Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Mental Health and Behavioral Sciences, James A. Haley Veterans Hospital, Tampa, FL, USA.
J Psychosom Obstet Gynaecol. 2021 Sep;42(3):253-257. doi: 10.1080/0167482X.2020.1789584. Epub 2020 Jul 30.
Pregnancy denial can be broken into two major types, non-psychotic and psychotic deniers, and further classified into pervasive, affective and persistent sub-types. It can lead to increased morbidity and mortality of the mother and neonate. Psychotic pregnancy denial is rare and the medical literature existing on the subject is limited to a small number of case reports and case series. No formal recommendation exists on the clinical management of psychotic pregnancy denial in the antenatal or postpartum period. The authors provide a comprehensive review of the literature regarding psychotic pregnancy denial, present an example of an unpublished case and provide suggestions for clinical management.
A 33-year-old primigravida at 37 6/7 weeks gestation presented with new-onset psychotic pregnancy denial with no prior history of psychosis. She had a negative medical work-up for organic causes of psychosis. Using a multidisciplinary approach, the decision was made to deliver the fetus at 38 1/7 weeks cesarean section due to concerns for patient and fetal safety. Following delivery, she was admitted to an inpatient psychiatric facility and underwent 16 bilateral electroconvulsive therapy (ECT) treatments to which she showed complete response.
Psychotic pregnancy denial is rare and potentially dangerous. Delivery prior to 39 weeks gestation is reasonable for worsening psychiatric disease but careful consideration of the risk-benefit analysis and ethical framework must be deliberated. In cases of worsening psychiatric disease in pregnancy, a multidisciplinary approach is necessary for comprehensive care. Psychotic denial of pregnancy leads to increased maternal and neonatal morbidity and mortality. Delivery prior to 39 weeks gestational age is reasonable to expedite psychiatric treatment.PrecisUsing a multidisciplinary approach, the decision to deliver before 39 weeks gestation is reasonable for worsening psychiatric disease.
妊娠否认可分为非精神病性和精神病性否认两种主要类型，并可进一步分为弥漫性、情感性和持续性亚型。它可导致母婴发病率和死亡率增加。精神病性妊娠否认很少见，现有的医学文献仅限于少数病例报告和病例系列。在产前或产后期间，针对精神病性妊娠否认，没有正式的临床管理建议。作者对精神病性妊娠否认的文献进行了全面回顾，提供了一个未发表病例的示例，并提出了临床管理建议。
一位 33 岁初产妇，妊娠 37 周 6/7 天，出现新发精神病性妊娠否认，此前无精神病病史。她接受了全面的医学检查，未发现精神病的器质性原因。采用多学科方法，由于担心患者和胎儿的安全，决定在 38 周 1/7 天行剖宫产分娩。分娩后，她被收入住院精神科病房，并接受了 16 次双侧电惊厥治疗（ECT），她对此完全有反应。
精神病性妊娠否认很少见且具有潜在危险。对于精神疾病恶化，在 39 周前分娩是合理的，但必须仔细考虑风险效益分析和伦理框架。对于妊娠期间精神疾病恶化的情况，需要多学科方法进行全面护理。妊娠否认导致母婴发病率和死亡率增加。在 39 周前分娩以加速精神治疗是合理的。
采用多学科方法，对于精神疾病恶化，在 39 周前分娩是合理的。
