[Cesarean section and sismotherapy in a severe psychotic parturient: A case report].
Psychiatric disorders may complicate the pregnancy and is one of the causes of maternal and fetal morbidity. We report the case of a patient with severe decompensated schizophrenia during her pregnancy that required prolonged hospitalization in psychiatric ward. The psychiatric status of the patient required the realization of a caesarean section at 36 weeks of amenorrhea. In our case, we decided to perform this cesarean section under general anaesthesia, since regional anaesthesia was not feasible in this patient in a state of uncontrolled agitation. Moreover, general anaesthesia permitted to combine cesarean section with a first session of electroconvulsive therapy, which had been declined during pregnancy. Given the huge amount of antipsychotic agents administered to the patient, we also studied their transplacental transfer and found a very high loxapine concentration in the fetus. Finally, this case raised several important ethical issues related to the management of the mother and her fetus in case of severe psychiatric disorders.
Département d'anesthésie réanimation, hôpital Cochin, 27, rue Faubourg-Saint-Jacques, 75014 Paris, France.
C
C
Vermersch
S
S
Smadja
O
O
Amselem
O
O
Gay
L
L
Marcellin
R
R
Gaillard
A
A
Mignon
D000328:Adult; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D002585:Cesarean Section / Q000379:methods*; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D005333:Fetus / Q000378:metabolism; D006801:Humans; D008152:Loxapine / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology* / Q000628:therapy*; D012559:Schizophrenia / Q000150:complications* / Q000628:therapy*; D012565:Schizophrenic Psychology
D014150:Antipsychotic Agents; D008152:Loxapine
Anesthésie locorégionale; Electroconvulsive therapy; Ethics; Grossesse; Pregnancy; Regional anesthesia; Schizophrenia; Schizophrénie; Sismothérapie; Éthique