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ECT Pregnancy Safety — MRCPsych Paper B MCQ

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HardPerinatal PsychiatryECT Pregnancy SafetyMRCPsych Paper B

A 30-year-old woman at 28 weeks' gestation has severe psychotic depression with persistent suicidal intent, refusal of food and fluids, and deteriorating physical health. An adequate antidepressant and antipsychotic trial has not produced improvement. The perinatal mental health team is considering electroconvulsive therapy (ECT). Which statement best reflects current UK guidance?

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Reveal the answer and explanation

Correct answer: D — Consider ECT now because the severe illness is creating serious maternal risk, with coordinated obstetric and anaesthetic care.

Explanation lettering: E = shown as B · B = shown as D · D = shown as E

B is correct. NICE CG192 recommends considering ECT during pregnancy for severe depression, severe mixed affective states, mania or catatonia when the woman's physical health or that of the fetus is at serious risk. Persistent suicidality, refusal of intake and physical deterioration meet this threshold; there is no restriction to a particular trimester. Delivery, established fetal compromise and catatonia are therefore not prerequisites. NICE also imposes no fixed requirement to fail two additional medication regimens when urgent risk requires rapid treatment. ECT is not risk-free: the evidence is mainly observational, and maternal, anaesthetic and transient fetal or obstetric complications can occur. It should consequently involve coordinated psychiatric, obstetric and anaesthetic assessment and pregnancy-specific monitoring. The original statement that there is simply 'no teratogenic risk' was too absolute for the available evidence.

Reference: National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance (CG192), recommendation 1.8.22, updated 2020. https://www.nice.org.uk/guidance/cg192/chapter/Recommendations