Table 1. Risks associated with ECT during pregnancy

Risk

Recommendations

Gastric reflux

Prolonged gastric emptying

Increased risk of regurgitation, aspiration, and pneumonitis, especially after first trimester

1. Consider pregnant patient as if she has full stomach.

2. Consider intubation after first trimester with caution, due to hypervascularity and edema causing bleeding (78).

3. Consider premedication with nonparticularte antacid (for example sodium citrate) (79), histamine-2 blocker, and gastric
motility enhancer.

4. Avoid atropine (increases chance of aspiration); use glycopyrrolate (less likely to cross placenta) (80).

Aortocaval compression

Generally later in pregnancy due to compression of venacava and aorta by large, heavy uterus

Reduces fetal circulation

1. Pretreat with intravenous hydration.

2. Avoid glucose solution to prevent diuresis.

3. Ensure adequate oxygenation, but not hyperventilation (78).

4. Place a wedge to elevate patient’s right hip to displace uterus to the left (81).

Medications with ECT during pregnancy

a) Muscle Relaxants

1. Succinylcholine does not cross placenta with normal doses (82).

2. Check pseudocholinesterase levels if maternal history suggests difficulty metabolizing succinylcholine (83); this
can cause respiratory difficulties in newborn.

b) Anticholinergic agents

1. Not recommended routinely in pregnancy.

2. Atropine crosses placenta quickly, causing fetal tachycardia and decreased variability in fetal heart rate.

3. Glycopyrrolate is less likely to cross placenta (79,84).

c) Barbiturates

1. Short-acting barbiturates typically have no known adverse effects that are special to pregnancy (70).