Serial Fetal Heart Rate Monitoring During Electroconvulsive Therapy in Late Pregnancy: A Case Report of Transition From Succinylcholine to Rocuronium Reversed With Neostigmine.
Katsuichiro Shimizu, Hiroyuki Muraoka, Tomoe Fujita et al.
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Case in brief
A 30-year-old primigravida at 30 weeks of gestation presented with severe major depressive disorder and suicidal ideation. Electroconvulsive therapy (ECT) was initiated at 32 weeks, initially using succinylcholine, which was later switched to rocuronium due to a shortage. Serial fetal heart rate monitoring showed transient changes, but fetal well-being was maintained. The patient delivered vaginally at 37 weeks, and postpartum ECT was successfully resumed.
What made this case unusual
The case highlights the transition from succinylcholine to rocuronium for ECT in late pregnancy, with successful reversal using neostigmine, which is not commonly reported.
Diagnostic / clinical pearl
Clinicians should consider rocuronium with neostigmine reversal as a viable alternative to succinylcholine for ECT in late pregnancy when necessary, ensuring careful fetal monitoring.
Why it matters
This case underscores the importance of multidisciplinary management in complex cases of severe psychiatric disorders during pregnancy, particularly when standard treatment options are limited.