Choice of contraception at 6-8 weeks postpartum in south-eastern Hungary.

OBJECTIVES: The aims of the study were to describe the sociodemographic determinants, breastfeeding- and sexual life-related predictive factors of contraceptive use at 6-8 weeks postpartum. METHODS: A prospective, web-based questionnaire survey was carried out by distributing an access code to women immediately after delivery at the Department of Obstetrics and Gynaecology, the University of Szeged, Szeged, Hungary, between 1 September 2013 and 1 May 2015. RESULTS: In total, 1875 women were invited to participate in the study, 632 of whom refused or were excluded and 644 were not sexually active. The remaining sexually active women (n = 599) completed the questionnaire. At 6-8 weeks postpartum, 22.5% were using an effective contraceptive method and 40.2% were relying on lactational amenorrhoea (LAM). We found a significant direct association between the educational level of a woman's partner and her use of an effective contraceptive method (p < .001) (adjusted odds ratio [AOR]: 1.9) or LAM (AOR: 1.49). Use of an effective contraceptive method before pregnancy increased the likelihood of using the same method after delivery (AOR: 3.16) and decreased the likelihood of LAM use at weeks 6-8 (AOR: 0.31). The AOR for effective contraceptive use was 2.23 times higher in women who had sexual intercourse once or more a week compared with those who had sexual intercourse less frequently. CONCLUSIONS: Concerted efforts to promote the use of long-acting reversible contraception (LARC) are required, particularly among women who would like future childbearing. Further research is needed on the factors contributing to the low uptake of LARC in this population.

[Forensic aspects of sexul assault].

No abstcarct available.

[Diagnosis and treatment of stroke during pregnancy]. / A stroke diagnózisa és kezelése terhesség alatt.

Stroke, the sudden onset of brain dysfunction from a vascular cause, is one of the most common causes of long-term disability. Although rare during childbearing years, stroke is even more devastating when it occurs in a young woman trying to start a family. Pregnancy and the postpartum period are associated with an increased risk of ischemic stroke and intracerebral hemorrhage, although the incidence estimates have varied. There are several causes of stroke that are in fact unique to pregnancy and the postpartum period, such as preeklampszia and eklampszia, amniotic fluid embolus, postpartum angiopathy and postpartum cardiomyopathy. The purpose of this article is to summarize existing data regarding incidence, risk factors and potential etiologies, as well as treatment strategies for stroke in pregnancy.

[Preconceptional and perinatal challenges of pregnancy in women with epilepsy]. / Epilepsziával szövodött terhesség preconceptionalis és perinatalis kihívásai.

Reproductive-aged women with epilepsy may present a number of specific issues to be managed in daily clinical practice. The impact of epileptic seizures and antiepileptic therapy on pregnancy outcome and the risk of teratogenicity should be minimized, which require careful attention and cooperation between obstetric gynecologyst and neurologist. The aim of the present paper is to review the impact of epilepsy attack on fetus and the pathomechanism and teratogenic effect of antiepileptic drugs.

[Knowledge of university students in Szeged, Hungary about reliable contraceptive methods and sexually transmitted diseases]. / Szegedi egyetemi hallgatók ismeretei a megbízható fogamzásgátlásról és a szexuális úton terjedo betegségekrol.

INTRODUCTION: Promiscuity and lack of use of reliable contraceptive methods increase the probability of sexually transmitted diseases and the risk of unwanted pregnancies, which are quite common among university students. AIM: The aim of the study was to assess the knowledge of university students about reliable contraceptive methods and sexually transmitted diseases, and to assess the effectiveness of the sexual health education in secondary schools, with specific focus on the education held by peers. METHOD: An anonymous, self-administered questionnaire survey was carried out in a randomized sample of students at the University of Szeged (n = 472, 298 women and 174 men, average age 21 years) between 2009 and 2011. RESULTS: 62.1% of the respondents declared that reproductive health education lessons in high schools held by peers were reliable and authentic source of information, 12.3% considered as a less reliable source, and 25.6% defined the school health education as irrelevant source. Among those, who considered the health education held by peers as a reliable source, there were significantly more females (69.3% vs. 46.6%, p = 0.001), significantly fewer lived in cities (83.6% vs. 94.8%, p = 0.025), and significantly more responders knew that Candida infection can be transmitted through sexual intercourse (79.5% versus 63.9%, p = 0.02) as compared to those who did not consider health education held by peers as a reliable source. The majority of respondents obtained knowledge about sexual issues from the mass media. CONCLUSIONS: Young people who considered health educating programs reliable were significantly better informed about Candida disease.

[Risk of maternal and fetal disease among women older than 40 years]. / Magzati és anyai betegségek kockázata 40 évesnél idosebb édesanyák esetén.

A rising trend in advanced maternal age has been observed over the last few decades. Several studies have assessed the association between advanced maternal age and adverse pregnancy outcome, including miscarriage, stillbirth, pre-eclampsia, gestational hypertension, gestational diabetes mellitus, preterm birth, delivery of a small- or large-for-gestational-age neonates and elective or emergency Cesarean section. These studies reported contradictory findings. The aim of the present paper is to summarize the evidence-based information regarding advanced maternal age and pregnancy outcomes.

Obstetric and psychosocial risk factors for depressive symptoms during pregnancy.

We aimed to determine the psychosocial and obstetric correlates of depressive symptomatology during pregnancy in South-Eastern Hungary. A total of 1719 women were screened for depression in four counties in 2006 and 2007, based on a Leverton Questionnaire (LQ) score of ≥12 at 14-24 weeks of gestation. The LQ scores indicated a probable depressive illness (PDI) in 17.2% of the study group. The best predictors in a multiple regression analysis were history of major depression (adjusted odds ratio [AOR]=3.23), and major life events (AOR=2.43). A perceived lack of social support from partner (AOR=1.79) and lack of support by family (AOR=1.23) were also significant determinants. Lack of planning of pregnancy (AOR=1.12) and a history of unfavourable obstetric outcome (AOR=1.42) also seem to predispose to PDI. Overall, psychosocial factors appeared important in the prediction of PDI, whereas economic features did not.

Determinants of emergency contraceptive use after unprotected intercourse: who seeks emergency contraception and who seeks abortion?

OBJECTIVE: To compare differences in contraceptive characteristics and the knowledge of emergency contraception (EC) between women who used EC after unprotected intercourse and those who sought abortion. DESIGN: A questionnaire survey. SETTING: A Hungarian university hospital. SAMPLE: Two large clinical groups were enrolled: women who were prescribed EC after unprotected intercourse (n= 952) (EC group) and women who presented for termination of pregnancy who had not taken EC after a contraceptive failure despite being suitable candidates to take EC (n= 577) (control group). METHODS: Questionnaire evaluation. MAIN OUTCOME MEASURES: Knowledge concerning, previous use of, and other factors related to EC use. RESULTS: The EC group experienced a condom failure significantly more often (odds ratio (OR) = 3.07), while the control group reported more failures with the contraceptive pill (OR = 0.69) and with periodic abstinence (OR = 0.09). Use of EC depended on age, education level, place of residence, accurate knowledge of EC (OR = 3.87) and previous EC use (OR = 1.16). Awareness of EC was influenced by information obtained from healthcare providers (OR = 3.63) or by school education (OR = 1.28). CONCLUSIONS: Women who use less reliable contraceptive methods should be targeted for health education that stresses the importance of reliable contraception and provides more detailed knowledge on EC and when it should be used.

Can a brief antepartum preventive group intervention help reduce postpartum depressive symptomatology?

BACKGROUND: Psychosocial and psychological interventions are generally effective in reducing depressive symptomatology in the postpartum period. Our aim was to evaluate the effectiveness of a brief preventive group intervention for postpartum depression (PPD) in a naturalistic setting, and study the effect of this on social and psychological risk factors. METHODS: We conducted a randomized controlled trial (n = 1,719) in south-eastern Hungary in 62 antepartum centers. Pregnant women (n = 710) underwent a 4-session preventive group intervention whereas a control group (n = 1,009) attended 4 sessions providing the same information given in usual care. RESULTS: Our intervention appeared to significantly reduce the risk of PPD, as defined by Leverton Questionnaire total scores (OR = 0.69). It resulted in an absolute risk reduction of about 18% in those with antepartum depression and 0.5% in those with no depression at recruitment. A multiple logistic regression analysis revealed a much reduced risk in those with a perceived lack of partner support (OR = 0.4) in the treatment group. Unplanned pregnancy, an irreversible risk factor affecting every fifth woman, also seemed to have a reduced effect on PPD after our group intervention (OR = 0.81). CONCLUSIONS: A brief preventive antepartum group intervention focusing on psychoeducation, stress management, improving coping mechanisms, and the development of social support can be effective in reducing postpartum depressive symptomatology.

Social dynamics of postpartum depression: a population-based screening in South-Eastern Hungary.

PURPOSE: To determine contributing psychosocial factors to postnatal depression (PND) in Hungary in 1996 and in 2006. METHODS: In 1996 and 2006, a total of 2,333 and 1,619 women, respectively, were screened for PND in South-Eastern Hungary, based on a Leverton questionnaire (LQ) score of ≥ 12 at 6-10 weeks after delivery. RESULTS: The LQ scores indicated an increase in PND from 15.0% in 1996 to 17.4% in 2006. The best predictors for PND in a multiple regression analysis were living in an urban environment [adjusted odds ratio (AOR) = 11.26], unstable relationship (AOR = 3.1) and a perceived lack of social support from partner (AOR = 3.65) in 1996, and recent major life events (AOR = 3.38), unstable relationship (AOR = 3.84), self-reported low income (AOR = 1.82), and intention to return to work soon after delivery (AOR = 0.47) in 2006. CONCLUSIONS: A self-defined low socioeconomic status and an intention to return to work have become significant factors in the development of PND. Besides the family factors recognized as salient variables in 1996, economic features came into prominence as newly identified main predictive factors for PND in 2006.

Validation of the Leverton Questionnaire as a screening tool for postnatal depression in Hungary.

OBJECTIVE: To assess the validity of the 24-item Leverton Questionnaire (LQ) in screening for postnatal depression (PND). METHOD: A two-phase, cross-sectional study was designed. Between January and October 2006, a sample of 1552 women attending a routine postnatal check-up at 6 weeks postpartum completed the LQ in southeast Hungary. On the basis of the LQ total score, the participants were stratified and randomly selected within each stratum for clinical evaluation (Structured Clinical Interview for DSM-IV). Receiver operating characteristic (ROC) analyses were used to examine the sensitivity and specificity of the LQ to detect PND. RESULTS: The best cut-off on the Hungarian version of the LQ for PND was 11/12, with a sensitivity of 88.0%, and a specificity of 94.4%, and a positive predictive value of 53.1%. Internal consistency was satisfactory (Cronbach alpha coefficients > or = 0.753). The sensitivity of the modified Beck Depression Inventory (BDI) in detecting PND was 86.2% and the specificity 90.4%. Although the BDI performed slightly better than the LQ in distinguishing between minor and major depression, both psychometric scales showed satisfactory screening performance. CONCLUSIONS: Our data confirm the validity of the Hungarian version of the LQ reliably to identify PND. We propose a cut-off of 11/12 for screening purposes for PND, the range of 11-14 for detecting minor depression and regarding a total score of 15 points or above as indicative of major depression.

Obstetric and sociodemographic risk of vulnerability to postnatal depression.

OBJECTIVE: To assess the associated obstetric and sociodemographic risk of vulnerability to postnatal depression in a population-based study. METHODS: All women presenting for postpartum care (n=1656) were surveyed at pregnancy care units of southern-eastern Hungary between January 2004 and May 2006 with an anonymously completed Leverton questionnaire (LQ). The demographic characteristics, obstetric data and related variables were determined as potential correlates of vulnerability to postnatal depression. Significant predictive factors associated with vulnerability were analysed by means of linear correlation and multiple regression analysis. RESULTS: The Leverton score significantly differed between primiparous and multiparous women [primiparous 11.3+/-7.0 (mean+/-standard deviation) and multiparous women 12.1+/-7.1]. The univariate difference was not significant as regards previous infertility [infertility: 11.4+/-6.2 and no infertility: 11.7+/-7.2]. Vulnerability to depression was diagnosed in 892 (53.9%) of the postpartum women. The predictors of vulnerability to postnatal depression include an unwanted pregnancy (AOR: 5.6, 95% CI: 3.97-9.71) and an unfavourable pregnancy case history (AOR: 2.27, 95% CI: 2.912-5.76). The higher number of children represent significantly lower odds for postpartum vulnerability in the case of multiparous women (AOR: 0.11, 95% CI: 0.05-0.16). CONCLUSION: The risk of postnatal depression can be modified by the sociodemographic and obstetric history data. PRACTICE IMPLICATIONS: Our predictive data reflect that the LQ is useful screening method for postnatal vulnerability and determine the advisability of intervention/preventive therapy control the effects of the risk factors concerning vulnerability.