Anesthesia Management of Electroconvulsive Therapy at the Late of Pregnancy: A Case Report

Abstract

Objectives: Major maternal depression is well known as a morbid and common disorder with a prevalence of 12% in the third trimester of pregnancy. Psychotropic medications might not be quite safe in these cases. In addition, pharmacological resistance and any life-threatening conditions can appear with the acute need for an instant therapeutic response. In these cases, electroconvulsive therapy (ECT) might be the only effective option. However, both clinicians and patients often feel hesitant to utilize ECT throughout pregnancy due to the lack of reliable literature. Case Presentation: The challenging case of a 26-year-old pregnant woman at the 37 weeks of gestation was presented with major depression, who achieved full symptomatic remission after ECT. The critical status of this case was well managed by ECT treatment. Through the follow-ups, it was found that she is under medical therapy and has a normal life now. She is taking care of her baby and her symptoms are controlled as well. Conclusions: Overall, ECT could be a safe and effective treatment at late pregnancy. Obviously, a multidisciplinary team approach is crucial for achieving the desired goals.

Safety of electroconvulsive therapy (ECT) in pregnancy: a systematic review of case reports and case series

“…These complications included transient changes in heart rate and rhythm, blood pressure, uterine contractions, fetal spasms, pelvic pain, and the appearance of mild symptoms of hypomania. Among these, transient fetal arrythmias and uterine contractions were the most frequent, reported 10 (Varan et al 1985 ; Bhatia et al 1999 ; DeBattista et al 2003 ; Bozkurt et al 2007 ; De Asis et al 2013 ; Halmo et al 2014 ; Moosavi Rineh et al 2020 ; Rabie et al 2021 ; Bhasin et al 2022 ; Patel et al 2022 ) and four times (Bhatia et al 1999 ; Bulbul et al 2013 ; Grover et al 2017 ; Rabie et al 2021 ), respectively. Moderate-grade complications were those that have not had a rapid resolution and/or have required medical intervention; the most frequent was preterm birth, reported in seven papers (Livingston et al 1994 ; Pinette et al 2007 ; Kasar et al 2007 ; Yang et al 2011 ; Bulut et al 2013 ; Ray-Griffith et al 2016 ; Bhasin et al 2022 ).…”

“…As regard to complications, Wise ( 1984 ) and Gannon et al ( 2021 ) reported only low-grade complications in the mother (supraventricular tachycardia and the onset of hypomanic symptoms, respectively) and there were no complications in the fetus; Moosavi Rineh (Moosavi Rineh et al 2020 ) and Patel (Patel et al 2022 ) instead reported the appearance of low-grade complications in the fetus (transient fetal arrhythmia in both cases) and no maternal complications. Among the moderate maternal complications, three cases of ECT-induced preterm delivery and two cases of pre-eclampsia were reported (Salzbrenner et al 2011 ; Thyen et al 2017 ).…”

Evaluation of the Efficacy of the ECT Patients Preparation Checklist in Reducing the Cancellation Rate in an Academic Hospital

“…Although there has been much debate about the importance of admitting patients under optimal conditions, the anesthesia team cooperated fully with psychiatrists in the emergency setting, such as catatonia. For example, a pregnant woman at the gestational age of 38 weeks with suicidal ideation was considered for ECT treatment and received 6 ECT sessions despite her high-risk status (21). On the whole, it was found that using this checklist can effectively limit the cancellation rate in ECT patients.…”