Coshal Shana, Jones Kristin, Coverdale John, Livingston Robin
COSHAL, JONES, COVERDALE, AND LIVINGSTON: Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX.
J Psychiatr Pract. 2019 Jan;25(1):2-6. doi: 10.1097/PRA.0000000000000359.
To inform obstetricians and psychiatrists about the safety of electroconvulsive therapy (ECT) administration during pregnancy and to reconcile conflicting recommendations concerning this treatment.
A systematically conducted overview was undertaken on the safety of ECT during pregnancy. The Cochrane Library, MEDLINE/PubMed, PsycINFO, and Ovid were independently searched by 2 of the authors from January 2015 to March 2017 using the following search terms: electroconvulsive therapy, ECT, and electroshock combined with pregnancy and reviews. Articles were reviewed and critically appraised using components of the PRISMA and AMSTAR systematic review assessment tools.
Of the 9 articles that were identified, 5 publications of varying methodological quality met inclusion criteria and involved a range of 32 to 339 patients. The most common problems that occurred in association with ECT were fetal arrhythmia, fetal bradycardia, premature birth, developmental delay, abdominal pain, uterine contraction, vaginal bleeding, placental abruption, and threatened abortion. The number of fetal deaths in each of the reviews ranged from 2 to 12. The authors of 1 of the 5 reviews recommended that ECT only be used as a last resort, whereas the authors of the other reviews took the stance that the administration of ECT during pregnancy was relatively safe. Differences in recommendations among reviews were in part due to inclusion criteria and how adverse events were attributed to ECT.
Our overview supports the conclusion, which has also been endorsed by the American College of Obstetricians and Gynecologists and the American Psychiatric Association, that administration of ECT during pregnancy is relatively safe. Conclusions about safety, however, will become better established with the availability of more data.
向产科医生和精神科医生告知孕期进行电休克治疗（ECT）的安全性，并协调有关该治疗的相互矛盾的建议。
对孕期ECT的安全性进行了系统的概述。2位作者于2015年1月至2017年3月独立检索了Cochrane图书馆、MEDLINE/PubMed、PsycINFO和Ovid，使用了以下检索词：电休克治疗、ECT、电击与妊娠及综述。使用PRISMA和AMSTAR系统评价评估工具的组件对文章进行了综述和严格评价。
在识别出的9篇文章中，5篇方法学质量各异的出版物符合纳入标准，涉及32至339名患者。与ECT相关的最常见问题是胎儿心律失常、胎儿心动过缓、早产、发育迟缓、腹痛、子宫收缩、阴道出血、胎盘早剥和先兆流产。各综述中的胎儿死亡数为2至12例。5篇综述中有1篇的作者建议ECT仅作为最后手段使用，而其他综述的作者则认为孕期进行ECT相对安全。综述之间建议的差异部分归因于纳入标准以及不良事件如何归因于ECT。
我们的概述支持美国妇产科医师学会和美国精神病学协会认可的结论，即孕期进行ECT相对安全。然而，随着更多数据的可得，关于安全性的结论将得到更好的确立。
