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Importance: The identification of the cavum septum pellucidum (CSP) is an integral part of the routine second trimester fetal anatomy scan. The absence or nonvisualization of the CSP has significant clinical implications and requires further evaluation and counseling for the pregnant patient. Objective: The aim of this review is to review the importance of accurate sonographic identification of the CSP and the underlying pathologies that can be associated with nonvisualization of this structure. Evidence Acquisition: A literature review was performed with PubMed using key words including CSP, fetal anatomy ultrasound, and fetal anomalies. Results: The absence of the CSP is associated with several central nervous system pathologies, all with a wide range of phenotypic outcomes, ranging from normal to very severe or lethal. Relevance: Most obstetrician-gynecologists will have a patient in whom a CSP is not identified on fetal ultrasound. Thus, it is imperative to have a general understanding of this relatively common entity.
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Tabique Pelúcido , Ultrasonografía Prenatal , Humanos , Tabique Pelúcido/diagnóstico por imagen , Tabique Pelúcido/anomalías , Ultrasonografía Prenatal/métodos , Embarazo , Femenino , Segundo Trimestre del EmbarazoRESUMEN
Adnexal masses in the third trimester of pregnancy may obstruct the pelvic outlet precluding labor induction and vaginal delivery. Expectant versus surgical management of adnexal cysts in pregnancy must carefully weigh maternal-fetal benefits and risks. Simple benign appearing cysts with low likelihood of malignancy may be amenable to percutaneous drainage as a bridge to interval postpartum laparoscopic cystectomy. We demonstrated posterior culdocentesis as a safe, minimally invasive technique to decompress a simple benign appearing left adnexal cyst obstructing the pelvic outlet in the third trimester at the time of labor induction to facilitate vaginal delivery and prevent primary cesarean delivery. Detailed sonographic cyst evaluation and counseling on underlying risk of malignancy must be considered to guide shared decision-making.
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IMPORTANCE: Since 2013, the United States has seen a rise in cases of congenital syphilis, culminating in a relative increase of 153% from 2013 to 2017 and 918 reported cases in 2017. In all, 50% to 80% of pregnant women with syphilis experience an adverse pregnancy outcome including stillbirth or spontaneous abortion. OBJECTIVE: This article aims to review the current evidence and recommendations for management of syphilis in pregnancy. EVIDENCE ACQUISITION: Original research articles, review articles, and guidelines on syphilis were reviewed. RESULTS: In pregnancy, routine screening for syphilis is recommended on initiation of prenatal care. In high-risk populations, repeat testing is recommended in the early third trimester and at delivery. Penicillin remains the recommended treatment in pregnancy. After treatment, nontreponemal titers should be repeated at minimum during the early third trimester and at delivery to assess for serologic response. In high-risk populations, titers should be repeated monthly. CONCLUSION AND RELEVANCE: Routine screening in pregnancy is essential for identification of syphilis infection and prevention of congenital syphilis. Subsequent adequate treatment with penicillin therapy more than 30 days before delivery and at the correct dosages depending on the stage of infection should be incorporated into clinical practice.
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Antibacterianos/uso terapéutico , Penicilinas/uso terapéutico , Complicaciones Infecciosas del Embarazo , Sífilis Congénita/prevención & control , Sífilis , Aborto Espontáneo , Femenino , Humanos , Tamizaje Masivo , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Factores de Riesgo , Mortinato , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Sífilis Congénita/etiología , Ultrasonografía PrenatalAsunto(s)
Anomalías Múltiples/diagnóstico , Encefalopatías/diagnóstico , Retardo del Crecimiento Fetal/diagnóstico , Pruebas Genéticas , Ictiosis/diagnóstico , Deformidades Congénitas de las Extremidades/diagnóstico , Microcefalia/diagnóstico , Diagnóstico Prenatal/métodos , Anomalías Múltiples/genética , Encefalopatías/genética , Muestra de la Vellosidad Coriónica , Consanguinidad , Femenino , Retardo del Crecimiento Fetal/genética , Edad Gestacional , Homocigoto , Humanos , Ictiosis/genética , India , Cariotipo , Deformidades Congénitas de las Extremidades/genética , Microcefalia/genética , Medida de Translucencia Nucal , Linaje , Fosfoglicerato-Deshidrogenasa/genética , Mutación Puntual , Ultrasonografía Prenatal , Adulto JovenRESUMEN
BACKGROUND: Conservative excisional measures used to manage cervical dysplasia are often cited as risk factors for preterm labor in subsequent pregnancies. OBJECTIVE: We performed an evidence-based review of the obstetric complications following excisional procedures for cervical dysplasia in women of reproductive age. EVIDENCE ACQUISITION: Between 1993 and 2016, there were 7 published meta-analyses of cohort studies that consistently demonstrated an association between excisional cervical procedures and preterm labor. However, controversy remains as to whether the increased risk is due to the cervical amputation or to the risk factors that underlie the dysplasia. RESULTS: Although data suggest an association between excisional procedures and preterm labor, the choice of the control group may either overestimate or underestimate the relative risk. In addition, recent data suggest that depth of excision greater than 10 to 12 mm is associated with increases in risk of preterm birth. CONCLUSIONS: Women with cervical dysplasia are at an increased baseline risk of preterm birth, and surgical excision confers additional risk. Pregnant patients with advanced cervical dysplasia or a history of surgical excision should be considered high-risk pregnancies.
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Conización/efectos adversos , Electrocirugia/efectos adversos , Trabajo de Parto Prematuro/etiología , Complicaciones Neoplásicas del Embarazo/cirugía , Resultado del Embarazo , Displasia del Cuello del Útero/cirugía , Cuello del Útero/cirugía , Conización/métodos , Electrocirugia/métodos , Femenino , Humanos , Embarazo , Factores de RiesgoRESUMEN
IMPORTANCE: An estimated 1% to 2.5% of pregnant women in the United States are infected with hepatitis C virus (HCV), which carries approximately a 6% risk of mother-to-infant transmission. OBJECTIVES: The aims of this article are to review the current evidence on HCV in pregnancy and to provide updated recommendations for management. EVIDENCE ACQUISITION: Original research articles, review articles, and guidelines on HCV in general and specifically in pregnancy were reviewed, as were drug safety profiles from the Food and Drug Administration. RESULTS: Pregnancy appears to have a beneficial effect on the course of maternal chronic HCV infection. However, it is associated with an increased risk of adverse fetal outcomes, including fetal growth restriction and low birth weight, and can be transmitted to the infant in utero or during the peripartum period. No perinatal intervention has been shown to reduce the risk of vertical transmission, but some may increase this risk. To date, no treatment regimens for HCV have been approved for use in pregnancy, but the new ribavirin-free, direct-acting antiviral regimens are being used with high efficacy outside pregnancy. CONCLUSIONS AND RELEVANCE: Hepatitis C virus infection in pregnancy generally does not adversely affect maternal well-being but is associated with adverse effects on the fetus because of pregnancy complications and vertical transmission. There are currently no approved treatment regimens for HCV in pregnancy; this should be an active area of research in obstetrics.
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Antivirales/uso terapéutico , Hepatitis C/tratamiento farmacológico , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Estudios de Casos y Controles , Manejo de la Enfermedad , Femenino , Hepatitis C/diagnóstico , Hepatitis C/transmisión , Humanos , Recién Nacido , Tamizaje Masivo , Guías de Práctica Clínica como Asunto , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Resultado del Embarazo , Estudios Retrospectivos , Factores de RiesgoAsunto(s)
Neoplasias Abdominales , Disección/métodos , Enfermedades Fetales , Teratoma , Neoplasias Abdominales/diagnóstico por imagen , Neoplasias Abdominales/patología , Neoplasias Abdominales/cirugía , Adulto , Diagnóstico Diferencial , Femenino , Enfermedades Fetales/diagnóstico , Enfermedades Fetales/patología , Enfermedades Fetales/cirugía , Humanos , Recién Nacido , Masculino , Embarazo , Teratoma/diagnóstico , Teratoma/patología , Teratoma/cirugía , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Ultrasonografía Prenatal/métodosRESUMEN
IMPORTANCE: Major congenital abnormalities, or birth defects, carry significant medical, surgical, cosmetic, or lifestyle consequences. Such abnormalities may be syndromic, involving multiple organ systems, or can be isolated. Overall, 2% to 4% of live births involve congenital abnormalities. Risk factors for birth defects are categorized as modifiable and nonmodifiable. Modifiable risk factors require thorough patient education/counseling. The strongest risk factors, such as age, family history, and a previously affected child, are usually nonmodifiable. OBJECTIVE: This review focuses on risk factors for birth defects including alcohol consumption, illicit drug use, smoking, obesity, pregestational diabetes, maternal phenylketonuria, multiple gestation, advanced maternal age, advanced paternal age, family history/consanguinity, folic acid deficiency, medication exposure, and radiation exposure. EVIDENCE ACQUISITION: Literature review via PubMed. RESULTS: There is a strong link between alcohol use, folic acid deficiency, obesity, uncontrolled maternal diabetes mellitus, uncontrolled maternal phenylketonuria, and monozygotic twins and an increased risk of congenital anomalies. Advanced maternal age confers an increased risk of aneuploidy, as well as nonchromosomal abnormalities. Some medications, including angiotensin converting enzyme inhibitors, retinoic acid, folic acid antagonists, and certain anticonvulsants, are associated with various birth defects. However, there are few proven links between illicit drug use, smoking, advanced paternal age, radiation exposure, and statins with specific birth defects. CONCLUSIONS AND RELEVANCE: Birth defects are associated with multiple modifiable and nonmodifiable risk factors. Obstetrics providers should work with patients to minimize their risk of birth defects if modifiable risk factors are present and to appropriately counsel patients when nonmodifiable risk factors are present.
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Anomalías Congénitas , Consejo/métodos , Conducta de Reducción del Riesgo , Anomalías Congénitas/epidemiología , Anomalías Congénitas/prevención & control , Anomalías Congénitas/psicología , Modificador del Efecto Epidemiológico , Femenino , Humanos , Embarazo , Medición de Riesgo , Factores de RiesgoRESUMEN
Congenital heart disease (CHD) occurs in 4-13 per 1000 births in the United States. While many risk factors for CHD have been identified, more than 90% of cases occur in low-risk patients. Guidelines for fetal cardiac screening during the second trimester anatomy ultrasound have been developed by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) in order to improve antenatal detection rates and to standardize the fetal cardiac screening examination. Patients found to be at increased risk of CHD because of risk factors or an abnormal screening examination should be referred for second trimester fetal echocardiography. Recently, 3D and 4D ultrasound techniques are being utilized to enhance detection rates and to better characterize cardiac lesions, and several first trimester ultrasound screening markers have been proposed to identify patients at increased risk of CHD. However, detection rates have not improved significantly due to limitations such as cost, access, and training that are associated with new technologies and screening methods. The most cost effective way to improve detection rates of CHD may be to standardize screening protocols across practices according to established guidelines and to have a low threshold for referral for fetal echocardiography.
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Corazón Fetal , Cardiopatías Congénitas , Ultrasonografía Prenatal/métodos , Femenino , Corazón Fetal/diagnóstico por imagen , Corazón Fetal/fisiopatología , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/fisiopatología , Humanos , Tamizaje Masivo/métodos , Guías de Práctica Clínica como Asunto , Embarazo , Trimestres del Embarazo/fisiología , Reproducibilidad de los Resultados , Factores de RiesgoRESUMEN
Obesity is a source of major morbidity and mortality and is a growing concern worldwide. Maternal obesity is associated with increased maternal and fetal risks during pregnancy. Bariatric surgery has emerged as one of the most sustainable treatments for severe obesity and its comorbidities. Patients who have undergone bariatric surgery often experience drastic improvements in hypertension and diabetes. It is not surprising, therefore, that the incidence of bariatric surgery is increasing, particularly in women of childbearing age. In fact, many women undergoing bariatric surgery plan to become pregnant in the future. Bariatric surgery may have a beneficial effect on rates of fetal macrosomia, gestational diabetes, hypertension, and preeclampsia. Conversely, studies have showed that bariatric surgery may increase the risk of small for gestational age infants and preterm birth. Given its rising incidence, it is important that physicians be able to thoroughly and accurately counsel and treat patients who plan to, or do, become pregnant after bariatric surgery.
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Cirugía Bariátrica , Obesidad/complicaciones , Obesidad/cirugía , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/prevención & control , Resultado del Embarazo , Atención Prenatal/métodos , Adulto , Cirugía Bariátrica/efectos adversos , Cirugía Bariátrica/métodos , Femenino , Humanos , Embarazo , Fenómenos Fisiologicos de la Nutrición Prenatal , Factores de RiesgoRESUMEN
The incidence of congenital heart disease is most commonly reported in 8 per 1000 live births. Situs anomalies are among the least common forms of congenital heart disease. This study defines situs and describes the variations of fetal situs anomalies. Situs refers to the arrangement of the viscera, atria, and vessels within the body. Situs solitus describes the normal arrangement; situs inversus describes inverted arrangement of the viscera and atria; and situs ambiguous (also referred to as heterotaxy) describes disturbances in arrangements that can neither be identified as solitus nor inversus. This review will concentrate on heterotaxy, as it is the most complicated situs abnormality to define, classify, and study. Prognosis of heterotaxy is variable but most correlated with cardiac anatomy. Management is concentrated on numerous cardiac operations and requires a multidisciplinary approach to address coexisting congenital anomalies.
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Síndrome de Heterotaxia/complicaciones , Síndrome de Heterotaxia/epidemiología , Adulto , Dextrocardia/epidemiología , Femenino , Asesoramiento Genético , Síndrome de Heterotaxia/clasificación , Síndrome de Heterotaxia/diagnóstico , Síndrome de Heterotaxia/terapia , Humanos , Incidencia , Levocardia/epidemiología , Embarazo , Pronóstico , Terminología como Asunto , Ultrasonografía PrenatalRESUMEN
As the average age that women have their first child increases and cancer therapies improve survival, obstetricians are more likely to care for pregnant women who have survived cancer. Managing these pregnancies can be challenging, as they may be associated with higher risks of maternal and neonatal morbidity and mortality. Different types of cancer require different types of intervention, including surgery, chemotherapy, radiation, or combinations of these. Prior cancer treatments therefore present different potential complications during pregnancy. Although for most women who survive cancer carrying a pregnancy does not seem to increase mortality rates, there are some associated neonatal morbidities. The most common perinatal complication associated with pregnancy after cancer is prematurity. Women who desire pregnancy after cancer survival should not be discouraged, but appropriate counseling and follow-up should be provided.
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Neoplasias de la Mama/complicaciones , Melanoma/complicaciones , Complicaciones Neoplásicas del Embarazo/etiología , Neoplasias Cutáneas/complicaciones , Neoplasias de la Tiroides/complicaciones , Neoplasias del Cuello Uterino/complicaciones , Neoplasias de la Mama/terapia , Consejo Dirigido , Femenino , Humanos , Atención Perinatal , Embarazo , Resultado del Embarazo , Nacimiento Prematuro/etiología , Pronóstico , Sobrevivientes , Neoplasias de la Tiroides/terapia , Neoplasias del Cuello Uterino/terapiaRESUMEN
Congenital atrioventricular block (CAVB) affects approximately 2% of fetuses of mothers with anti-Ro or anti-La antibodies, regardless of maternal rheumatologic symptoms. Anti-Ro and anti-La antibodies are antinuclear antibodies commonly found in autoimmune diseases. Congenital atrioventricular block is associated with a relatively high fetal morbidity and mortality, particularly more advanced degrees of block. There is significant controversy surrounding surveillance of anti-Ro/La-positive pregnancies and treatment of fetuses diagnosed with CAVB. Studies of dexamethasone in the treatment of CAVB have yielded conflicting results, with most suggesting only a limited potential benefit in first- and seconddegree CAVB and in cases complicated by fetal hydrops. Larger prospective studies are needed to further evaluate the efficacy of intravenous immunoglobulin in the treatment of CAVB and of intravenous immunoglobulin and hydroxychloroquine in the prevention of CAVB in fetuses of at-risk mothers. Surveillance and treatment regimens should be determined on a case-by-case basis, taking into consideration the degree of CAVB, costs, and potential adverse effects of treatment.
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Antiinflamatorios/uso terapéutico , Antirreumáticos/uso terapéutico , Bloqueo Atrioventricular/congénito , Bloqueo Atrioventricular/tratamiento farmacológico , Factores Inmunológicos/uso terapéutico , Bloqueo Atrioventricular/inmunología , Dexametasona/uso terapéutico , Femenino , Histocompatibilidad Materno-Fetal/inmunología , Humanos , Hidroxicloroquina/uso terapéutico , Inmunoglobulinas/uso terapéutico , Recién Nacido , Embarazo , Diagnóstico PrenatalRESUMEN
OBJECTIVE: To characterize antithrombin (AT) levels in normal pregnancy. METHODS: We performed secondary analyses with data from 3 studies. Using a single measurement from each subject in the first analysis (cross-sectional), we correlated AT levels with gestational age from the middle of the second trimester throughout the third trimester of pregnancy. Using serial measurements in a second analysis (cohort), we compared AT levels between the late first and second trimesters of pregnancy and baseline (the level at 6 weeks postpartum). Using serial measurements in a third analysis (cohort), we analyzed the pattern of change in AT levels in the immediate postpartum period. Assays of AT activity were performed using the Dade Behring (Siemens) Berichrom Antithrombin III Chromogenic Assay. AT levels were correlated with gestational age using the Pearson correlation coefficient and compared between the different time points using one-way ANOVA. RESULTS: Overall, AT levels were 20% lower than baseline during pregnancy (p<0.01). There was no significant difference between AT levels obtained between late first trimester and late second trimester. From midtrimester to term, however, AT levels were negatively correlated with gestational age with a 13% drop during this period of time (r=-0.26 [-0.39, -0.11]; p<0.01). Immediately after childbirth, AT levels fell precipitously to 30% below baseline (p<0.05) and reached a nadir 12 hours postpartum before rising and returning to baseline by 72 hours postpartum. CONCLUSION: It appears that antithrombin (AT) is consumed at the time of delivery. Our findings have implications for AT replacement or even anticoagulation at the time of delivery.
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Antitrombina III/metabolismo , Adulto , Biomarcadores/sangre , Estudios Transversales , Femenino , Edad Gestacional , Humanos , Periodo Posparto/sangre , Embarazo , Segundo Trimestre del Embarazo/sangre , Tercer Trimestre del Embarazo/sangreRESUMEN
Fetal growth restriction is a complex problem in modern obstetrics. It is a condition of suboptimal fetal growth based on a genetically predetermined potential and affects approximately 5% to 10% of pregnancies. It is traditionally defined as an estimated fetal weight less than the 10th percentile. Those pregnancies that are affected by growth restriction are associated with increased risk of perinatal morbidity and mortality. Because of this increased risk, these pregnancies are monitored more closely to try to identify those fetuses at the greatest risk of fetal demise and initiate delivery before this critical event. Although the ideal management strategy is still being determined, there are several modalities available to assist in assessment of the growth-restricted fetus. These include the nonstress test test, biophysical profile, and Doppler velocimetry, most commonly of the fetal umbilical artery, in addition to sonographic growth assessment. The use of multiple fetal assessment tools may help improve the prediction of adverse outcomes and initiate delivery before cardiovascular collapse.
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Retardo del Crecimiento Fetal/diagnóstico , Retardo del Crecimiento Fetal/terapia , Biofisica , Cardiotocografía , Parto Obstétrico , Femenino , Retardo del Crecimiento Fetal/diagnóstico por imagen , Retardo del Crecimiento Fetal/fisiopatología , Humanos , Flujometría por Láser-Doppler , Arteria Cerebral Media/diagnóstico por imagen , Monitoreo Fisiológico , Embarazo , Proteína Plasmática A Asociada al Embarazo/análisis , Arteria Renal , Ultrasonografía Doppler , Ultrasonografía Prenatal , Arterias Umbilicales/fisiopatología , Arteria Uterina/fisiopatologíaRESUMEN
UNLABELLED: Vaccinations in pregnancy are an important aspect of prenatal care and of improving not only maternal health but also neonatal outcomes. Only 2 vaccines are specifically recommended during pregnancy: influenza and tetanus, diphtheria, and acellular pertussis (Tdap). Because influenza illness disproportionately affects pregnant women compared with other populations, annual prevention of influenza illness is recommended for all women who will be pregnant during influenza season (October to May). Influenza vaccination has been recently reported to also result in decreased febrile respiratory illnesses in the newborn, likely through passive antibody transfer. Pertussis infection rates are rising in the United States as vaccine-induced immunity wanes, with the mortality burden primarily seen in infants aged <6 months. Pertussis immunization with Tdap is now recommended for all pregnant women during the late second (>20 weeks) or third trimester with the intent to both protect the pregnant woman and provide passive antibody to the infant before vaccination at 2 months of age. Provider support for these recommendations regarding both annual influenza vaccination and postpartum Tdap vaccination during pregnancy is critical to ensuring vaccine delivery and improving both maternal and fetal health. The article reviews the epidemiology and clinical aspects of influenza and pertussis infection with particular attention to pregnancy and recommendations for vaccination in these women. TARGET AUDIENCE: Obstetricians and gynecologists, ophthalmologists, neurologists, family physicians, emergency room physicians LEARNING OBJECTIVES: After completing this CME activity, obstetricians and gynecologists should be better able to analyze how influenza infection disproportionally affects pregnant women. Assess how influenza vaccination improves maternal and likely neonatal outcomes. Evaluate pertussis infection and immunity in adults, and counsel pregnant women as to the benefits of Tdap vaccination, particularly for the infant.
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Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Tos Ferina/prevención & control , Femenino , Humanos , Gripe Humana/tratamiento farmacológico , EmbarazoRESUMEN
OBJECTIVE: To evaluate platelet function in mothers and fetuses/neonates exposed to magnesium sulfate intrapartum. METHODS: This was a prospective cohort study of mothers and fetuses/neonates exposed to magnesium sulfate intrapartum compared to mothers and fetuses/neonates not exposed. Platelet aggregometry was performed in duplicate on specimens from subjects using two different agonists, ADP and collagen, on a whole blood impedance aggregometer. RESULTS: Specimens were processed from 11 mothers and 10 fetuses/neonates exposed to magnesium and 12 mothers and fetuses/neonates, not exposed. There was no difference in platelet aggregation between the specimens from the mothers who were exposed and mothers not exposed. In the specimens from the fetuses/neonates, there was no difference using collagen as an agonist, but using ADP as an agonist, there was a remarkable difference - 0.0 ohms in the exposed group vs. 3.0 ohms in the unexposed group (p < 0.01). CONCLUSIONS: In-utero magnesium sulfate exposure significantly suppresses fetal platelet function.
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Anticonvulsivantes/efectos adversos , Sulfato de Magnesio/efectos adversos , Agregación Plaquetaria/efectos de los fármacos , Tocolíticos/efectos adversos , Adolescente , Adulto , Anticonvulsivantes/uso terapéutico , Femenino , Sangre Fetal/efectos de los fármacos , Humanos , Recién Nacido , Trabajo de Parto , Sulfato de Magnesio/uso terapéutico , Masculino , Trabajo de Parto Prematuro/prevención & control , Preeclampsia , Embarazo , Estudios Prospectivos , Convulsiones/prevención & control , Tocolíticos/uso terapéutico , Adulto JovenRESUMEN
UNLABELLED: Perinatal depression is an increasingly common comorbidity of pregnancy and is associated with adverse birth outcomes. Newer classes of antidepressants have been developed with a variety of mechanisms and improved side effect profiles. There is increasing use of these medications in reproductive-aged women. Medical providers have to balance the need to prevent relapse of maternal depressive symptoms with the need to minimize fetal exposure to medications. We review the literature on 10 of the most commonly used antidepressant medications: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, duloxetine, bupropion, and mirtazapine. The pharmacokinetic properties of the medications are detailed, as well as practical considerations for their use in pregnant and lactating women. Guidance on counseling and management of pregnancies complicated by perinatal depression is discussed. TARGET AUDIENCE: Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES: After completing this CME activity, physicians should be better able to differentiate the current classes of medications utilized commonly for perinatal depression, evaluate the reported adverse effects of antidepressant medications on the patient and developing fetus and choose the appropriate antidepressant medications for a depressed patient who is breast-feeding.