Continuous Fetal Monitoring During Electroconvulsive Therapy: A Prospective Observation Study

Figures & data

Table 1 Descriptive Characteristics of Patients and ECT Sessions

Subjects	Age	Diagnosis	#ECT	EGA Span of ECT	Medications	Central Seizure Duration	Peripheral Seizure Duration
1	25	Depression Anxiety	2	18 0/7 – 18 2/7	Clonazepam Lamotrigine	43–56 sec	35–39 sec
2	24	Bipolar disorder	9	16 6/7 – 24 1/7	Nortriptyline Lithium Promethazine Opiates	44–137 sec	44–112 sec
3	35	Bipolar disorder Depression Anxiety Suicidal ideation	23	30 0/7 – 31 2/7	Fluoxetine Buspirone Nortriptyline	30–106 sec	25–56 sec
4	29	Depression Social anxiety	6	30 0/7 – 31 6/7	Sertraline Buspirone Haldol	114–133 sec	50–74 sec
5	22	Depression Suicidal ideation	4	34 6/7 – 36 2/7	None	39–62 sec	39–50 sec

Table 2 Recommendations for Performing ECT in Pregnant Patients

Fetal Heart Rate Monitoring
<24 weeks	Fetal heart tones before and after procedure
≥ 24 weeks^A	Non stress test before and after procedure
Anesthesia
Premedication	H2 blocker or proton pump inhibitor
	IV hydration
≥ 16 weeks	Recommend intubation
Induction agents	Methohexital or propofol
Technique	Avoid hyperventilation
	Left lateral decubitus positioning with a wedge (>20 weeks)
Location
< 24 weeks	Any ECT facility
≥ 24 weeks	In proximity to labor and delivery facility^B
Medications	Withhold antiepileptic medications the night before
Pregnancy specific conditions	Preeclampsia and placenta previa are not contraindications, but patients should be medically stable prior to undergoing ECT

Notes: ^AThis should be adjusted to the specific institution’s gestational age for neonatal resuscitation; ^BIf there is no obstetric facility near the ECT facility, patients should be counseled that the likelihood of needing emergent obstetric care is very low and it is safe to proceed with ECT.