Emergency management of agitation in pregnancy

This study aimed to better understand how agitated pregnant women are pharmacologically managed in a psychiatric emergency service (PES).

A retrospective chart review was conducted on 80 women admitted to a PES with HCG-positive urine, from January 1, 2004, to June 30, 2005. Of these, 31 patients required medication for agitation. We describe the demographics (age, ethnicity, housing status, insurance status), chief complaint, medical status, drug use and medical management in the PES, as well as pregnancy awareness, prenatal care and trimester. Patient data were analyzed using simple frequency calculations and cross tabulations with SPSS.

Thirty-one (39%) patients received 34 doses of psychotropic medication. Haloperidol, alone or in combination with a benzodiazepine, was the most frequently administered psychotropic medication, while risperidone was the second most commonly administered medication. Two patients required brief restraint for assaultive behavior that was unresponsive to any other intervention.

There are algorithms that provide guidance to clinicians regarding the pharmacological management of aggression. However, there are no efficacy or safety studies that recommend strategies for the management of the agitated pregnant patient.