الفهرس 
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Abstract
Antenatal and postpartum major depressive episode (MDE) according to Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) is defined as either daily sustained sad mood or lack of enjoyment or desire for a minimum two weeks plus four associated manifestations (only three if the two major symptoms are present);
• Unintentional notable slimming up or down.
• Sleepiness or sleeplessness.
• Tiredness sensation.
• Guilty or futility sensation.
• Declined concentration capacity.
• Frequent suicidal thoughts.
• Psychomotor excitation or delay.
That start throughout pregnancy or during the first 4 weeks postpartum respectively.
There are multiple underlying risk factors for antepartum and postpartum depression that involve, genetic factors, younger age, having twins or triplets, past history of depression, family history for depression, lack of social endorsement, life stressors, low socioeconomic status,
accidental unwanted pregnancy, vulnerable personality, having diseased infants, having medical health problems, sleep deprivation and depression during pregnancy which is considered the major predictive one for depression after delivery.
Depression has major negative impacts on both women and fetus during pregnancy or after delivery. Pregnant women with depression are highly probable to have bad nutrition with insufficient body weight gain, miss her prenatal meetings, have poor state of health, be involved in risky behaviors such as substance use, tobacco smoking and alcohol drink with their subsequent adverse outcomes on both mother and fetus, to undergo elective operative delivery and to have poor Maternal-fetal attachment.
Perinatal depression impacts the offspring negatively in the form of increased the risk for; Intrauterine Growth Retardation (IUGR), Preterm Birth (PTB), Low Birth Weight (LBW), Stillbirth, poorer physical health, neurodevelopmental delay including impaired cognition progress, delayed motor development, impaired language acquisition, difficult infant temperament and impaired social-emotional functioning.
The current study was conducted to develop Egyptian practice guidelines for peripartum depression in primary healthcare. Also, to improve evidence-based practice in
Egyptian primary healthcare, to improve the mental health of the Egyptian females and their infants and to decrease the overall morbidity and mortality of the Egyptian females in child bearing period and their offspring on the long round.
The current study was conducted through Delphi technique by participation of thirteen experts at psychiatry and family medicine specialties from different governmental universities, Ministry of Health and Population (MOHP), World Health Organization (WHO) and World Organization of Family Doctors (WONCA).
The Delphi study was conducted through three phases: 1) phase one included a literature review about different practice guidelines and evidence- based researches in the first part and formulation of a basic model about Egyptian practice guidelines for peripartum depression in the second part; 2) phase two included three consecutive Delphi rounds via e-amil and 3) phase three which included reviewing the final version of the Egyptian practice guidelines for peripartum depression in primary healthcare.
The current study recommended health education programs, provision of awareness about physical exercise’s importance for prevention of antenatal and postnatal depression, adding telephone- based peer support for the preventive measures of the antenatal depression and family therapy for the postpartum depression prevention. Screening for all the pregnant women every trimester by patient health questionnaire II and screening for all the new mothers every well child clinic visit in the first year after delivery by Edinburg Postpartum Depression Scale (EPDS). Diagnosis by beck depression inventory II questionnaire and Postpartum Depression Screening Scale (PDSS) for antenatal and postnatal depression respectively with post diagnosis evaluation for: 1) Comorbid anxiety; 2) Bipolar disorder; 3) Thoughts of harming intrauterine fetus or newborns; 4) Suicidal thoughts and 5) Psychotic features. Cognitive Behavioral Therapy (CBT) for treatment of mild cases and CBT with half dose sertraline for moderate cases of antenatal depression. Cognitive Behavioral Therapy (CBT) for mild cases, CBT and the usual dose sertraline for moderate cases with no hormonal therapy for any patient. Referral for patients with: 1) severe depression; 2) comorbid anxiety; 3) bipolar disorder; 4) thoughts of harming intrauterine fetus or newborns; 5) suicidal thoughts; 6) psychotic features; 7) substance abuse.
Most of these recommendations were consistent with available international clinical practice guidelines for identification and management of peripartum depression and mirrored many controlled clinical trials in their findings about the effectiveness of the different recommended preventive measures and various lines of treatment.