miscarriage with previous vaginal bleeding, vaginal bleeding, self-limited abdominal pain, and self-limited fetal spasms, were observed. We added 1 case of a pregnant patient at approximately 9 weeks gestation who experienced a threatened abortion after the administration of ECT.
CONCLUSIONS:
Although the data are limited, they suggest that ECT is relatively safe when administered during the first trimester of pregnancy. The possible adverse consequences of ECT during the first trimester of pregnancy should be carefully weighed against the potential benefits of ECT on untreated mental illness.
