Serotonin Syndrome in Obstetrics: A Case Report and Review of Management.

Serotonin syndrome (SS) is a life-threatening condition, usually precipitated by a combination of serotonergic agents. Data regarding the incidence and management of SS in obstetrics are limited. This study presents a case of SS provoked by an atypical antipsychotic in a second trimester, singleton gestation, and reviews the management of SS in an obstetric patient. We present a case of a schizophreniform, pregnant patient with a singleton gestation admitted to a community, military hospital for serotonin syndrome. The patient was admitted to the intensive care unit (ICU) by the obstetrics team, where she was managed conservatively. The cornerstones of therapy were as follows: discontinuation of offending agent, intravenous fluids, supplemental oxygen, telemetry, and hourly neurological assessments. Fetal status was monitored daily. After stabilization, the patient was transferred from the ICU to inpatient psychiatry for continued care. Although serotonin syndrome is infrequently encountered in obstetrics, it is paramount that all obstetricians are familiar with its recognition and management, particularly in community hospital settings. The low incidence of reported SS is largely attributed to under-recognition, as the syndrome can mimic other more common obstetric diagnoses such as preeclampsia. Given the increasing prevalence of mental health disorders, it is essential for obstetricians to be aware of the potential for SS in our patient population.