Management of Antenatal Agitation in a Tertiary Care Center in Central India: A Secondary Analysis

Background The presence of psychiatric symptoms in pregnancy is a common occurrence that requires swift and effective management to avoid harm to self, caregivers, staff, and, above all, the reliant fetus. However, there is a dearth of knowledge, practical guidelines, and research in the context of managing agitated states of antenatal patients. To bridge this critical knowledge gap, this research endeavors to illuminate the practices surrounding the management of agitated pregnant women with respect to psychiatric emergencies in a tertiary care hospital. Aims and objectives This study aims to study the pattern of psychotropic drugs used to manage agitation in antenatal patients in a tertiary care institute. Methods This retrospective record-based study was conducted in a tertiary care center in Central India to assess psychiatric referrals for the management of acute agitation in the department of obstetrics and gynecology. The consultation-liaison (CL) records of interdepartmental psychiatric referrals were assessed for a duration of one year between September 2022 and August 2023. Results The most frequently used treatment was intramuscular promethazine 25 mg, given to 32.20% of the participants. This was followed by intramuscular haloperidol 1.25 mg (14.69%) and tablet olanzapine 5 mg (10.17%). Tablet haloperidol 2.5 mg and intramuscular haloperidol 5 mg combined with promethazine 25 mg were each administered to 6.78% of the participants. Other treatments included tablet lorazepam 2 mg (6.21%), intramuscular lorazepam 2 mg (6.21%), intramuscular haloperidol 2.5 mg (9.60%), intravenous lorazepam 2 mg (2.26%), and tablet quetiapine 50 mg (1.13%). Verbal de-escalation was employed for 3.95% of the participants. None of the patients had to be restrained physically. Conclusion This study on antenatal agitation found promethazine followed by haloperidol as the most common treatment, used intramuscularly in low doses. Benzodiazepines like lorazepam were used sparingly, while verbal de-escalation proved effective in some cases.