Obstetric and neonatal outcomes of women admitted antenatally to a mother and baby unit due to significant mental health illness (Protti, Parisaie, Koniman, Thomas, Lawn, 2020)

Protti O. Parisaie M. Koniman W. Thomas D. Lawn T.

Archives of Women's Mental Health 2020;23(2): 280.

Aims: To evaluate the obstetric, neonatal and psychiatric outcomes of women with severe mental health illness who were admitted antenatally and delivered whilst an inpatient at the Margaret Oates Mother and Baby Unit (MBU) in East London. This presentation will highlight the joint working between maternity and psychiatric services in supporting high risk pregnant women requiring inpatient psychiatric care. Method(s): Retrospective case-note review of all women admitted to the MBU whilst pregnant over a 6-year period (2010 - 2015). Result(s): 52 antenatal patients were admitted to the MBU over the study period. Majority were under 35 years of age (75%), primips (54%) and had a BMI <=30 (59%). 60% of patients reported socioeconomic difficulties and 17% divulged a history of domestic abuse. Women were admitted as planned admissions or where there was deterioration in their mental health in late pregnancy. The commonest psychiatric diagnoses were schizophrenia (36%), bipolar disorder (34%) and depression (22%). 18% had a history of suicide attempts and 38% were current smokers and/or users of alcohol or illicit substances. The livebirth rate was 98%. All babies were born at >=36 weeks gestation. 90% of women who went into labour spontaneously had a vaginal delivery. Out of the 22 caesarean sections performed, 3 required general anaesthesia with the primary indication being maternal psychiatric illness. The average birthweight of the babies was 3218g (2320g-4540g). 92% were born with good Apgars. Discussion(s): Despite 58% of these high-risk patients presenting from other maternity or psychiatric units (96% in the third trimester), the outcome is favourable. This is likely due to the care provided by specialist psychiatric nurses, specialist perinatal mental health midwife, perinatal psychiatrists and obstetricians. These women are screened for diabetes, preeclampsia and growth restriction1. The unit would generally aim for a vaginal delivery where clinically appropriate and this is evidenced by the successful high vaginal delivery rate in the study. Conclusion(s): In the latest MBRRACE report2 into maternal death, almost a quarter of women who died between 6 weeks and 1 year after pregnancy died from mental-health related causes, with 1 in 7 dying by committing suicide. Allwomen deserve access to expert perinatalmental health care, which is best offered in a multi-disciplinary fashion, in order to ensure the best outcome for both mother and baby. Admission to a psychiatric mother and baby unit confers a good outcome for both mother and baby if admitted antenatally.