[Case report: electroconvulsive therapy during pregnancy]

The treatment for psychiatric disorders in pregnancy remains difficult to implement. We report the case of a 28-year-old woman, 20 weeks pregnant when admitted in our psychiatric department. She presented severe depressive disorder, associated with agitation, and psychotic symptoms as delusion and hallucinations occurred. The patient had a history of recurrent mood disorders dating back to eight years before the current admission, including some atypical episodes (psychotic symptoms only), and alternating with free periods without any trouble. A non-specific personality disorder is also probably present. We first used antidepressant (clomipramine) and sedative phenothiazine drugs. Because of the lack of therapeutic efficacy, three weeks later we tried another pharmacologic prescription, that also failed to improve the patient' status. It was hence decided to proceed with electroconvulsive therapy. We describe here the management of the courses, especially the careful monitoring and the anesthetic features we employed, among which endotracheal intubation, oxygen supply, real-time ultrasonography, and recording uterine contractions and fetal heart rate. All theses measures were applied within a surgical-obstetrical theatre. Nine bifrontal courses were performed in five weeks. They rapidly and completely improved the psychiatric symptoms. No sign of fetal neither maternal bad tolerance occurred. While the patient had been authorized to leave hospital, in 34th weeks amenorrhea a routine ultrasonographic examination discovered worrying fetal ascites signs. After the emergency caesarean delivery, the male newborn child undergone immediately surgical treatment for vascular meconium peritonitis, but died nine days later with metabolic post-surgical troubles. This fatal outcome after electroconvulsive therapy leads us to discuss its possible involvement, and in a more general way the safety and place of this treatment in pregnancy psychiatric disorders. They remain critical situations in which therapeutic methods should be rapidly decided. The authors wish others practitioners to bring new case-reports in order to assess the ECT safety-use during pregnancy.