Importance: The importance of women's mental health services is becoming more evident as we learn more about the impact of mental health on maternal and perinatal outcomes.Objective: The purpose of this review is to identify the importance of mental health issues arising during pregnancy including prevention, timely diagnosis and treatment, and referral to specialized services.Evidence Acquisition: A literature search was undertaken using the search engines PubMed, CINAHL, and PsycINFO. The search terms were as follows: "mental health services" or "behavioral health" or "mental health counseling" or "psychological" and "delivery of health care" and "pregnancy" or "pregnant." The years searched were January 2000 to November 2020. The search was limited to English language.Results: Of the 255 abstracts identified and reviewed, 35 full-text articles were the basis of this review. Literature summarizing the availability and models of care for mental health services for pregnant women is limited. After reviewing the literature, the themes of depression and anxiety in the antepartum and postpartum periods that emerged as mental health issues, especially during adolescent pregnancies, the coronavirus pandemic, intimate partner violence, and pregnancy loss, are of primary importance to obstetrical providers. All of these issues can have a significant impact on maternal and neonatal outcomes and should be addressed during routine practice.Conclusions and Relevance: Maternal mental health is garnering deserved attention and has enormous implications on maternal and infant outcomes. Obstetrical providers should be comfortable with screening, identification, and basic treatment algorithms including when to refer to specialized services.Relevance Statement: Mental health issues during pregnancy and the postpartum period can be profound with severe maternal and perinatal consequences.Target Audience: Obstetricians and gynecologists, family physicians, psychiatrists.Learning Objectives: After completing this activity, the learner should be better able to identify the mental health services that are available for pregnant women; outline the common mental illnesses that are present during adolescent pregnancies; explain the risk factors that have been linked with perinatal depression; and describe the management and potential complications of pregnant patients presenting with mental illness.

Importance Uterine dehiscence is a separation of the uterine musculature with intact uterine serosa. Uterine dehiscence can be encountered at the time of cesarean delivery, be suspected on obstetric ultrasound, or be diagnosed in between pregnancies. Management is a conundrum for obstetricians, regardless of timing of onset. Evidence Acquisition A literature search was undertaken by our research librarian using the search engines PubMed, CINAHL, and Web of Science. The search term used was “uterine dehiscence.” The search was limited to the English language, and there was no limit on the years searched. Results The search identified 152 articles, 32 of which are the basis for this review. Risk factors, treatment, and management in subsequent pregnancies are discussed. The number of prior cesarean deliveries is the greatest risk factor for uterine dehiscence. Unrepaired uterine dehiscence can cause symptoms outside of pregnancies and may require repair for alleviation of these symptoms. Dehiscence should also be repaired prior to subsequent pregnancies. Conclusion and Relevance Planned delivery prior to the onset of labor with careful monitoring of maternal symptoms is the preferred management strategy of women with prior uterine dehiscence. Careful attention should be paid to the lower uterine segment thickness when ultrasonography is performed in women with prior cesarean delivery. Relevance Statement An evidence-based review of uterine dehiscence in pregnancy and how to manage subsequent pregnancies following uterine dehiscence. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to identify the risks of pregnancy following uterine dehiscence; explain treatment of uterine dehiscence; and describe symptoms of unrepaired uterine dehiscence.

Amniotic fluid volumes are tightly regulated, and amniotic fluid derangement can indicate maternal complications or fetal abnormalities. Ultrasound estimate of amniotic fluid provides a tool to evaluate the maternal-fetal-placental interface in real-time. Oligohydramnios and polyhydramnios are associated with adverse maternal and neonatal outcomes. Oligohydramnios is associated with adverse maternal and neonatal outcomes including cesarean delivery, operative vaginal delivery, induction of labor, postpartum hemorrhage, small for gestational age neonate, intrauterine demise, neonatal death, NICU admission, and APGAR less than 7 at. 5 minutes of life Polyhydramnios is associated with adverse outcomes including cesarean delivery, induction of labor, placental abruption, shoulder dystocia, cord prolapse, postpartum hemorrhage, intrauterine fetal demise, NICU admission, neonatal death, APGAR less than 7 at 5 minutes of life, large for gestational age neonate, and respiratory distress syndrome. Therefore, Amniotic fluid should be evaluated when maternal or fetal well-being is in question.

Community birth is defined as birth that occurs outside the hospital setting. Birthing in a birth center can be safe for certain patient populations. Home birth can also be safe in well-selected patient with a well-established transfer infrastructure should an emergency occur. Unfortunately, many areas of the United States and the world do not have this infrastructure, limiting access to safe community birth. Immersion during labor has been associated with decreased need for epidural and pain medication. Delivery should not occur in water due to concerns for infection and cord avulsion. Umbilical cord non-severance (also called lotus birth) and placentophagy should be counseled against due to well-documented risks without clear benefit. Birth plans and options should be regularly discussed during pregnancy visits.

Importance: Uterine rupture during labor is a calamitous event that can result in maternal/neonatal morbidity/ mortality. Lower uterine segment (LUS) thickness measurement is a proposed method to determine the risk factor of uterine rupture in women undergoing trial of labor after cesarean. Does this measurement predict uterine rupture risk?Objectives: This review examines current evidence to determine if a thin LUS ultrasound diagnosis during pregnancy with prior cesarean delivery(s) can reliably predict uterine rupture risk while attempting vaginal birth after cesarean (VBAC).Evidence Acquisition: Electronic databases (PubMed and CINAHL) were searched with one limitation of abstracts in English. Search terms used were "lower uterine segment" AND "risk(s)" AND "rupture" OR "dehiscence.Results: After reviewing 164 identified articles, 15 were used in this review. Of the studies including LUS thickness measurement, notable differences were found: gestational age at time of measurement, full thickness measurement versus myometrial thickness, number of sonographers involved, ultrasound technique (transabdominal vs transvaginal), and blinding. Other factors influencing LUS thickness include fetal weight, amniotic fluid volume, and gestational age. The most recent systematic review and meta-analysis suggests that an LUS > 3.65 mm should be safe for a VBAC, 2-3.65 mm is probably safe, and <2 mm identifies a patient at higher risk for uterine rupture/dehiscence.Conclusions: Study heterogeneity, absence of an agreed upon thickness threshold, poor correlation between ultrasound and MRI measurements, or physical cesarean measurements currently make VBAC uterine rupture risk prediction uncertain.Relevance: Our aim is to analyze existing literature to determine if evidence supports LUS measurement in women undergoing VBAC after cesarean to determine risk of uterine rupture.Target Audience: Obstetricians and gynecologist, family physicians Learning Objectives: After completing this learning activity, the participant should be able to identify the differences and how they occur between studies evaluating the thinness of the LUS in women undergoing a trial of labor after cesarean delivery; compare the accuracy of LUS measurement between ultrasound, MRI, and physical measurement at cesarean delivery; and describe the factors that influence the thinness of the LUS.Uterine rupture is an acute catastrophic event that mandates a timely diagnosis and immediate operative intervention for the best maternal/fetal outcome. Although an uncommon even during labor with an incidence of 22/10,000 births, uterine rupture is one of the true obstetric emergencies. 1 All authors, faculty, and staff have no relevant financial relationships with any ineligible organizations regarding this educational activity.