Managing Acute Behavioural Disturbance in Perinatal Women: A Systematic and State of the Art Review of Guidelines.

Abstract

Background: Guidelines for managing acute behavioural disturbance typically exclusively focus on care for adults in mental health and related settings, how this should be adapted to safely manage in pregnancy and the early postpartum including in settings such as maternity wards is less clear.

Aims: To undertake a systematic and state of the art review on managing acute behavioural disturbance (ABD) in perinatal (pregnant and postpartum) women.

Materials and methods: A systematic review of national and international mental health guidelines for managing perinatal acute behavioural disturbance and a state of the art review synthesis of adult mental health management of acute behavioural disturbance principles, pregnancy and lactation pharmacotherapy principles, and obstetrics risks relevant to perinatal ABD management.

Results: Only two published guidelines that included perinatal ABD were identified. Many overarching principles in ABD management are suitable for perinatal women, however adaptation of sedation and physical restraint is necessary to ensure safety in pregnancy. Identified were principles of pharmacological exposure and choice of agent in pregnancy that can be applied to ABD as well as principles in pregnancy that can be utilised for safer physical restraint.

Conclusion: When managing ABD in pregnancy or postpartum including on maternity wards, many of the guiding principles such as the use of least restrictive practices and de-escalation can be applied without adaptation to perinatal period. However, when pharmacological agents and/or physical restraint are indicated then certain adaptations for pregnancy and lactation are required to ensure the safe care of women and infants.