The optimal treatment for depressive disorders in pregnancy remains controversial. Clinicians are often hesitant to prescribe pharmacologic agents during pregnancy, especially in the first trimester, and the effects of electroconvulsive therapy in pregnancy have not been prospectively evaluated. The present case reports on the apparent safety and efficacy of electroconvulsive therapy for the treatment of depression in pregnancy when used in carefully selected and carefully monitored patients. Fetal heart rate monitoring and real-time ultrasonography were performed, and the results suggest that maternal electroconvulsive therapy has little effect on fetal status.