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10. Continuous Fetal Monitoring During Electroconvulsive Therapy: A Prospective Observation Study

Author

Rabie,Nader, Shah,Ronak, Ray-Griffith,Shona, Coker,Jessica L, Magann,Everett F, Stowe,Zachary N, Rabie,Nader, Shah,Ronak, Ray-Griffith,Shona, Coker,Jessica L, Magann,Everett F, and Stowe,Zachary N

Abstract

Nader Rabie,1 Ronak Shah,2 Shona Ray-Griffith,3 Jessica L Coker,3 Everett F Magann,4 Zachary N Stowe5 1Tripler Army Medical Center, Department of Obstetrics and Gynecology, Honolulu, HI, USA; 2Our Lady of Angels, Department of Obstetrics and Gynecology, Bogalusa, LA, USA; 3University of Arkansas for Medical Sciences, Department of Psychiatry, Little Rock, AR, USA; 4University of Arkansas for Medical Sciences, Department of Obstetrics and Gynecology, Little Rock, AR, USA; 5University of Wisconsin School of Medicine and Public Health, Psychiatric Institute and Clinic, Madison, WI, USACorrespondence: Everett F MagannUniversity of Arkansas for Medical Sciences, Department of Obstetrics and Gynecology, Little Rock, AR, USAEmail efmagann@uams.eduObjective: The use of electroconvulsive therapy in pregnancy has been limited by concerns about its effects on fetal well-being, despite limited evidence that suggests it is safe and effective. No studies have utilized continuous fetal heart rate monitoring during electroconvulsive therapy sessions. We aimed to describe the fetal heart rate patterns of patients undergoing electroconvulsive therapy.Design: This study is a prospective case series of pregnant patients undergoing electroconvulsive therapy with continuous fetal heart rate monitoring.Setting: University-based hospital.Population: Pregnant patients with a psychiatric indication for electroconvulsive therapy.Methods: Patients underwent fetal heart rate monitoring immediately prior, during and immediately after ECT therapy.Main Outcome Measures: Characterization of the fetal heart rate tracing.Results: Five subjects underwent 44 electroconvulsive therapy sessions. Continuous fetal monitoring was performed on 34 of the sessions. Transient fetal heart rate decelerations occurred in 4 sessions, all self-resolved and none required intervention.Conclusion: This case series is the first to report the results of continuous FHR monitoring during electroconvulsive therapy. The most

Published
2021

14. Fetal Assessment in Buprenorphine Maintained Women using Fetal Magnetoencephalography: A Pilot Study

Author

ESCALONA-VARGAS, Diana, COKER, Jessica L., RAY-GRIFFITH, Shona, SIEGEL, Eric R., LOWERY, Curtis L., STOWE, Zachary N., and ESWARAN, Hari

Subjects
Adult, Magnetocardiography, Brain, Magnetoencephalography, Pilot Projects, Heart Rate, Fetal, Opioid-Related Disorders, Article, Buprenorphine, Analgesics, Opioid, Pregnancy Complications, Young Adult, Fetus, Pregnancy, Case-Control Studies, Humans, Female, Fetal Monitoring, Fetal Movement
Abstract

BACKGROUND AND AIMS: In-utero exposure to opioids including buprenorphine (BUP) has been shown to affect fetal activity, specifically heart-rate variability (FHRV) and fetal movement (FM). Our objective was to extract simultaneous recordings of fetal cardiac, and brain-related activity in BUP-maintained and non-opioid exposed pregnant women using a novel non-invasive biomagnetic technique. DESIGN: A pilot study was conducted, recording and analyzing biomagnetic data from fetuses of BUP-maintained and non-opioid exposed pregnant women. Signals were acquired with non-invasive 151-channel SARA (SQUID-Array for Reproductive Assessment) system. Advanced signal-processing techniques were applied to extract fetal heart and brain activity. SETTING: University of Arkansas for Medical Sciences (UAMS, Little Rock, Arkansas, USA). PARTICIPANTS: Eight BUP-maintained pregnant women from UAMS Women’s Mental Health Program between gestational ages (GA) of 29 to 37 weeks who were treated with 8mg to 24mg of BUP daily. Sixteen pregnant women with no known opioid-exposure in the same GA range were also included. MEASUREMENTS: Outcome measures from the fetal heart and brain signals included: heart rate (FHR), FM, FHR accelerations, FHR-FM coupling, FHRV, fetal behavioral states (FBS) and power spectral density (PSD) of spontaneous brain activity. These measures were analyzed at three GA intervals. FINDINGS: Fetal heart and brain activity parameters were successfully extracted and quantified from 18 non-opioid and 16 BUP recordings. Overall analysis in both groups show that: FHR and FM ranged from 131-141 bpm and 5-11 counts, respectively. In the 35-37 week GA, the coupling duration (~9s) was the shortest, while three of the FHRV parameters were the highest. The PSD of brain activity revealed highest power in 0.5-4Hz bandwidth. Transitions in FBS from quiet to active sleep were >50% of sessions. CONCLUSIONS: This pilot study showed that a novel biomagnetic technique allows simultaneous quantification of cardiac and brain activities of a group of buprenorphine-exposed and non-exposed fetuses in the third trimester.

Published
2018

16. Buprenorphine Medication for Opioid Use Disorder: A Study of Factors Associated With Postpartum Treatment Retention.

Author

Ray‐Griffith, Shona, Tharp, Emily, Coker, Jessica L., Catlin, David, Knight, Bettina, Stowe, Zachary N., and Ray-Griffith, Shona

Subjects
OPIOID abuse, OPIOIDS, BUPRENORPHINE, DRUG toxicity, BIVARIATE analysis
Abstract

Background and Objectives: The factors associated with medication for opioid use disorder (MOUD) treatment retention among pregnant women with opioid use disorder (OUD) are largely unknown. This study sought to characterize factors associated with postpartum treatment retention.Methods: A retrospective chart review from 2014 to 2017 was conducted among women with OUD in pregnancy treated with buprenorphine. Women were assigned to the treatment retention group if they attended an appointment within 10 to 14 weeks postpartum. Others were assigned to the dropout group. The groups were compared using bivariate analysis for sociodemographic variables, obstetrical and neonatal outcomes, clinical and subjective opioid withdrawal symptoms, buprenorphine dosage, urine drug toxicology (UDT) results, and other factors.Results: A total of 64 pregnancies received treatment until delivery, and 47 (73.1%) were retained in treatment by 12 weeks postpartum. The treatment dropout group had lower buprenorphine doses at delivery, a higher percentage of benzodiazepine positive UDT, and number of UDT positive for benzodiazepine in the third trimester. Breastfeeding rates were higher in the treatment retention group.Discussion and Conclusions: Future research of variables related to postpartum treatment retention is needed to provide guidelines regarding MOUD during the perinatal period and to optimize maternal and fetal well-being.Scientific Significance: This study supports previous recommendations that aggressive treatment of withdrawal symptoms in pregnant women with OUD is needed to maximize treatment retention. This is the first study to find that breastfeeding was associated with postpartum treatment retention; while, increased use of benzodiazepines during pregnancy was associated with postpartum treatment dropout. (Am J Addict 2021;30:43-48). [ABSTRACT FROM AUTHOR]

Published
2021
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